Is it Strep?

One tough question pediatricians are often asked via email and cell phone is:

Does my child have strep?

Without a magic flashlight and throat swabs that travel through cyberspace or cell towers it’s a guess at best, but there are some clues to help figure it out.

Does kiddo have severe throat pain that causes difficulty swallowing? 

Strep throat hurts. Bad. Children with strep will usually avoid eating and drinking — even stuff they like. If yours turns down a favorite that’s normally on the forbidden list, that’s a red flag.

Are tonsils red and swollen with white patches or streaks of pus?

Strep throat infection is caused by the bacteria streptococcus, and often causes tonsils to look swollen and angry red with yucky looking white goo. A viral sore throat will look red too, but it’s rarely as dramatic as strep.

Is there fever? How high? 

Strep can cause high fever, often up to 104 F. Parents tend to get alarmed — a red flag that this is more than your run-of-the-mill viral illness. A garden variety sore throat may or may not have fever.

Does kiddo have a headache, stomach ache or vomiting? 

When these are present along with a sore throat, suspect strep!

It’s possible to have many of these signs and symptoms, but not have strep throat. The cause could be a viral infection or some other kind of illness. That’s why your doctor tests for strep throat with a rapid strep test or throat culture.

It’s also possible to have the bacteria that causes strep without having a sore throat. Some people are carriers of strep, which means they can pass the bacteria on to others, but the bacteria are not making them sick.

Call your doctor if your child has any of these signs and symptoms:

  • A sore throat without cold symptoms
  • A sore throat accompanied by tender, swollen lymph glands
  • A severe sore throat that lasts longer than 48 hours
  • A fever higher than 101 F in older children
  • Rash with sore throat
  • Problems breathing or difficulty swallowing anything, including saliva
  • If strep has been diagnosed, a lack of improvement after taking antibiotics for 24 to 48 hours
  • Fever, pain or swelling in the joints, shortness of breath or a rash up to 3 weeks after a strep infection; these can be warning signs of rheumatic fever
  • Dark urine more than a week after a strep infection; this may indicate kidney inflammation (poststreptococcal glomerulonephritis)

It’s always important to treat a strep infection with antibiotics to prevent complications like rheumatic fever. If you suspect strep, hightail it to the doc for testing. Better safe than sorry!


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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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