Karla Robinson, MD
Recurrent sore throats, missed days at school, and countless sleepless nights are a reality for many parents this time of year. Tonsillitis, strep throat, and pharyngitis can caused by many different types of infections and it can be difficult for concerned parents to sort through all of the information. We will review some common causes of “sore throat” and what you need to know if your child is battling these illnesses.
What is a “sore throat”?
Medically termed pharyngitis, a “sore throat” refers to the sensation of pain coming from the pharynx or other structures located in the back of the throat. In young children, localizing the source of the pain can sometimes be difficult as painful or difficulty swallowing can also include structures in the upper digestive tract such as the esophagus. Therefore, it is always necessary to have a medical provider perform a full assessment on any child complaining of sore throat, or difficulty swallowing.
What are common causes of a “sore throat”?
There are many causes of sore throat ranging from trauma to infectious. However the most commonly encountered cause of pharyngitis in children is infection. Different types of infections can lead to pharyngitis. These include viral, bacterial, and fungal infections.
Viral pharyngitis includes those sore throats as a result of the common cold, flu, or other upper respiratory viruses. These are often accompanied by other upper respiratory symptoms such as runny nose, nasal congestion, and/or cough. Hand-foot-and-mouth disease, another common viral illness in childhood, may present as a sore throat accompanied by a rash on the hands and feet. Mononucleosis or “mono” as it is commonly referred to, is also a viral infection common in childhood. Mononucleosis tends to affect
older children and adolescents, and is often seen with extreme fatigue, fever and swollen lymph nodes in the neck.
The most common bacterial cause of pharyngitis is Group A streptococcus, also known as “strep throat”. This is often seen in high numbers during the winter and early
spring. Common among school-aged children, it is typically seen with high fever, fatigue, headache, nausea and/or abdominal pain, and tender, swollen lymph nodes in the neck. There is commonly an absence of other upper respiratory symptoms such as cough, nasal congestion, and runny nose in most. However in very young children, there may simply be nasal congestion, and fever as the presenting symptoms of the infection.
Fungal infections of the throat structures can be seen in infants or the immunocompromised. Thrush, a common condition seen in infants, can also lead to difficulty eating and swallowing due to throat pain.
What are the treatments?
Most often in the cases of viral infections, the treatment is usually symptomatic until the infection resolves on its own. Symptoms of viral pharyngitis tend to resolve within 3 to 7 days. Rest, fluids, and fever-reducers are the mainstay of treatment. In addition to these measures, throat lozenges, hard candy and topical sprays may provide some limited relief.
There are some herbal preparations that are marketed for sore throat relief, however they are not recommended for use in children.
Treatment for bacterial pharyngitis, particularly in the case of strep throat, is aimed at reducing the symptoms of pharyngitis and preventing complications. Some notable
complications of untreated strep infections include tonsillar abscess, kidney inflammation, rheumatic fever, and neurologic complications. Treatment is in the form of antibiotics and
is most effective when started within 48 hours of symptoms.
Antifungal medication is used for the treatment of fungal throat infections such as thrush. Symptoms generally resolve within 3 to 4 days.
When do the tonsils need to be removed due to infection?
While the surgical removal of tonsils in children has been controversial in recent years, tonsillectomy remains one of the most common surgical procedures in children. Over
500,000 tonsillectomies are performed on children under age 15 each year. In cases of infection, removal of the tonsils is generally indicated if there have been more than 6 throat infections within a year, or recurrent infections in subsequent years. They may also be indicated in the case of chronic infections unresponsive to antibiotic treatment.
While certainly common, throat infections in children should always prompt a visit to a medical provider. Swift diagnosis and treatment lead to better outcomes, reduced frequency of complications, and decreased transmission of infection.