How Can I Tell the Difference Between Strep Throat vs. a Sore Throat?

Few things tug at a parent’s heartstrings quite like hearing that little voice turn raspy or seeing your child wince with every swallow. A sore throat can turn even the happiest kid into a snuggly, low-energy version of themselves, and it is natural to wonder what is really going on. Knowing the difference between strep throat versus another cause of a sore throat can help you bring comfort and let you know when it is time to reach out to your provider.

Signs of a Strep Throat Infection

If you are wondering, “What does strep feel like?” then you may have never had to endure this unfortunate discomfort. Strep causes a scratchy throat, pain with swallowing, and has a rapid onset. The most recognizable physical symptoms are small red spots on the roof of the mouth along with swollen and tender tonsils. It occasionally has white patches or streaks of pus on both tonsils.

When should you consider a strep test? If there are fever, swollen and tender neck nodes, red tonsils, or red dots on the roof of your mouth, especially without cough or runny nose. Children need testing before antibiotics will be prescribed by your provider.

Bottom line: symptoms can overlap. A molecular strep test is the best way to confirm strep throat.

The typical presentation that I see of a child with strep is a rapid onset of symptoms with red spots on the roof of the mouth and larger more tender lymph nodes on the front of the the neck, with minimal or no cold symptoms. There may, however, be times when your child has a cold and then develops strep as a separate illness, which is more common in the winter months or the beginning or end of the school year. This usually looks like a new, or worsening, severe sore throat that develops several days into cold symptoms. Testing for strep would be indicated for either of these presentations, or even if you just have concerns.

Strep is rare in children younger than 3 years old but common among kids aged 5 to 15. Risk factors for infection include close contact with an infected person, crowded settings such as schools and daycare centers, and seasonal factors. Strep spreads more readily in the chilly winter months when people spend more time in close quarters.

If you suspect your child has strep throat, your provider can run a quick in-office test. If strep throat is diagnosed, your provider will prescribe antibiotics to help relieve symptoms more quickly, reduce the risk of spreading the disease, and help prevent complications so your child can get back to feeling like themselves.

Antibiotics make kids less contagious, and you are considered no longer contagious after 12-24 hours of antibiotic treatment. Kids can usually start going back to school if they meet these three requirements:

• They have been on antibiotics for at least 12 hours.
• Their fever has been gone for at least 24 hours.
• They are feeling better.

I usually tell my families that your child will feel better within 1 to 2 days and is contagious for the first 24 hours after starting antibiotics for strep throat. However, if their fever has been gone for at least 24 hours, then a 12-to-24-hour period after starting antibiotics may be appropriate to return to school as long as they are also feeling better. Returning to play or activity depends on how they are feeling but typically this will be in 2 to 3 days after starting antibiotics. Always make sure that you complete the entire course of the antibiotics as prescribed.

On the flip side, if your child is not improving within 2 days of starting antibiotics, or they appear sicker, then they may need to be reevaluated.

Common Causes of a Sore Throat Without Being Sick with Strep

If your child has a sore throat and you are wondering, “Is it strep, a virus, or something else?” you are asking the right question. A sore throat does not necessarily mean you are ill, and even if you are, most sore throats are not caused by strep.

Strep is distinct from other sore throats because the symptoms come on quickly, with a sore throat that hits all at once. When a sore throat is caused by a viral illness, such as the common cold, symptoms usually develop more gradually. Moreover, a sore throat from another illness may be accompanied by upper respiratory symptoms like cough, nasal congestion, runny nose, and stuffy nose.

While a bacterium causes strep, many other sore throats are caused by viruses like influenza (the flu), adenoviruses, coronaviruses (including COVID-19), and Epstein-Barr (the virus that causes mono). Pathogens are not the only cause of sore throats; you can also get an irritated throat due to seasonal allergies, irritants, postnasal drip, acid reflux, vocal strain (shouting or excessive singing or talking), dry air, secondhand smoke, and other environmental factors.

Tips to Relieve a Non-strep Sore Throat

Antibiotics are only necessary to combat bacterial infections like strep. Most other pathogens that cause a sore throat are viruses and typically resolve on their own. Whether you are dealing with a viral infection or a garden-variety sore throat, there are a few things you can do to ease the discomfort.

If it is age-appropriate for your child, I typically recommend a decongestant to help soothe the throat during the daytime if cold symptoms are the cause, as minimizing the postnasal drip tends to reduce the severity of a sore throat.

• Manage pain: Use over-the-counter pain medications like acetaminophen or ibuprofen in age/weight-appropriate doses.
• Soothe with cold foods: A popsicle or some ice cream not only helps relieve pain but also helps lift your child’s spirits.
• Gargle: Rinsing with warm water and salt can help relieve a sore throat; just be sure your child does not swallow any.
• Hydrate: Make sure your child drinks plenty of fluids. Water or electrolyte solutions are an excellent choice, but a mug of warm tea with honey can also soothe a scratchy throat.
• Eat carefully: Choose soft foods and avoid anything too hot, spicy, or crunchy.
• Use a humidifier: Dry air is a common cause of a sore throat. A humidifier adds moisture to the air and could help fix the problem at the root.
• Suck on lozenges: Commonly called cough drops, many lozenges are specially formulated to soothe a sore or scratchy throat. Note that lozenges can be a choking hazard for kids under four. A sucker with adult supervision is a better choice for younger children.
• Avoid triggers: Stay away from any known irritants like tobacco smoke, chemicals, dust, pollen, and mold.

It is worth noting that many of these relief strategies also work for the common cold, flu, strep throat, and other illnesses that cause sore throat symptoms. However, strep throat is effectively treated with antibiotics and will not respond to honey and popsicles alone.

When to See Your Provider for a Persistent Sore Throat

Most sore throats are not strep throat and will resolve on their own with a little rest and recuperation. Contact your child’s provider if you suspect symptoms are caused by strep throat or if they experience any of the following:

• Sore throat accompanied by tender, swollen lymph nodes
• Sore throat accompanied by a rash
• Sore throat lasting longer than 48 hours
• A fever of 101 degrees Fahrenheit or higher that lasts for more than a day or two
• Trouble swallowing, breathing, or speaking
• Dehydration
• Drooling
• Blood in the saliva
• No improvement in symptoms after 48 hours of antibiotic treatment

If your child has a sore throat and is not feeling well, you do not need to wait for severe symptoms before you bring them in. The team at Wee Care Pediatrics is here to figure out what is causing a sore throat, provide the proper treatment, and answer any questions you may have along the way. If medication is necessary, we may even be able to dispense it here in clinic and get you both home without a stop at the pharmacy. Sore throats are uncomfortable, but taking care of them does not have to be.

Sources

Mayo Clinic, Strep Throat

CDC, About Strep Throat

UCDavis Health, How do you know if it’s strep throat or a sore throat?

AMA, What doctors want patients to know about strep throat

Hopkins Medicine, Strep Throat