Sore throat in children

A sore throat can be painful and cause discomfort when you swallow.

Key points

  1. Having a sore throat is very common, especially in children. The discomfort can range from a scratchy feeling to severe pain.
  2. A sore throat can be caused by a viral infection, such as a cold or the flu, or a bacterial infection, most commonly Streptococcus (often known as 'strep throat').
  3. In some higher-risk groups, untreated strep throat can cause rheumatic fever and heart damage for life.
  4. If your child is at higher risk of rheumatic fever and they have a sore throat, they need to be checked by a nurse or GP. If they have strep throat, they will be prescribed antibiotics to treat it.  
  5. If your child is not at higher risk of rheumatic fever, antibiotics are usually not required or helpful for a sore throat.
Māori and Pasifika children are most at risk of developing rheumatic fever and should see a doctor or nurse if they show ANY sign of sore throat.

What causes sore throat?

Around 90% (9 out of 10) of sore throats are caused by viral infections. An example of a viral sore throat is one you get when you have a cold. Viral sore throats usually get better by themselves within a week. Antibiotics do not fix viral sore throats.  

Some sore throats are caused by bacteria, most commonly Streptococcus (often known as 'strep throat'). In at-risk people, untreated strep throat can lead to rheumatic feverChildren and young people at risk of rheumatic fever require treatment with antibiotics for 10 days to prevent rheumatic fever. 

Other conditions that can cause a sore throat include:


What are the signs of sore throat in children?

Your child may complain of pain or a raw feeling in your throat. This is usually worse when they swallow.

Symptoms of sore throat include:

  • a painful or scratchy throat, especially when you swallow
  • difficulty swallowing
  • redness at the back of the mouth
  • cold and flu symptoms such as a cough, hoarseness, red eyes and runny nose (usually not seen with strep throat)
  • a fever (greater than 38.5 degrees Celsius)
  • swollen tonsils, sometimes with white patches
  • swollen or tender glands in their neck
  • headache
  • stomach pain.

It is not possible to be sure from symptoms whether a sore throat is caused by a virus or bacteria. This is why people at higher risk of rheumatic fever should always get a throat swab done. See diagnosis and treatment of strep throat

When to see your doctor about a sore throat

Children at higher risk of rheumatic fever – check every sore throat

For children and young people at higher risk of rheumatic fever, it is very important that a sore throat is always checked early by a nurse or GP. This is because untreated strep throat can cause rheumatic fever and heart damage for life in at-risk people.

Your child is at higher risk of rheumatic fever if:

  • they have had rheumatic fever before
  • someone in their family or household has had rheumatic fever.

Or, if they have 2 or more of the following:

  • of Maori or Pasifika ethnicity
  • aged 3-35 years
  • live in poorer or crowded living conditions.

Other children 

Children who are not higher-risk for rheumatic fever do not need to have every sore throat checked. You should see your family doctor if your child has:

  • symptoms that are not improving after 48 hours
  • not been drinking much for more than 24 hours, or you are worried about them being dehydrated
  • great difficulty swallowing
  • increased snoring when asleep, or periods of stopping breathing when asleep
  • tender lumps in their neck that are getting bigger
  • any other symptoms you are concerned about.

Seek immediate medical help if your child:

  • has difficulty breathing, ie, struggling for each breath or making a grunting noise with each breath
  • develops a skin rash
  • has any other symptoms that appear life-threatening.

Phone Healthline 0800 611 116 if you are unsure what to do.

Will my child need antibiotics?

Most sore throats are caused by viruses. Antibiotics do not fix viral sore throats.  

Antibiotics are prescribed if: your child is at risk for rheumatic fever and tests positive for strep throat, or if their sore throat is severe, such as with scarlet fever. 

If your child has a bacterial infection, such as strep throat, but is not at risk of rheumatic fever they usually do not need antibiotics. The body’s immune system can usually clear out a sore throat on its own without antibiotic treatment.

If your child is prescribed antibiotics, make sure they take all the doses for 10 days even if their symptoms have improved. Your child can return to school or daycare 24 hours after they start antibiotics. 

What can I do to ease a sore throat?

Pain relief can help any sore throat. It will help your child eat and drink. You can relieve pain in the following ways:

  • taking paracetamol (follow the dosage instructions on the bottle; it is dangerous to give more than the recommended dose)
  • gargling with warm salt water (1 teaspoon of salt per glass of water)
  • using throat sprays, but stop using them if your child doesn’t like them
  • sucking on lozenges – this increases saliva production. Don't give them to young children because of the risk of choking
  • drinking warm liquids – honey or lemon is a common way of providing relief
  • sipping cool liquids and having ice blocks.

What can I do to prevent a sore throat? 

To help stop infections spreading or coming back:

  • encourage your child to cover their mouth and nose when they sneeze or cough
  • don’t share utensils or toothbrushes
  • try to create space between your children when they sleep. This limits the chance of bugs such as those that cause strep throat being spread from one child to another through coughs and sneezes. This is important all the time – not just when they are sick.

Learn more 

Cold season: managing without antibiotics BPAC 2018
More than 3300 visits to free sore throat clinics NZ Government Press Release, 10 July 2014
It starts with a sore throat East Bays Courier, Auckland, 7 August 13
NZ children get better start to life  NZ Government Press Release, 8 July 2013
Budget 2013: Additional $21.3m to fight rheumatic fever  NZ Government Press Release, 21 May 2013
Rheumatic fever prevention programme NZ Ministry of Health, 2014
Sore throat in children KidsHealth NZ, 2014

Credits: Health Navigator Editorial team. Reviewed By: Dr Christine McIntosh BSc,MBChB, Dip. Paed. Dip. O&G, FRNZCGP. Last reviewed: 11 Mar 2019