Sore Throat / Strep Throat

A common symptom of cough and cold viruses is a sore throat, which makes sense when you think about it. A common problem you get from a stuffed and runny nose is postnasal drip (the dripping of mucous secretions from the back of the nose to the back of the throat, especially when lying down). This constant drippage is quite irritating to the throat and thus makes it sore and inflamed. Another cause of sore throat from viral infections is the large chunk of the lymphatic tissue (where white blood cells are born and raised) in the throat. When they sense a viral intruder in the upper airway, they go into action getting swollen and inflamed in the process, leading to a sore throat. There are also some viruses that just make your throat feel crummy by attacking the upper airway. 

For most viral sore throats, we try to maintain good symptomatic care at home with Tylenol/acetaminophen or Advil/Motrin/ibuprofen for kids who are having trouble eating or drinking due to the pain. Older kids who are able to can get a drastic decrease in pain and irritation in the back of the throat with warm salt water gargles. For sore throats that are caused mainly by postnasal drip, we try to keep up with nasal saline to help decongest the nose and thin out whatever mucous is dripping from the back of the nose to the back of the throat. 

We do always have to be on the lookout for strep throat, though, which is a bacterial infection of the throat that we do want to treat with antibiotics to get rid of posthaste. So how do docs figure out if it is strep throat or a viral throat infection? Well, we test for it with rapid or PCR-based tests (PCR stands for polymerase chain reaction and tests for the bacteria’s genetic material). If we don’t trust those results, we can also send for a culture that will see what bacteria grows over 48-72 hours.

How do you know who to test? Excellent question. Over the years, there have been great studies to help pediatricians weed out those kids with sore throats who need a test and those who don’t. So much so, there is what is called the Centor Criteria: a group of questions/physical exam findings that give us an idea of how likely it is that a kiddo has strep throat.  And it goes like this:

Is the child over the age of 3?  (under the age of 3 is super rare for strep throat)

Is there exudate or swelling of the tonsils? (the more junk on the tonsils, the more likely strep)

Are there tender or swollen neck lymph nodes?

Have we had a fever above 100.4 °F with the sore throat? (the more fever, the more likely strep)

Is there a cough? (strep usually does not come with a cough) 

And then if you answer these questions yielding a score of 2 or above, the child is probably getting a strep test. If you answer the questions with a 4 or above, some docs may not even test and will just start treatment due to the high probability that your kiddo has strep.