A sore throat is characterized by pain, discomfort, or scratchiness in the throat, often worsening with swallowing. This condition is common in pediatric populations, affecting millions of children annually. The incidence is particularly high in school-aged children due to the increased exposure to infectious agents. Sore throats get a lot of attention because they cause considerable discomfort. Fortunately, most are caused by mild infections that resolve on their own over time.
Anatomy of the throat
The throat, or pharynx, is a muscular tube that serves as a passageway for food and air. It is divided into three main sections: the nasopharynx, located behind the nasal cavity; the oropharynx, situated behind the oral cavity; and the hypopharynx, which is above the larynx and esophagus. Key structures in the throat include the tonsils, which are lymphoid tissues located on either side of the oropharynx, and the adenoids, located in the nasopharynx. The throat also contains the epiglottis, which prevents food from entering the airway during swallowing. Pain in the throat typically originates from inflammation or infection of these structures, with the tonsils and pharyngeal walls being the most commonly involved.
What is the most common cause of a sore throat in children?
Viral pharyngitis
The most common cause of a sore throat in children is viral pharyngitis. Viral infections, such as those caused by adenoviruses, rhinoviruses, influenza viruses, and coronaviruses, account for most sore throat cases. These viruses infect the cells that line the inside of the throat, leading to inflammation of the pharyngeal tissues, pain, and discomfort. Viral pharyngitis is most prevalent in children aged 3-15 years. Distinguishing features include a sudden onset of sore throat, often accompanied by symptoms such as cough, runny nose, and fever. The throat may appear red and swollen, sometimes with the presence of small white patches. Viral pharyngitis can be differentiated from bacterial infection by the absence of high fever (greater than 40 degrees Celsius or 104 degrees Fahrenheit), swollen lymph nodes in the neck, and thick white exudates on the tonsils. Treatment is supportive, focusing on symptom relief with fluids, rest, and analgesics.
Other common medical conditions associated with a sore throat in children
Streptococcal pharyngitis
Streptococcal pharyngitis, better known as “strep throat,” is caused by infection with group A Streptococcus bacteria. It is a frequent cause of sore throat in children, particularly those aged 5-15 years. It presents with a sudden onset of sore throat, fever, headache, and abdominal pain. Sneezing, coughing, and runny nose are rare in Streptococcal pharyngitis. The throat typically appears red with swollen tonsils and white exudates. Tender anterior cervical lymph nodes are often present. Diagnosis is confirmed with a rapid antigen detection test or throat culture, and treatment involves antibiotics such as penicillin or amoxicillin.
Other bacterial infections
Other species, such as Neisseria gonorrhoeae, Mycoplasma pneumoniae, and Chlamydia pneumonia, can cause bacterial pharyngitis. These infections are less common but can present with sore throat, fever, and other systemic symptoms. Diagnosis involves specific cultures or serological tests, and treatment includes appropriate antibiotics.
Infectious mononucleosis
Infectious mononucleosis is caused by the Epstein-Barr virus. It often affects adolescents and young adults and presents with a sore throat, fever, fatigue, and swollen lymph nodes. The tonsils are typically enlarged with a white or gray coating. Splenomegaly is a common finding. Diagnosis is confirmed with a heterophile antibody test or EBV-specific serology. Treatment is supportive, focusing on rest and hydration.
Hand, foot, and mouth disease, and herpangina
Hand, foot, and mouth disease, and herpangina are related conditions caused by coxsackievirus. They are common in children under 10 years. Hand, foot, and mouth disease presents with a sore throat, fever, and a characteristic rash on the hands, feet, and inside the mouth. The rash consists of small, red spots that may become blisters. Herpangina presents with a sudden onset of fever, sore throat, and small, painful ulcers on the tonsils and soft palate. The ulcers are typically surrounded by a red halo. Both conditions are diagnosed based on clinical presentation and are managed supportively.
Allergic rhinitis
Allergic rhinitis can cause a sore throat due to postnasal drip, where mucus from the nasal passages drips down the throat, causing irritation. Symptoms include sneezing, itchy eyes, and a runny nose. Diagnosis is based on clinical history and allergy testing. Treatment involves antihistamines and avoiding allergens.
Sinusitis
Sinusitis or inflammation of the sinuses can lead to a sore throat from postnasal drip. It is common in children and presents with nasal congestion, facial pain, and headache. Diagnosis is based on clinical symptoms and imaging if needed. Treatment includes nasal decongestants and, if bacterial, antibiotics.
Pharyngoconjunctival fever
Pharyngoconjunctival fever is caused by adenovirus infection. It affects children and presents with sore throat, fever, and conjunctivitis. It often occurs in outbreaks. The throat appears red with possible white exudates. Treatment is supportive.
Epiglottitis
Epiglottitis is a life-threatening condition caused by bacterial infection, most commonly Haemophilus influenzae type b (Hib). It affects children aged 2-7 years. Symptoms include sudden onset of sore throat, high fever, drooling, and difficulty breathing. The child may sit in a tripod position to breathe. Treatment requires immediate airway management and antibiotics.
Peritonsillar abscess
Peritonsillar abscess is a complication of bacterial infection of the tonsil. It is more common in adolescents and young adults and presents with severe sore throat, fever, and a muffled voice. Upon examination, the tonsil appears displaced medially by the abscess, causing deviation of the uvula. Treatment involves drainage and antibiotics.
