Strep Throat in Children: Scarlet Fever, Symptoms, and Treatment

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 bacteria that causes some of the most common infections in children, from strep throat to scarlet fever. Most cases are uncomplicated and treated easily with penicillin, but knowing the symptoms is important so your child gets the right treatment.

What is strep?

Group A Streptococcus (Streptococcus pyogenes) is a bacteria that naturally lives in the throat and on the skin of many people. About 5–15% of healthy children carry the bacteria without having any symptoms.

When the bacteria 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 abscesses, 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 patches
• Swollen lymph nodes — tender, enlarged glands on the neck
• Headache
• Stomach pain and nausea — especially in younger children
• Loss of appetite

What distinguishes strep from a common cold?

It's important to tell apart bacterial throat infection (strep) from viral throat infection (a cold). Some clues that can help:

Scarlet fever — strep with a rash

Scarlet fever is a strep infection where the bacteria produces a toxin that causes a characteristic skin rash. The illness was feared for centuries, but today it's easily treated with antibiotics.

Symptoms of scarlet fever

Scarlet fever starts like 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 then spreads to the belly, back, and arms
• Pastia's lines — more intense redness in skin folds (armpits, inner elbow, 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 for several weeks.

How it spreads

Strep spreads through respiratory droplets (coughing, sneezing) and direct contact. The incubation period is short — typically 2–5 days.

How long is my child contagious?

• The child is contagious from the start of symptoms
• After starting penicillin, the child is considered non-contagious after 24 hours
• Without treatment, the child can spread strep for 2–3 weeks

Preventing spread:

• Good hand hygiene — wash hands frequently
• Avoid sharing glasses, cutlery, and towels
• Keep the child home for at least 24 hours after starting antibiotics
• Notify the daycare or school

Diagnosis

The doctor can do a rapid strep test by swabbing the throat. The test gives results in minutes and is fairly reliable. Sometimes a throat culture is also sent to the lab to confirm the result.

Testing is important because:

• Symptoms can look like viral sore throat
• Only bacterial throat infections should be treated with antibiotics
• An accurate diagnosis prevents unnecessary antibiotic use

Treatment

Penicillin

Strep infections are treated with penicillin V. Standard treatment is:

• 10-day course of penicillin
• Dose depends on the child's weight
• Penicillin is available as liquid for younger children and tablets for older ones

Other treatment

If your child is allergic to penicillin, the doctor can 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 3 months
• Plenty of fluids — offer warm 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 more than once?

Yes, it is entirely possible to get strep infection repeatedly. The body develops some immunity to the specific toxin that causes scarlet fever, but there are multiple toxin types. So children can get scarlet fever more than once, though it's uncommon.

Some children are more prone to repeated strep infections. If your child gets strep several times in a short period, talk to your doctor. In rare cases, it may be worth checking 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, especially 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 in developed countries, but serious; can damage heart valves
• Glomerulonephritis — kidney inflammation that can cause blood in urine

When should you see a doctor?

Contact your doctor or go to urgent care if your child:

• Has severe sore throat with high fever (over 101°F / 38.5°C)
• Has swollen tonsils with white patches
• Develops a rash in addition to throat symptoms
• Doesn't improve after 2–3 days on antibiotics
• Has difficulty swallowing or opening their mouth
• Is very drowsy or lethargic
• Has trouble breathing or is drooling heavily (may indicate abscess)

Strep at daycare and school

Strep is common in daycare settings and schools, especially during winter months. According to the AAP and CDC:

• Children can return to daycare/school 24 hours after starting antibiotics, as long as they feel well enough
• A follow-up throat culture after treatment is not routinely necessary
• During outbreaks, screening of contacts may occasionally be recommended

Frequently asked questions

Can babies get strep?

Yes, but strep throat is uncommon in children under 3. In the youngest children, strep may 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 scarlet fever rash fades after 3–4 days, but peeling can last for several weeks.

Can adults catch strep from children?

Yes, strep spreads between all age groups. Adults can get strep throat and, rarely, scarlet fever. Good hand hygiene and not sharing utensils reduces the risk.

Does my child need to be retested after treatment?

No, a follow-up test after a full course of penicillin is not usually necessary. The exception is if your child still has symptoms after finishing treatment.

Read more

• Fever in Children — When to See a Doctor
• Ear Infections in Children
• Rashes in Children — Overview
• Vaccines for Children

Sources

1. CDC — Group A Streptococcal Infections
2. AAP — Strep Throat
3. Mayo Clinic — Scarlet fever
4. IDSA — Clinical Practice Guidelines for Streptococcal Pharyngitis