Strep throat

young boy getting throat swab young boy getting throat swab

What is strep throat?

Strep throat is a throat infection caused by a type of bacteria called streptococcus.

Strep throat is more common in children four to eight years old and is rare in children younger than two years of age.

The most common cause of strep throat is Group A beta-haemolytic streptococcus (GABS). This bacteria can also cause complications in other parts of the body.

Signs and symptoms of strep throat

The symptoms for strep throat are similar to symptoms for a sore throat caused by a virus or other illnesses. The most common symptoms are:

  • fever
  • sore throat
  • loss of interest in eating or drinking because of pain
  • difficulty swallowing
  • enlarged red tonsils​, sometimes covered with white-yellow coating.

Some children may have other symptoms such as headache, nausea, vomiting, abdominal pain and muscle pain.

How is strep throat diagnosed?

To find out the cause of your child’s sore throat, the doctor will take a throat swab. This involves wiping a thin cotton bud along the side and back of your child’s throat. The swab is then sent to a lab to be tested for GABS bacteria. Your doctor will normally receive the results within a day or two.

Some clinics may use a rapid test (which gives results within minutes) to identify strep. Rapid tests are only useful if they show that your child has the streptococcus bacteria (known as a positive result). A negative rapid test result does not always mean that your child does not have strep throat. The result should always be checked by taking a throat swab.

A throat swab is very important for diagnosis as strep throat looks similar to vi​ral
, which cannot be treated with antibiotics.

How is strep throat treated?

If the throat swab is positive for GABS, the doctor will prescribe oral antibiotics (antibiotics to be taken by mouth) for your child. Strep throat can sometimes get better without medication, but a GABS infection can cause complications if it is not treated.

​Taking care of your child at home

Manage the fever and pain

Acetaminophen or ibuprofen can be used to treat fever or pain. ASA should not be given to children.​

Complete the antibiotics

The fever and the throat pain usually improve about three days after your child starts taking antibiotics. However, even if your child seems to be better, it is very important to complete the entire course of antibiotics. This will make sure the infection does not return and will also prevent complications and antibiotic resistance.

​Offer your child soft foods and a liquid diet

Eating and drinking may be painful for a child with strep throat. Here are some tips to make it easier for them.

  • If your child is having trouble swallowing, give soft foods that are easy to swallow, such as soups, ice cream, pudding or yogurt.
  • Give plenty of liquids. Sipping with a straw or sippy cup may help.
  • If your child is more than 12 months old, try giving one or two teaspoons (5 to 10 mL) of pasteurized honey to soothe the throat and ease the cough.
  • Let an older child try gargling with warm salt water to soothe their throat.

Ice cubes and lozenges may provide some relief for older children or teens. Do not give them to younger children, however, because they are a choking hazard.

​Reduce the spread of the infection

Strep throat can spread easily to family members and your child’s classmates. Any child or adult who lives in your home and has the same symptoms in the five days after your child is diagnosed should have a throat swab.

Your child's infection is no longer contagious after your child has been on antibiotics for 24 hours. This means that your child can return to school after one day if they are feeling better.

Other tips to prevent the spread of infection

  • Wash hands​ with warm soapy water or alcohol-based hand rub often.
  • Do not let your child share drinking glasses or eating utensils with friends or classmates.
  • Be sure to wash your child's glasses and utensils in hot soapy water or a dishwasher.
  • Have your child sneeze into their elbow or cover their mouth and nose when coughing.
  • Avoid kissing and having close facial contact with your child until they are better.

Complications of strep throat

Throat abscess

A throat abscess (a collection of pus in the throat tissues) can develop from strep throat. The symptoms include high fever, muffled voice, difficulty opening the mouth, increased salivation and drooling and neck swelling. See a doctor if these symptoms occur.

Rheumatic fever

Although rare, rheumatic fever can also develop as a complication of strep throat. The condition can involve the skin, joints, heart and brain. Treating the strep throat with antibiotics almost always prevents rheumatic fever.

Other complications

These can include joint inflammation (arthritis) and kidney inflammation. GABS is also the bacteria responsible for scarlet fever.

​When to get medical attention

Call your child’s regular doctor if:

  • the fever does not go away within three days of starting antibiotics
  • your child develops a fever, a rash, joint swelling, blood in the urine or shortness of breath.

Go to the nearest Emergency Department or call 911 if your child:

  • is unable to drink or eat and is becoming dehydrated
  • has trouble breathing.

​Key points

  • The main symptoms of strep throat are fever and sore throat.
  • If you suspect that your child might have strep throat, see a doctor for a throat swab.
  • Make sure your child finishes any antibiotics they are prescribed to prevent relapse and complications.
  • Use soft foods, cold drinks and pain medications, if needed, to reduce any pain.
  • Make sure that any other family members or close contacts with similar symptoms see their health care provider.

Shawna Silver, MD, FRCPC, FAAP, PEng