Sore Throat in Children: Symptoms, Treatment, and When to See a Doctor

Your child refuses to eat, complains of a sore throat, and feels warmer than usual. Sore throat is one of the most common reasons children see a doctor. But what is causing it, and does your child need antibiotics?

Sore throat (tonsillopharyngitis) affects children repeatedly, and it can be hard to know whether it is a harmless viral infection or something that needs treatment. This guide covers everything you need to know.

What is a sore throat?

A sore throat is an inflammation of the throat and tonsils. The condition can be caused by a virus or bacteria, and treatment depends on the cause.

Viral sore throat is by far the most common and accounts for 70–85% of all cases in children. Common viruses include:

• Cold viruses (rhinovirus, adenovirus)
• Epstein-Barr virus (infectious mononucleosis)
• Influenza virus
• RSV

Bacterial sore throat is caused in most cases by Group A Streptococcus and accounts for 15–30% of cases in children between 3 and 15 years old.

Symptoms of a sore throat

Symptoms of viral sore throat

• Gradually worsening sore throat — pain when swallowing, but not necessarily severe
• Cold symptoms — runny nose, cough, sneezing
• Low to moderate fever — typically below 101.3°F (38.5°C)
• Hoarseness
• General feeling of being unwell — fatigue and irritability
• Sometimes conjunctivitis (pink eye) as well

Symptoms of bacterial sore throat (strep)

• Sudden, severe sore throat — marked pain when swallowing
• High fever — often 101.3–104°F (38.5–40°C) with chills
• Swollen, red tonsils with white or yellowish patches
• Swollen and tender lymph nodes in the neck
• Headache and stomachache — common in children
• Absence of cough and runny nose — this often distinguishes it from viral

Symptoms in babies and toddlers

Babies and toddlers cannot always explain that their throat hurts. Watch for these signs:

• Refuses to eat or drink, pushes food away
• Drooling more than usual
• Fussy, irritable, and hard to comfort
• Prefers soft or liquid food
• Has a fever without a clear cause
• Points to or holds their throat

How to tell viral from bacterial

It can be difficult to distinguish the two, but some clues can help:

Suggests viral (antibiotics NOT needed):

• Cough, runny nose, and nasal congestion
• Gradual onset
• Hoarseness
• Blisters in the mouth or throat
• Mild symptoms

Suggests bacterial (antibiotics MAY be needed):

• Sudden onset with high fever
• Swollen tonsils with white patches
• Swollen lymph nodes
• No cough or runny nose
• Child is between 3 and 15 years old

Doctors often use the Centor criteria (modified for children) to assess the likelihood of strep:

1. Fever above 101.3°F (38.5°C)
2. Swollen, tender lymph nodes at the front of the neck
3. White patches on the tonsils
4. Absence of cough

The more criteria that are met, the more likely strep is. With 3–4 criteria, a rapid strep test is recommended.

Diagnosis

Rapid strep test

Your doctor can perform a rapid test by swabbing the tonsils. The test gives results in 5–10 minutes. A positive test confirms strep, while a negative test makes a viral cause very likely.

Throat culture

If the rapid test is negative but the doctor still suspects strep, a throat swab can be sent for culture. Results take 1–2 days.

Blood tests

If mononucleosis (mono) is suspected, or if the sore throat is prolonged, blood tests may be ordered. Mono often causes very swollen tonsils, high fever, and marked fatigue.

Treatment for viral sore throat

Viral sore throat does not require antibiotics. The body fights the virus on its own, and the illness usually resolves in 5–7 days. Treatment focuses on symptom relief:

Pain relief

• Acetaminophen (Tylenol/Panadol) — follow age-appropriate dosing
• Ibuprofen (Motrin/Advil) — can be used from 3 months of age; effective against inflammation and pain
• Give pain relief consistently during the first few days if the child is clearly uncomfortable

Fluids and food

• Plenty of fluids — offer water, diluted juice, or popsicles regularly
• Cold drinks — ice, yogurt, and smoothies can soothe a sore throat
• Soft food — oatmeal, soup, purees, mashed banana
• Avoid acidic and salty food — orange juice and chips sting an inflamed throat
• Popsicles — popular with children and provide real relief

Other measures

• Rest — let your child rest, but do not force bed rest
• Humidified air — dry indoor air can worsen a sore throat
• Honey (from 12 months of age) — a teaspoon of honey can soothe sore throat and cough. Do NOT give to children under 1 year

Treatment for bacterial sore throat

If a rapid test confirms strep, the sore throat is treated with antibiotics:

• Penicillin V for 10 days is standard treatment per AAP guidelines
• Dosing is adjusted for the child's weight
• Most children feel better within 24–48 hours
• Child is no longer considered contagious 24 hours after starting antibiotics

Important about antibiotics:

• Complete the full course even if the child feels better
• Stopping the course early increases the risk of relapse
• If your child is allergic to penicillin, alternative antibiotics are available

How long should your child stay home?

• Viral sore throat: Child can return to daycare/school when they are feeling well and fever has resolved
• Bacterial sore throat: Child should stay home for at least 24 hours after starting antibiotics, provided they are fever-free and feeling well

Recurring sore throat

Some children are troubled by repeated episodes of sore throat. If your child has:

• 7 or more sore throat episodes in the past year
• 5 or more per year for the past two years
• 3 or more per year for the past three years

a tonsillectomy may be worth discussing. Talk to your pediatrician, who can refer you to an ENT (ear, nose, and throat) specialist.

When should you contact a doctor?

Call your pediatrician if your child:

• Has a severe sore throat with fever above 101.3°F (38.5°C) for more than 2–3 days
• Has swollen tonsils with white patches
• Refuses to drink for more than 24 hours
• Has a sore throat lasting more than a week
• Has recurring episodes of sore throat

Seek emergency care if your child:

• Has difficulty swallowing saliva (drooling)
• Has trouble opening their mouth
• Has breathing difficulties or stridor
• Has one-sided swelling in the throat (possible peritonsillar abscess)
• Is extremely lethargic or unresponsive

Frequently asked questions

Can babies under 1 year get a sore throat?

Yes, but strep throat is uncommon in infants. Viral sore throat can affect babies from a very young age. Babies typically show it by refusing to feed and being extra fussy.

Does my child always need antibiotics for a sore throat?

No. Antibiotics should only be given for confirmed bacterial (strep) sore throat. Most cases are viral and will resolve on their own. Unnecessary antibiotic use contributes to antibiotic resistance.

Is a sore throat contagious?

Yes, both viral and bacterial sore throat are contagious. Viral infections spread through droplets and contact. Bacterial (strep) spreads through respiratory droplets. Good hand hygiene is the most important preventive measure.

Can a sore throat cause complications?

Untreated strep throat can in rare cases lead to a peritonsillar abscess, ear infection, or rheumatic fever. Viral sore throat rarely causes complications. Proper antibiotic treatment effectively prevents these complications.

How is mono different from a regular sore throat?

Mononucleosis (mono) typically causes extremely swollen tonsils, persistent high fever, marked fatigue, and swollen lymph nodes throughout the body. The illness lasts longer (2–4 weeks) and can cause an enlarged spleen. Your doctor can confirm the diagnosis with a blood test.

Further reading

• Fever in children — when to call the doctor
• Ear infections in children

Sources

1. AAP — Management of Pharyngitis in Children
2. WHO — Streptococcal Pharyngitis
3. CDC — Group A Streptococcal Disease