Your Child's Sore Throat: Knowing When It's Strep or Tonsillitis

Sore throat, strep throat, tonsillitis. Confused about the difference? You're not alone. Many people use these terms incorrectly to describe any throat irritation, but they are not all the same.

Sore throat basics
A red, painful throat can be caused by a viral or bacterial infection. It may be the only symptom your child has, or she may also have a fever, swollen glands or nasal congestion. In young children, sore throats are often caused by viral infections. These need no special treatment other than rest, fluids and acetaminophen or ibuprofen to help with the pain. Ask your doctor, though, before you give any over-the-counter medications to your child. Usually, the child does not feel too sick and symptoms pass in three to five days.

Strep throat is caused by the bacteria Streptococcus pyogenes. It tends to cause more serious symptoms in children. Older children may complain of a very painful throat, and they may have swollen glands and a fever higher than 102 degrees F. A younger child may not be able to tell you what is wrong, but may have a fever and be very cranky. There may also be a thick discharge from the nose.

If the tonsils are inflamed, your child may have tonsillitis. This can occur with a viral or bacterial infection. Tonsils are the fleshy pieces of tissue on both sides of the back of the throat.

When to call the doctor
If your child complains of a sore throat that lasts more than a day or so, call the doctor to rule out a more serious infection. Call the doctor right away if there are other symptoms, such as:

• Fever
• Rash
• Headache
• Stomachache
• Trouble swallowing

Seek immediate medical care if:

• The fever is over 105 degrees F
• There is neck pain or stiffness
• Your child is younger than 3 months of age
• Other medical problems are present

In some cases, a sore throat needs to be treated as an emergency. Call 9-1-1 if your child has any of these symptoms along with a sore throat:

• Difficulty breathing
• Inability to swallow
• Drooling
• Extreme illness with a rash or bruises
• Cannot open mouth, cry or speak

What the doctor or health care provider will do
During an office visit, the doctor will take a culture to see if your child has strep throat. This involves rubbing a cotton-tipped applicator on the back of your child's throat. A positive test means your child will need antibiotics to treat the infection.

The doctor will also look into your child's throat. If pockets of pus or inflammation on the tonsils are seen, the diagnosis may be tonsillitis.

What about repeat infections?
Surgery to remove the tonsils (tonsillectomy) used to be the standard treatment for kids who had frequent bouts of tonsillitis or strep throat. Today, this is still the second most common surgery performed on children. But a 2007 study in the Archives of Otolaryngology showed that "watchful waiting," including treatment with antibiotics if needed, may be preferable to surgery in most cases. Why? Over time, kids' immune systems mature and repeat infections become less frequent.

When is surgery necessary?
Your doctor may suggest removing your child's tonsils if he or she suffers chronic sore throats, in addition to any of these conditions:

• Sleep apnea (when breathing stops during sleep)
• Noisy breathing
• Trouble swallowing

Surgery has not actually been proven to help in all cases, but doctors sometimes recommend it to relieve other problems, such as:

• Snoring
• Recurring, severe ear infections or hearing loss
• Frequent sinus infections
• Persistent mouth-breathing

Making the decision
Tonsillectomy is a common procedure, but it still has risks. At the same time, repeat infections from tonsillitis can also be serious if not treated.

Ask your child's doctor about all the pros and cons of surgery so you can make an informed decision. Get a second opinion from another doctor if you are still unsure.

Sources:

Buskens E, van Staaij B, van den Akker J, Hoes AW, Schilder AGM. Adenotonsillectomy or watchful waiting in patients with mild to moderate symptoms of throat infections or adenotonsillar hypertrophy. Archives of Otolaryngology-Head & Neck Surgery. 2007 Nov;133(11):1083-1088.

Centers for Disease Control and Prevention. Ambulatory and inpatient procedures in the United States, 1996. Accessed December 7, 2007.

American Academy of Pediatrics. Parenting Corner Q&A: Sore Throat. Accessed December 7, 2007.