Sore Throat (Viral)

Two different germs cause sore throats – viruses and bacteria. They are both contagious and easily spread to others.

• The germs hang out in the nose and throat. When the infected person coughs, sneezes, or talks, the germs go into the air. They are then breathed in by others.
• The germs can also land on things and be picked up by touching them.

Most often, a sore throat is caused by a virus like the flu or common cold. The sore throat will go away on its own in a few days without any treatment.

When a sore throat comes on fast, it may be caused by the bacteria streptococci (strep-tuh-kaak-sai), or strep. Antibiotics will not help treat viruses.

Symptoms of a Virus

If your child has a sore throat with any of these symptoms, it is likely due to a virus.

• Sore throat, maybe red with yellow patches
• Decreased appetite
• Red, itchy, or watery eyes
• Sleeping more than normal
• Runny nose, stuffed nose, or sneezing
• Fussiness
• Cough
• Hoarseness

Diagnosis

It is important to know if your child’s sore throat is due to a virus or to strep bacteria.

• The doctor or health care provider will examine your child and ask about their symptoms.
• If they suspect strep, 1 or 2 soft swabs will be brushed over the back of your child’s throat to do 1, or both, of the tests on the next page. Your child may gag a little.
  • A rapid strep test (rapid antigen test) – It takes up to 30 minutes to get the results of a rapid strep test. You will stay until you get the results.
  • A throat culture – Sometimes only this test is done. If your child had a rapid strep test first, the same swab can be sent to the lab for testing. It takes 1 to 2 days to get the results. The lab will notify your child’s doctor or health care provider, who will then let you know the results.
• A positive rapid strep test or positive throat culture means that your child has strep throat. They must start to take antibiotic medicine right away. Early treatment can prevent harm to the body.
• Let your child’s doctor know if they are a strep carrier. Strep carriers always test positive for strep even after taking antibiotics. Their sore throat will be treated like a virus.

How to Care For Your Child

There are things you can do to help your child feel better.

• Give them soft, easy-to-swallow foods, like applesauce, mashed potatoes, hot cereal, or eggs. Do not force them to eat. Your child may not want to eat much if it hurts to swallow. 
• Give them lots of liquids, like water, Pedialyte^®, diluted apple juice, or popsicles. Give small amounts of liquid often (Picture 1).
• To soothe a sore throat, for children:
  • For children over age 1, give warm fluids like water, herbal tea with honey, or diluted apple juice. Do not give honey to children under age 1. For some children, cold fluids or popsicles can be soothing.
  • For children over age 4, give throat or cough lozenges or use throat sprays. Read the label to know the right dose for your child. Do not use throat sprays that contain benzocaine, as this could cause a drug reaction.
  • For children over age 6 who are able to gargle without swallowing, mix ½ teaspoon of table salt in 8 ounces of warm water. Have them swish and gargle the mixture 2 to 3 times a day for the next few days. Do not let your child swallow the salt water; have them spit it out.
• For a fever or throat pain, give acetaminophen (such as Tylenol^®) or ibuprofen (Advil^®, Motrin^®) as directed. Read the label to know the right dose for your child. Do not give aspirin or products that contain aspirin. 

How to Protect Others 

• Good hand washing is VERY important! Clean your hands and your child’s hands often with soap and water. Wash for 15 to 20 seconds, or the time it takes to sing the Happy Birthday song (Picture 2). If soap and water are not available, an alcohol-based hand sanitizer that contains at least 60% alcohol may be used. Rub hands until dry.
• Make sure to wash your child’s drinking glass and eating utensils in hot soapy water before others use them.
• Give your child a paper bag and have them put their used tissues in this bag. Moisture from the child’s nose and mouth is contagious.

When to Call the Doctor

Call your child's doctor of health care provider if they:

•  Start pulling at their ears.
• Have a sore throat that lasts more than 3 days.
• Have trouble breathing.
• Start drooling, can't talk, or voice gets muffled.
• Can't eat or drink.
• Have a fever:
  • Younger than 3 months of age - 100.4° Fahrenheit (F) or 38° Celsius (C) or above.
  • Older than 3 months of age 
    • 104° F (40° C) or above.
    • Above 102° F (38.9° C) for more than 2 days or it keeps coming back.
    • Treated to bring their fever down, but it hasn’t worked.
  • Any age - call with a fever and:
    • Has an unusual rash.
    • Looks ill, is fussy, or is drowsy.
    • Has been in a very hot place, such as an overheated car.
    • Is not eating or drinking and shows signs of dehydration - dry or sticky mouth, sunken eyes, dark urine, dry diapers, or not urinating.
    • Has a stiff neck, a bad headache, a very sore throat, a painful stomach ache, vomiting, or diarrhea.
    • Has immune system problems that make them more likely to get sick, such as sickle cell disease or cancer, or takes medicine that weakens the immune system.

Sore Throat (Viral) (PDF), Somali (PDF), Spanish (PDF)

HH-I-121 11/89, Revised 5/22 Copyright 1989, Nationwide Children’s Hospital