All About Strep Throat
If you asked any of my mom friends what the most frustrating common kid illness is, I'd be willing to bet the mortgage that most would say strep throat (with the stomach bug being a very close second).
Unfortunately, frequent strep throat infections are a right of passage for many school-age kids, and their families often pay the collateral damage price. I groan every time one of my kids gets it, mainly because they feel crummy but also because I know at least one other family member will catch it, and we'll have several days of missed school and work.
The best part of having kids is that someone's always on hand to get me sick, am I right?
What is Strep Throat?
Strep throat is a common bacterial infection that primarily affects children aged 5–15 years and the moms they slobber on (kidding).
It is caused by Group A Streptococcus bacteria (GAS), also known as Streptococcus pyogenes. It typically presents as acute pharyngotonsillitis, a fancy medical term for "crazy painful red swollen throat" caused by inflammation of the throat and tonsils. However, strep throat can sometimes be sneaky and have other symptoms, like rash, stomach aches, vomiting, or headache.
The most common time strep throat circulates is late winter through early spring, but it can occur any time throughout the year.
The infection is very contagious and easily spreads through respiratory droplets or direct contact with infected individuals. Sharing drinks, chapstick, and kisses are significant ways that strep can spread.
Elementary schools are breeding grounds for the infection, as younger kids don't keep to themselves very well! The incubation period (time between infection and symptom presentation) for strep throat is approximately 2 to 5 days, so it can move through a household slowly over a few weeks. Fun!
How Do I Know if It's Strep Throat or a Virus?
Many viruses can cause a red, swollen throat, making distinguishing between a strep infection and a common virus difficult. This summer, I dragged all three of my kids into the pediatrician's office because I was convinced they had strep throat, but they didn't! It was just a virus that caused red spots in the throat.
Strep throat can only be diagnosed by a medical provider like your doctor or nurse practitioner. The provider will evaluate the history of illness, how the throat looks, and the presence or absence of typical symptoms seen with strep throat or viral colds. Ultimately, if the doctor suspects strep throat, they will swab the tonsils with a Q-tip-like device and do a lab detection test before making a diagnosis.
Here are some common strep throat symptoms that should put your parent-radar on high alert:
- Sudden onset of sore throat
- Fever greater than 100.4°F
- Pain when swallowing; it can be sharp and intense
- Dark red/purplish colored spots or white patches on and around the tonsils
- Swollen and tender lymph nodes in the neck
- Headache (more common in kids)
- Abdominal pain (more common in kids)
- Nausea and vomiting (more common in kids)
- A fine, red, bumpy rash that can appear in places like the armpits, groin, elbow/knee crease, or sometimes the chest or belly
- Absence of other symptoms you would typically see with a virus, like coughing, sneezing, etc.
Your child's pediatrician should always evaluate any severe symptoms. If your child has difficulty breathing, is unable to drink fluids, is drooling, has an abscess or sizeable swollen lump on their neck or in their throat, has severe pain, cannot move their head or neck around, or has anything going on that is concerning to you, always bring them to the doctor or urgent care/an emergency room for prompt evaluation.
How is Strep Throat Treated?
Strep throat is a bacterial infection treated with antibiotic therapy. The goal of treatment is to reduce pain, clear the infection, and allow kids to eat and drink normally.
Please note that if your child's strep test returns negative, most providers will assume that the sore throat is caused by a virus that can't be treated with antibiotics. In this case, parents are usually advised to watch and wait and bring their child back if there is no improvement within a few days.
The drug of choice to treat strep throat is good old penicillin. In kids, amoxicillin (a related drug in the same drug class) is often used as the first choice because it is easier to dose and tastes better. If your child is allergic to amoxicillin, there are many other options for treatment.
Strep throat can cause a lot of misery, but fortunately, it is usually very easy to treat. Treatment for strep throat lasts 7 to 10 days. Please give your child their medicine for as long as instructed, even if they feel better. For the nerds in the group, amoxicillin is a "time-dependent killer," which means that it takes a long time to kill off the harmful bacteria completely.
When will they feel better?
Kids usually start to feel better after 2 or 3 doses of antibiotics. Parents can use acetaminophen or ibuprofen for pain and fever control until the infection improves. Warm salt water gargles (for older kids) and cool drinks or popsicles can also help.
My kids would tell you that popsicles are the best part of strep because I let them have as much as they want! Pro tip: I also keep a supply of Pedialyte popsicles in the freezer if they are having trouble staying hydrated.
How Long is My Child Contagious?
According to the CDC, kids can return to school or daycare when they are fever-free and have received at least two doses of antibiotic therapy. Some schools or centers may advise that a child stay home until they are fever-free for 24 hours and have received antibiotics for 24 hours. With strep throat's long incubation period, be alert for other household members getting sick. Strep throat can be the gift that keeps on giving.
One piece of practical advice that is often given is to replace toothbrushes, chapsticks, etc., and sanitize any oral care products after 3 days of antibiotic therapy. The jury is still out on this one, but it can't hurt and might help!
Last spring, we had strep throat run through our house several times, and I lost my cool and purchased an industrial-size package of toothbrushes. I was on a daily toothbrush-changing spree for a while. I'm not sure that it helped, as I probably set the adult record for most strep throat infections over the age of 35 in a 6-month period…
Best of luck, parents!
The following references were used to compile this information:
American Academy of Pediatrics. (2021). Red Book: 2021–2024 Report of the Committee on Infectious Diseases (32nd ed.). American Academy of Pediatrics.
Centers for Disease Control and Prevention. (2024, March 1). Clinical Guidance for Group A Streptococcal Pharyngitis. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
Mayo Clinic. (2022, November 30). Strep throat - Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/syc-20350338
Williams, S. E. (2024). Group A Streptococcal (Group A Strep) Infections. HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/infections/Pages/group-a-streptococcal-infections.aspx
This article has been reviewed by Andrea Morrissey, PharmD, Board Certified Pediatric Pharmacy Specialist, and Chief Content Officer of Kids Med Guide. The content is for educational and entertainment purposes only and does not replace professional medical advice. Always consult your healthcare provider for medical guidance, and call 911 in an emergency.
Kids Med Guide is not liable for your interpretation or reliance on this material. You assume full responsibility for its use and any resulting decisions.
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