mfuesThe phone rings and I already know what the question on the other end is most likely to be, “My child has a scratchy throat, should I bring him in?” Welcome to “sore throat season!” Teasing out when to seek medical attention and when to stick with tender loving care can be difficult. So, it seems a great time to sort through all the interesting ways your child’s throat can really be a pain.

Viral infections account for 90 to 95% of sore throat infections. They tend to run their course over about 7 days and usually only require supportive care. There are several viruses worth noting:

1) The common cold – viral sore throats are typically associated with cold symptoms, including cough, congestion, runny nose and fever. One particular virus, adenovirus, is quite common and can also cause vomiting and diarrhea, a rash and white patches on the throat.

2) Mononucleosis (aka “kissing disease”) – this infection caused by Epstein-Barr virus typically only causes a cold in young children; however, a teenager with a sore throat, enlarged tonsils, enlarged lymph nodes, high fevers and general malaise could very well have contracted classic mono. Antibiotics are of no benefit and can often cause a rash. Sometimes the spleen is enlarged, thus these children should be followed by their pediatrician and avoid contact sports until the spleen size returns to normal. So if you suspect it may be mono, call the pediatrician.

3) Laryngitis – sore throats accompanied by hoarseness are almost always a viral infection, typically caused by parainfluenza (a type of virus not related to influenza). This is the same virus that causes croup in babies, whose airways are much smaller and are more likely to make the famous barking cough. In older children and adults, the airway is much larger and the inflammation of the larynx (aka voice box) simply causes hoarseness. So, if your child is typically pretty chatty, this can sometimes be a very quiet time in the house!

4) Other viral infections – herpangina or hand-foot-mouth disease caused by coxsackie A virus is quite common in little ones. Typically, small sores can be identified in the throat and similar blisters may be seen on the hands, feet and buttocks area. Symptomatic care is all that is typically required. Influenza can also cause sore throat but is typically accompanied by fever, nausea, muscle aches and profound fatigue. If you suspect influenza, call the pediatrician. Treatment within the first 48 hours can lessen symptoms and hopefully prevent complications. And if you haven’t gotten a flu vaccine, now is the time!

Bacterial infections are not common causes of sore throats, but the most well known is “strep” throat, caused by the bacteria, Group AStreptococcus. Typically, children with strep have high fevers and painfully swollen tonsils without congestion or cough. A few tell-tell signs include, a tongue that appears whitish and swollen and may appear like a “strawberry” with red bumps, unusually bad breath (we call this “strep breath”), high fever and enlarged tonsils with a white coating. Some patients may also develop scarlet fever with a bright red rash that becomes rough like sandpaper. Call the pediatrician for a strep test and antibiotics if positive to prevent strep-related complications.

Irritants and allergies causing post-nasal drip often cause sore throats lasting more than a week. When sleeping, nasal fluid may drip down the throat repeatedly, leading to contact irritation resulting in a child awakening with a scratchy throat. Typically, enlarged lymph nodes are not seen in these patients, and they do not have fever.

So, when to seek medical attention? Call your child’s pediatrician if sore throat is accompanied by any of the following: high fevers, a rash (especially a sandpaper rash), very enlarged tonsils, difficulty breathing, or flu-like symptoms. Hand washing and covering your cough are excellent preventive measures.