Strep Throat: What Parents and Caregivers Need to Know

March 3, 2025

boy has strep throat. Children's ENT doctor examines boy's throat. Children's diseases, medical examination.

All sore throats are not created equal. When a sore throat is caused by a virus, for example, it tends to resolve on its own without complications, and at-home remedies will usually provide relief along the way. Strep throat—also known as strep pharyngitis—is a very different matter.

Caused by the bacteria Streptococcus pyogenes, (also called Group A Streptococcus), strep throat can be serious, especially if left untreated. Some of its complications include tonsillar abscesses, acute rheumatic fever, rheumatic heart disease and kidney inflammation, among others. That’s why it’s so important to diagnose and treat a child’s strep throat promptly and effectively.

Strep throat usually affects children 3 years and older, says Dr. Brittany Sakhno, a Brooklyn-based pediatrician and instructor in pediatrics at Weill Cornell Medicine.

The telltale symptoms of strep throat include the following:

Sore throat
Abdominal pain
Fever
Headache
Swollen lymph nodes in the neck

“By contrast, a cough, congestion and runny nose are usually not present when a child has strep throat, and are more typical of a viral infection,” says Dr. Sakhno. As a parent, bring your child in for testing if you are concerned.

How do you diagnose strep throat?

“Mainly, we look for significant redness in the back of the throat, little red dots on the roof of the mouth (called petechiae) and white spots (called exudates) on the tonsils,” Dr. Sakhno says. “Sometimes, we see a rough rash on the child’s skin that feels like sandpaper and a bumpy red tongue that resembles the skin of a strawberry; these are signs of scarlet fever.

“Strep throat is highly contagious,” she adds. “Therefore, we ask parents and caregivers whether anyone else in the family or any of the child’s classmates has a strep infection.”

This is especially important in children who have recurrent strep infections to help identify the source.

Thankfully, there are tests your pediatrician can perform in the office to confirm or rule out strep throat. “A quick test that has been available for many years is the rapid antigen test. However, it can miss up to 30 percent of cases. That’s why a follow-up throat culture can be needed, but it can take several days for the results to come back. Fortunately, a test called the rapid strep PCR assay is 95 percent accurate and only takes 20 minutes. This PCR (polymerase chain reaction) test is what our Cornell pediatric clinics use,” says Dr. Sakhno.

Are there other possible diagnoses?

Depending on your child’s vaccine history, your pediatrician may be able to rule out two rare, potentially life-threatening conditions that also cause a sore throat: epiglottitis—an infection of the small flap that covers the windpipe, caused by Haemophilus influenzae type b (Hib); and Diphtheria, another deadly bacterial disease that obstructs breathing and swallowing.

Both of these have become quite rare in the U.S., thanks to safe and effective vaccines. The Hib vaccine, administered to infants as young as 2 months old, protects against epiglottitis caused by the Hib bacteria. And since the introduction of the DTaP vaccine (the “D” in DTaP stands for Diphtheria), that deadly disease has all but disappeared in the U.S.

A slew of viral infections can cause a sore throat. But, as Dr. Sakhno notes above, these are often accompanied by a runny nose, congestion and cough, meaning it’s unlikely that the child has strep when these symptoms are part of the mix.

How do you treat strep throat?

Penicillin or amoxicillin taken for 10 days are both highly effective. And, fortunately, if your child is allergic to these antibiotics, alternative options are available.

Why is it necessary to take antibiotics for strep throat?

Beyond the curative powers of antibiotics for strep, it’s critically important for your child to take them to prevent both immediate complications and delayed post-strep sequelae (consequences) that can occur weeks after a strep infection. These include the following:

Acute rheumatic fever

“A serious complication of an untreated strep throat is acute rheumatic fever,” she says. “It presents as joint pain, chest discomfort, shortness of breath, abnormal movements and rash, and can progress to rheumatic heart disease.” These symptoms develop in around 1 percent of untreated strep throat infections and begin a few weeks after the sore throat. Antibiotics taken for strep throat reduce a child’s risk of developing rheumatic fever by 70 to 80 percent.

Nephritis (kidney damage)

Damage to the kidneys after a strep throat infection can also occur in some cases, leading to swelling in the arms and legs, high blood pressure and dark urine several weeks post-infection.

“Once again, antibiotics taken for the original throat infection will prevent most cases of kidney involvement,” Dr. Sakhno says.

Infectious complications

The strep bacteria can also spread to nearby areas of the body as well as the nervous system and cause:

Abscesses in the tonsils
Meningitis and other diseases of the nervous system
Ear infections
Sinus infections
Sepsis: a potentially life-threatening condition that occurs when the infection-causing bacteria enters the bloodstream

Antibiotics help to reduce the risk of a strep throat infection spreading to these other areas of the body, she says.

What if my child gets strep throat repeatedly?

“There’s a natural tendency for strep throat infections to decline as children get older,” she says. Still, if your child gets strep often, it’s possible that they are a “carrier” of strep, meaning that they continue to have the strep bacteria even when not feeling ill. This happens in 12 percent of children.

To help your child’s pediatrician determine whether your child is a carrier, ask yourself the following questions and discuss them with your child’s pediatrician:

Are these infections truly distinct episodes with a full recovery in-between?
Did you administer the complete, 10-day course of antibiotics?
Are your child’s symptoms consistent with a strep infection as outlined above?

Ask your pediatrician if your child should be tested when they’re symptom-free, such as during a well visit. If the strep test is positive, they may be a carrier. The good news is that carriers are very unlikely to transmit the infection to others and are also unlikely to develop strep complications.

Can home remedies help?

Supportive measures, such as warm liquids, lozenges, acetaminophen and ibuprofen, can help your child feel better. But, Dr. Sakhno advises, “avoid viewing these as alternative treatments capable of fighting the strep infection on their own.”

When is a tonsillectomy recommended?

Tonsillectomy isn’t usually indicated, even for recurrent infections, because children typically outgrow them as they mature. But “there may be times when an ENT consult is recommended,” she says.

When can my child return to school after a strep throat episode?

According to the most recent studies, 91 percent of children test negative 12 hours after starting antibiotics for strep throat. Therefore, it is a-okay to have your child return to school when they’ve been on antibiotics for at least 12 hours and has been fever-free for at least 24 hours without using fever-reducing medications such as acetaminophen or ibuprofen.