Signs and Symptoms of Strep Throat in Kids

Strep throat, a bacterial infection that forms in the tonsils or throat, is one illness to watch out for in kids. Anyone can get strep throat, but it’s much more common in children than in adults – especially during the school year and colder months. 

Alexy Arauz Boudreau, MD, MPH, a Mass General Brigham pediatrician who cares for patients at Mass General for Children, explains how to recognize the signs of strep throat in kids so they can get started on treatment and feel better sooner.

What is strep throat?

Strep throat, also known as streptococcal pharyngitis or strep tonsillitis, is an infection that’s caused by bacteria in the back of the throat. The bacteria are called Group A Streptococcus. It usually forms in the tonsils, which are small glands on either side of your throat. 

According to the Centers for Disease Control and Prevention (CDC), strep throat is most common in children between 5 and 15 years old. Children younger than 3 years old rarely get strep throat because of their biology.  

Symptoms of strep throat in kids

Dr. Arauz Boudreau explains that most cases of strep throat begin with a sore throat, but that symptom alone doesn’t necessarily mean your child has strep. “Most sore throats are symptoms of the common cold, so it’s important to know the difference between strep and a sore throat,” she says.

Common signs and symptoms of strep throat in kids

• Sore throat, which may start quickly, appear red, or feel painful when swallowing.
• Red and swollen tonsils. They also may have white patches or streaks of pus on them.
• Small red spots on the roof of the mouth (called petechiae)
• Swollen or painful glands in the front of the neck, under the jaw
• Fever

Less common strep throat signs and symptoms in kids

• Headache or stomachache
• Nausea or vomiting
• Rash on the back, chest, or arms (also known as scarlet fever)

Can a child have a cough with strep throat?

Coughing is not usually a symptom of strep throat, Dr. Arauz Boudreau says.

“If your child has a cough along with other symptoms like a runny nose or hoarseness in their voice, it’s more likely they have a viral infection instead of strep throat,” she advises. Coughing is typically a symptom of respiratory viruses like the common cold, the flu, or COVID-19.

How do kids get strep throat?

The most common way to get strep throat is if you’re in close contact with someone else who has it. People who are often in contact with children, like parents and teachers, are at increased risk for strep throat.

“School and daycare are some of the most common places for children or parents to catch an illness like strep throat,” Dr. Arauz Boudreau says. “If your child was in close contact with someone who has strep throat, they could bring that bacteria home and it can spread to other family members.”

If someone has strep throat, they spread the bacteria through respiratory droplets by talking, sneezing, or coughing. Your child can get strep throat if they:

• Talk to or spend time close to someone with strep throat. Your child can breathe in the other person’s respiratory droplets that contain the bacteria.
• Touch something that has droplets on it, such as a toy or doorknob, and then touch their face, mouth, or nose
• Use the same utensils, plate, or cup as someone who has the bacteria, without washing the items first

A child usually develops symptoms about 2 to 5 days after being exposed to someone else with strep throat. 

Strep throat tests and treatment 

If you think your child might have strep throat, call their pediatrician or health care provider. They may ask questions about your child’s symptoms and ask that they come in for an appointment.

How to test for strep throat

There are two ways a doctor tests for strep throat:

1. Rapid strep test. A health care provider rubs a long cotton swab on the back of your child’s throat. In the office, they test the swab to see if it contains the bacteria that causes strep throat, and you find out the results in just a few minutes. When this test is positive, you can be confident in the result. If it is negative, but your doctor still suspects your child has strep throat, they may send a throat culture. 
2. Throat culture. This test is done like a rapid strep test with a swab to the throat, but the results take 1 to 2 days. Your child may need this if their rapid strep test is negative, since a throat culture can catch bacteria that the faster test may have missed.  

“The swab test can feel uncomfortable, but it’s very quick,” says Dr. Arauz Boudreau. “The test helps us confirm your child has strep throat, so we can get them started on the proper treatment.”

Treatment for strep throat

Health care providers often treat strep throat with antibiotics. This medication fights off the bacteria and helps your child feel better faster. It also helps prevent the bacteria from spreading to other people and prevents other complications that can be caused by strep throat. Remember to have your child finish the entire course of antibiotics, even if they feel back to normal. “This is important to avoid partial treatment, which is when some bacteria remains and can cause further health complications,” adds Dr. Arauz Boudreau.

Ask your child’s pediatrician or health care provider how long they should stay home after starting the antibiotic. Usually, your child can go back to school or daycare after taking antibiotics for at least 12 to 24 hours, unless they have a fever — then they should stay home until they no longer have one.

If your child isn’t feeling better after 48 hours of starting the antibiotic or they are having trouble swallowing, call their health care provider. 

Strep throat complications

It’s rare for children to experience complications after strep throat, but it is possible for the bacteria to spread to other parts of the body. Call your child’s pediatrician if they experience:

• Sinus or ear pain
• Trouble swallowing due to abscesses, or pockets of pus, around their tonsils or neck
• High blood pressure or hypertension, which may lead to a headache. Learn how to measure blood pressure at home.
• Swelling around the eyes or in the face, hands, or feet
• Dark or reddish-brown urine, decreased amount of urine, or decreased need to pee
  
• Painful joints (arthritis) or fever
  
• Fatigue
  
• Uncontrolled or jerky body movements

Some of these symptoms may be signs of a more serious infection, like post-streptococcal glomerulonephritis or rheumatic fever. Talk to your child’s pediatrician if you’re concerned about any of their symptoms.

Recurring strep throat in children

It’s possible your child could get strep throat again, even after taking the full course of antibiotics. The bacteria can sometimes remain in the tonsils even after treatment. If your child has recurrent strep throat, their provider might prescribe a different type of antibiotic or refer them to an ear, nose, and throat doctor for other treatment options.

“Strep throat is common in children, so knowing the signs can help you catch it earlier,” says Dr. Arauz Boudreau. “The sooner your child gets tested, the sooner we can start treatment and help them feel better.”