Your child is complaining of a sore throat, has a fever, and maybe a red rash on their body. Could it be strep?
Group A Streptococcus (GAS) is a bacterium that causes some of the most common infections in children, from sore throat to scarlet fever. Most cases are harmless and treated easily with penicillin, but it's important to recognize the symptoms so your child gets the right treatment.
What Is Strep?
Group A Streptococcus (Streptococcus pyogenes) is a bacterium found naturally in the throat and on the skin of many people. About 5–15% of healthy children carry the bacterium without any symptoms.
When the bacterium causes infection, the two most common illnesses are:
- Strep throat — infection in the throat and tonsils
- Scarlet fever (scarlatina) — strep throat with a characteristic rash
Strep can also cause skin infections like impetigo and boils, but in this article we focus on throat and rash infections.
Symptoms of Strep Throat
Strep throat often comes on suddenly and is most common in children between 3 and 15 years old. Typical symptoms include:
- Sudden and severe sore throat — the child complains of pain when swallowing
- Fever — often 101–104°F (38.5–40°C), sometimes with chills
- Swollen tonsils — red, with white or yellowish coating
- Swollen lymph nodes — tender and enlarged glands in the neck
- Headache
- Stomach pain and nausea — particularly in younger children
- Reduced appetite
What Distinguishes Strep from a Common Cold?
It's important to distinguish between bacterial sore throat (strep) and viral sore throat (cold). Some signs can help:
| Strep Throat | Viral Sore Throat | |
|---|---|---|
| Cough | Rarely | Common |
| Runny nose | Rarely | Common |
| Fever | High (over 101°F/38.5°C) | Low to moderate |
| Tonsils | Swollen with coating | Mildly red |
| Onset | Sudden | Gradual |
| Age | Most common ages 3–15 | All ages |
Children under 3 rarely get strep throat. In very young children, strep can instead cause a prolonged cold-like illness with green nasal discharge, mild fever, and irritability.
Scarlet Fever — Strep with a Rash
Scarlet fever is a strep infection where the bacterium produces a toxin that causes a characteristic skin rash. The illness was feared for centuries, but today is easily treated with antibiotics.
Symptoms of Scarlet Fever
Scarlet fever begins like a regular strep throat, but after 1–2 days the rash appears:
- Red, sandpaper-like rash — the skin feels rough and dry, like sandpaper
- Starts in the groin, armpits, and neck and spreads to the stomach, back, and arms
- Pastia's lines — more intense redness in skin folds (armpits, elbow creases, groin)
- Pallor around the mouth — the face is red, but the area around the mouth is pale (circumoral pallor)
- Strawberry tongue — the tongue may first have a white coating, then become red and bumpy
The rash usually fades after 3–4 days and is followed by peeling, especially on the fingertips and toes. Peeling can last several weeks.
A simple trick for recognizing the scarlet fever rash: Press on the skin with your finger. If the skin blanches and shows a white spot that quickly turns red again, it may be scarlet fever.
Contagion and Incubation Period
Strep spreads through droplets (coughing, sneezing) and direct contact. The incubation period is short — usually 2–5 days.
Contagious period:
- The child is contagious from the onset of symptoms
- After starting penicillin treatment, the child is considered non-contagious after 24 hours
- Without treatment, the child can spread the illness for 2–3 weeks
Preventing spread:
- Good hand hygiene — wash hands frequently
- Avoid sharing glasses, utensils, and towels
- Keep the child home for at least 24 hours after starting antibiotics
- Notify the daycare or school
Diagnosis
Your doctor can do a rapid strep test (throat swab). The test gives results within minutes and is quite reliable. Sometimes a throat culture is also sent to the lab to confirm the result.
Testing is important because:
- Symptoms can resemble viral sore throat
- Only bacterial sore throat should be treated with antibiotics
- Correct diagnosis prevents unnecessary antibiotic use
Treatment
Penicillin
Strep infections are treated with penicillin V (phenoxymethylpenicillin). Standard treatment is:
- A 10-day course of penicillin
- The dose depends on the child's weight
- Penicillin comes as a liquid for younger children and tablets for older ones
Complete the full antibiotic course even if your child feels better after a few days. Stopping treatment early increases the risk of relapse and complications.
Other Treatment
If the child is allergic to penicillin, the doctor may prescribe other antibiotics such as erythromycin or cephalosporins.
Symptom relief:
- Acetaminophen (Tylenol) for fever and pain (follow age-appropriate dosing)
- Ibuprofen can also be used for pain and inflammation in children over 6 months
- Plenty of fluids — offer lukewarm or cool drinks
- Soft foods — yogurt, soup, ice cream, and smoothies are easier to swallow
- Rest — let the child rest and take it easy
Can a Child Get Strep Multiple Times?
Yes, it is entirely possible to get a strep infection more than once. The body develops some immunity to the specific toxin that causes scarlet fever, but there are multiple types of toxins. So children can get scarlet fever more than once, although it is uncommon.
Some children are more prone to repeated strep infections. If your child gets strep several times in a short period, discuss it with your doctor. In rare cases, it may be appropriate to check whether the child is a chronic carrier.
Possible Complications
The vast majority of children with strep make a full recovery with proper treatment. Complications are rare, but can occur, particularly without treatment:
- Peritonsillar abscess — a collection of pus behind the tonsil
- Ear infection — strep can spread to the middle ear
- Sinusitis — infection in the sinuses
- Rheumatic fever — rare but serious. Can damage the heart valves
- Glomerulonephritis — kidney inflammation that can cause blood in the urine
Rheumatic fever is extremely rare in developed countries, but is an important reason why strep throat is treated with antibiotics. Proper treatment with penicillin effectively prevents rheumatic fever.
When Should You See a Doctor?
Contact your doctor or urgent care if your child:
- Has a severe sore throat with high fever (over 101°F/38.5°C)
- Has swollen tonsils with white coating
- Develops a rash in addition to throat symptoms
- Does not improve after 2–3 days on antibiotics
- Has difficulty swallowing or opening the mouth
- Is very sluggish or lethargic
- Has breathing difficulties or is drooling excessively (may indicate a peritonsillar abscess)
Call 911 immediately if your child has severe breathing difficulties, cannot swallow saliva, or shows signs of serious infection (rapid deterioration, bluish skin color, confusion).
Strep at Daycare
Strep is common in daycare and school settings, particularly during winter months. According to the CDC:
- The child may return to daycare/school 24 hours after starting antibiotics, provided their general condition is good
- A negative follow-up test after treatment is not necessary
- In the event of repeated outbreaks at daycare, screening of children may be considered
Frequently Asked Questions
Can babies get strep?
Yes, but strep throat is uncommon in children under 3. In very young children, strep can cause more vague symptoms like a cold, irritability, and reduced appetite.
Is scarlet fever dangerous?
No, with proper treatment scarlet fever is a harmless illness. The rash looks dramatic but goes away on its own. The most important thing is to complete the antibiotic course.
How long does strep last?
With antibiotic treatment, most children feel better within 24–48 hours. Without treatment, symptoms can last 7–10 days. The rash from scarlet fever fades after 3–4 days, but peeling can last several weeks.
Can adults catch strep from children?
Yes, strep spreads between all age groups. Adults can get sore throat and, in rare cases, scarlet fever. Good hand hygiene and avoiding sharing utensils reduces the risk of transmission.
Does the child need to be retested after treatment?
No, a follow-up test after completing the penicillin course is not usually necessary. The exception is if the child still has symptoms after finishing treatment.
Read More
- Fever in children — when to see a doctor?
- Sore throat in children
- Impetigo in children
- Rashes in children — overview
- Vaccines for children