When to worry about your child’s sore throat

Follow me on Twitter @DrClaire

Sore throats happen all the time in childhood — and most of the time, it’s nothing to worry about. Most of the time, they are simply part of a common cold, don’t cause any problems, and get better without any treatment.

Sometimes, though, a sore throat can be a sign of a problem that might need medical treatment. Here are four examples:

Strep throat. This infection, caused by a particular kind of streptococcus bacteria, is quite common. Along with a sore throat, children may have a fever, headache, stomachache (sometimes with vomiting), and a fine, pink rash that almost looks like sandpaper. All of these symptoms can also be seen with a viral infection, so the only way to truly know if it’s strep throat is to swab for rapid testing and/or a culture. Strep throat actually can get better without antibiotics, but we give antibiotics to prevent complications, which, while rare, can include heart problems, kidney problems, and arthritis.

Peritonsillar or retropharyngeal abscess. This is a collection of pus either behind the tonsils (peritonsillar) or at the back of the throat (retropharyngeal) and can be dangerous. Redness and swelling on one side of the throat, or a bad sore throat with fever and neck stiffness, can be signs.

Stomatitis. This is caused by viruses, and leads to sores in the mouth and throat. It gets better by itself, but it can make eating and drinking very uncomfortable, which is why some children with stomatitis (especially very young children) end up with dehydration. There are medications that can help coat the sores and make drinking easier, to help prevent dehydration.

Ingestion. Little children are curious and don’t have the best self-preservation skills. If they drink something that is a strong acid or alkali, it can burn the mouth and throat as it goes down. Household products such as bleach, drain cleaners, toilet bowl cleaners, some detergents, and even some beauty products such as hair straighteners, can do terrible damage. If an adult didn’t witness the ingestion, all they might know is that the child is suddenly complaining of mouth and throat pain.

Here’s when you should call the doctor about your child’s sore throat

• if your child is having any trouble breathing, or if their breathing just seems different to you
• if your child is having trouble swallowing, especially if they are drooling
• if your child has a stiff neck
• if your child has a high fever (102° F or higher) that doesn’t go down with acetaminophen or ibuprofen, or keeps coming back after going down briefly
• if your child is refusing to drink or is drinking much less than normal
• if the pain is severe (any severe pain warrants a call to the doctor)
• if your child is so sleepy that they are hard to wake or keep awake
• if your child has a rash, headache, stomachache, or vomiting, to be checked for strep throat (or other infections). If your child has been around someone with strep, any sore throat warrants an appointment to get checked.

If none of those are happening, that’s good news — and chances are your child will be fine in a day or two.

Here are some ways to make a child with a sore throat more comfortable

• Cold liquids, or cold foods like popsicles, ice cream, or refrigerated Jell-0. If they don’t want to eat, that’s fine, but they have to drink. Give sips of a little at a time if needed.
• Acetaminophen or ibuprofen. Check with your doctor for the right dose for your child’s age and weight.
• If your child has mouth sores, avoid foods that are salty, spicy, acidic (like orange juice), or sharp (like potato chips). Stick with bland and soft.
• Use a humidifier to help keep the throat moist.

As always: if you have any questions or concerns, call your doctor.