Strep Throat Infection

Is this your child's symptom?

  • Your child was diagnosed with a Strep throat infection
  • A doctor has told you your child probably has Strep throat or
  • Your child has a positive Strep test
  • Your child is taking an antibiotic for Strep throat and you have questions
  • You are worried that the fever or sore throat is not getting better fast enough

Symptoms of Strep Throat Infection

  • Pain, discomfort or raw feeling of the throat
  • Pain is made worse when swallows
  • Children less than 2 years of age usually can't complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings.
  • Other symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting.
  • Cough, hoarseness, red eyes, and runny nose are not seen with Strep throat. These symptoms point more to a viral cause.
  • Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat.
  • If you look at the throat with a light, it will be bright red. The tonsil will be red and swollen, often covered with pus.
  • Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep.

Cause of Strep Throat

  • Group A Strep is the only common bacterial cause of a throat infection. The medical name is Strep pharyngitis.
  • It accounts for 20% of sore throats with fever.
  • Any infection of the throat usually also involves the tonsils. The medical name is Strep tonsillitis.

Diagnosis of Strep Throat

  • Diagnosis can be confirmed by a Strep test on a sample of throat secretions.
  • There is no risk from waiting until a Strep test can be done.
  • If your child has cold symptoms too, a Strep test is usually not needed.

Prevention of Spread to Others

  • Good hand washing can prevent spread of infection.

 

When to Call for Strep Throat Infection

When to Call for Strep Throat Infection

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Fainted or too weak to stand
  • Purple or blood-colored spots or dots on skin with fever
  • You think your child has a life-threatening emergency

Go to ER Now

  • Can't swallow any fluids and new onset drooling
  • Purple or blood-colored spots or dots on skin without fever

Call Doctor or Seek Care Now

  • Trouble breathing, but not severe
  • Great trouble swallowing fluids or spit
  • Stiff neck or can't move neck like normal
  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
  • Fever higher than 104° F (40° C)
  • Will not drink or drinks very little for more than 8 hours
  • Can't open mouth all the way
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Urine is pink or tea (brown) color
  • Taking antibiotic more than 24 hours, and sore throat pain is severe. The pain is not better 2 hours after taking pain medicines.
  • Taking antibiotic more than 48 hours and fever still there or comes back
  • Taking antibiotic more than 3 days and other Strep symptoms not better
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Strep throat infection on antibiotic with no other problems

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Fainted or too weak to stand
  • Purple or blood-colored spots or dots on skin with fever
  • You think your child has a life-threatening emergency

Go to ER Now

  • Can't swallow any fluids and new onset drooling
  • Purple or blood-colored spots or dots on skin without fever

Call Doctor or Seek Care Now

  • Trouble breathing, but not severe
  • Great trouble swallowing fluids or spit
  • Stiff neck or can't move neck like normal
  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
  • Fever higher than 104° F (40° C)
  • Will not drink or drinks very little for more than 8 hours
  • Can't open mouth all the way
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Urine is pink or tea (brown) color
  • Taking antibiotic more than 24 hours, and sore throat pain is severe. The pain is not better 2 hours after taking pain medicines.
  • Taking antibiotic more than 48 hours and fever still there or comes back
  • Taking antibiotic more than 3 days and other Strep symptoms not better
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Strep throat infection on antibiotic with no other problems

Care Advice for a Strep Throat Infection

What You Should Know About Strep Throat:

  • Strep causes 20% of throat and tonsil infections in school age children.
  • Viral infections cause the rest.
  • Strep throat is easy to treat with an antibiotic.
  • Complications are rare.
  • Here is some care advice that should help.

Antibiotic by Mouth:

  • Strep infections need a prescription for an antibiotic.
  • The antibiotic will kill the bacteria that are causing the Strep throat infection.
  • Give the antibiotic as directed.
  • Try not to forget any of the doses.
  • Give the antibiotic until it is gone. Reason: to stop the Strep infection from flaring up again.

Sore Throat Pain Relief:

  • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
  • Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
  • Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
  • Medicated throat sprays or lozenges are generally not helpful.

Pain Medicine:

  • To help with the pain, give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Use as needed.

Fever Medicine:

  • For fevers higher than 102° F (39° C), give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Note: fevers less than 102° F (39° C) are important for fighting infections.
  • For all fevers: keep your child well hydrated. Give lots of cold fluids.

Fluids and Soft Diet:

  • Try to get your child to drink adequate fluids.
  • Goal: keep your child well hydrated.
  • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
  • Solids. Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: fluid intake is much more important than eating any solids.
  • Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces.

What to Expect:

  • Strep throat responds quickly to antibiotics.
  • The fever is usually gone by 24 hours.
  • The sore throat starts to feel better by 48 hours.

Return to School:

  • Your child can return to school after the fever is gone.
  • Your child should feel well enough to join in normal activities.
  • Children with Strep throat need to be taking an antibiotic for at least 12 hours.

Call Your Doctor If:

  • Trouble breathing or drooling occurs
  • Dehydration suspected
  • Fever lasts more than 2 days after starting antibiotics
  • Sore throat lasts more than 3 days after starting antibiotics
  • You think your child needs to be seen
  • Your child becomes worse

Copyright 2000-2025 Schmitt Pediatric Guidelines LLC. Date Updated: Mar 31 2025 13:41 Version 0.1

Powered by RemedyConnect. Please read our disclaimer.

< Back to Is Your Child Sick?
Is Your Child Sick?®

latest news

starfish
February 12, 2026
There are cases of measles in NC, and we are aware of exposures in Chapel Hill, Durham, and Wake County. We can give the MMR dose early to families who want it. This applies to infants 6-12 months who have not gotten a dose yet or kids under 4-5 years who have not gotten their second MMR dose. At this time, the NC DHHS and health departments are not recommending this unless traveling or living in an area with sustained transmission. 2 doses of the MMR vaccine are highly effective (97%) at preventing measles infections. At CHCAC, children receive their first dose at 12 months of age and a second dose at 4 years of age, ensuring they are fully protected as soon as possible, in accordance with the most up-to-date AAP recommendations. Some infants aged 6 months to 11 months who travel internationally or in high-prevalence areas may need a dose to protect them; however, they still require the 1-year and 4-year-old doses as well. If you are ever concerned about a possible exposure to measles, please CALL before entering our office. DO NOT ENTER the office. NC DHHS keeps a list of areas with measles exposures here . This is a highly contagious illness, and special precautions must be taken to prevent spread. The virus can be present in the air for 2 hours after an infected person is in the room, and 90% of susceptible patients can be infected. As always, if you have questions, we are here to help make sense of it all!
close

Dynamic Is Your Child Sick? v0.3 7/7/2025