Sore throat in children

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

COVID-19 pandemic

If you have any respiratory symptoms such as a cough, sore throat, shortness of breath, head cold or loss of smell, with or without fever, call your GP or Healthline's dedicated COVID-19 number 0800 358 5453 to check whether you need to be tested for COVID-19.

Key points about sore throat in children

  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.

Seek immediate medical help if your child:

  • has difficulty breathing, eg, struggling for each breath or making a grunting noise with each breath
  • has great difficulty swallowing
  • develops a skin rash
  • is not able to drink much or shows signs of dehydration (very dry mouth, no urine for more than 8 hours, confused and drowsy)
  • develops a fever (high temperature)
  • has severe pain at the back of their throat 
  • has any other symptoms that appear life threatening.

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

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 a 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 their throat. This is usually worse when they swallow.

Other symptoms of sore throat include:

  • 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
  • nausea and vomiting
  • 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 should I bring my child to see a doctor?

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 Māori or Pasifika ethnicity
  • aged 3–35 years
  • live in poorer or crowded living conditions.

Other children 

Children who are not at 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
  • 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, eg, struggling for each breath or making a grunting noise with each breath
  • has great difficulty swallowing
  • develops a skin rash
  • is not able to drink much or shows signs of dehydration (very dry mouth, no urine for more than 8 hours, confused and drowsy)
  • develops a fever (high temperature)
  • has severe pain at the back of their throat 
  • has any other symptoms that appear life threatening.

Call Healthine 0800 611 116 if you are unsure what to do.

There are lots of places you can get a sore throat checked:

  • You can go to your normal doctor or nurse – it's free for your child under 13. 
  • Your child's school may have a free sore throat checking clinic – contact the school to find out.
  • You can call Healthline on 0800 611 116 for advice (all calls are free, even from a cell phone if you are in New Zealand).

How are the causes of a sore throat diagnosed?

Your doctor will ask questions about your child's symptoms and will look in their mouth. They may take a throat swab to test for Streptococcus if your child is at high risk of rheumatic fever. If glandular fever is suspected your child may need to have a blood test.

How is a sore throat treated?

The treatment of a sore throat depends on the cause. Most sore throats are caused by viruses. Antibiotics do not fix viral sore throats. If your child has a viral sore throat, they do not need antibiotics. However, there are some self-care measures that you can do to help ease your child's sore throat. Read more about what can I do to help ease my child's sore throat

Will my child need antibiotics?

Antibiotics are prescribed if your child is at high risk for rheumatic fever and tests positive for strep throat, or if their sore throat is severe, such as with scarlet fever. The course of the antibiotics is usually for 10 days, and it is important that your child complete the full 10 days of antibiotics, even if your child starts to feel better. This helps to stop strep throat from turning into rheumatic fever. Antibiotics can be given in a form of a capsule, liquid or as an injection. 

Children with strep infection may need to stay away from school or early childhood centres for at least 24 hours after they start antibiotics, to reduce the risk of spreading the strep bacteria. 

What can I do to help ease my child's 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? 

Take the following steps 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 eating utensils (eg, cups, knives, forks or spoons) 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.
  • Keep your home warm and dry. This helps prevent bugs from spreading from one person to one another. 

Learn more 

Sore throat in children KidsHealth NZ
More than 3300 visits to free sore throat clinics
 NZ Government Press Release
It starts with a sore throat East Bays Courier, Auckland
NZ children get better start to life  NZ Government Press Release
Budget 2013: Additional $21.3m to fight rheumatic fever  NZ Government Press Release
Rheumatic fever prevention programme Ministry of Health, NZ

References

  1. Sore throat Auckland Regional HealthPathways, NZ, 2020
  2. Sore throat  Ministry of Health, NZ
Credits: Health Navigator Editorial team. Reviewed By: Dr Christine McIntosh, GP and senior research fellow in paediatrics, child and youth health, University of Auckland Last reviewed: 11 Mar 2019