Less common but serious medical conditions associated with a sore throat in children
Retropharyngeal abscess
Retropharyngeal abscess is a deep neck infection that can occur in children, particularly those under five years. It presents with fever, sore throat, neck stiffness, and difficulty swallowing. The child may hold their neck extended to ease breathing. Diagnosis is confirmed with imaging, and treatment requires surgical drainage and antibiotics.
Ludwig’s angina
Ludwig’s angina is a severe cellulitis of the floor of the mouth, usually arising from dental infections. It affects children of all ages and presents with sore throat, swelling of the neck, and difficulty breathing. Diagnosis is clinical, and treatment involves airway management and antibiotics.
Diphtheria
Diphtheria is a condition caused by infection with Corynebacterium diphtheriae. It is rare in vaccinated populations but can cause a sore throat with a thick, gray pseudomembrane in the throat. It affects children of all ages. A throat culture confirms the diagnosis, and treatment includes antitoxin and antibiotics.
Stevens-Johnson syndrome
Stevens-Johnson syndrome is a severe reaction to medications or infections, presenting with a sore throat, fever, and widespread rash with blistering. It can affect children of all ages. Diagnosis is clinical, and treatment requires hospitalization and supportive care.
Kawasaki disease
Kawasaki disease is an inflammatory condition affecting children under five years. It presents with fever, sore throat, red eyes, rash, and swollen lymph nodes. Diagnosis is clinical, and treatment involves intravenous immunoglobulin and aspirin.
Peritonsillar cellulitis
Peritonsillar cellulitis, a complication of tonsillitis, causes a severe sore throat, fever, and difficulty swallowing. The tonsil appears swollen and inflamed. The diagnosis is clinical, and treatment includes antibiotics.
Acute rheumatic fever
Acute rheumatic fever follows untreated streptococcal pharyngitis and presents with a sore throat, fever, rash, and joint pain. It affects children aged 5-15. Diagnosis is clinical and supported by laboratory tests, and treatment involves antibiotics and anti-inflammatory medications.
Lemierre’s syndrome
Lemierre’s syndrome is a rare but serious condition caused by Fusobacterium necrophorum, leading to sore throat, fever, and septic thrombophlebitis of the internal jugular vein. It affects adolescents and young adults. Diagnosis is confirmed with imaging, and treatment requires antibiotics and sometimes surgery.
Systemic lupus erythematosus (SLE)
Systemic lupus erythematosus (SLE) is an autoimmune condition that can cause a sore throat, fever, rash, and joint pain. It affects adolescents and young adults. Diagnosis is based on clinical criteria and laboratory tests, and treatment involves immunosuppressive medications.
Thyroiditis
Thyroiditis, inflammation of the thyroid gland, can cause a sore throat along with neck pain and swelling. It affects children of all ages. Diagnosis is based on clinical examination and thyroid function tests, and treatment involves anti-inflammatory medications.
Additional symptoms that can help identify the cause of a sore throat in a child
- Coughing: Coughing often accompanies viral infections such as viral pharyngitis, where the sore throat is due to inflammation caused by the virus.
- Sneezing and a runny nose: Sneezing and a runny nose are typical symptoms of allergic rhinitis or viral upper respiratory infections, where the throat is irritated by postnasal drip.
- Difficulty swallowing: Difficulty swallowing, especially with drooling, can indicate more severe conditions like epiglottitis or a retropharyngeal abscess, where inflammation or infection obstructs the throat.
- Fever: Fever is a common symptom in infections like streptococcal pharyngitis, tonsillitis, and infectious mononucleosis, where the body’s immune response to infection causes an elevated temperature.
- Neck swelling: Neck swelling can be seen in conditions like retropharyngeal abscess or lymphadenitis, where the infection spreads to the neck tissues.
- Shortness of breath: Shortness of breath is a critical symptom in severe conditions like epiglottitis or Ludwig’s angina, where the airway is compromised due to swelling or infection.
Advice for parents
A child with a sore throat should see a doctor if the pain is severe, persistent, or accompanied by alarming symptoms such as difficulty breathing, drooling, high fever (greater than 40 degrees Celsius or 104 degrees Fahrenheit), or neck swelling. Appropriate treatment and management depend on the underlying cause. Viral infections generally require supportive care with rest, fluids, and pain relievers, while bacterial infections like streptococcal pharyngitis necessitate antibiotics. Immediate medical attention is crucial for severe conditions such as epiglottitis or retropharyngeal abscess to prevent complications and ensure proper treatment.
Prevention
Here are some tips to help your child avoid getting a sore throat:
- Encourage frequent hand washing with soap and water to reduce the spread of infections.
- Teach children to avoid close contact with individuals who are sick.
- Ensure your child receives recommended vaccinations, including the flu shot and the Haemophilus influenzae type b (Hib) vaccine, to protect against common pathogens.
- Maintain a healthy environment by keeping surfaces clean and avoiding shared utensils or cups.
- Encourage good respiratory hygiene, such as covering the mouth and nose with a tissue or elbow when coughing or sneezing.
- Ensure your child has a balanced diet and gets adequate rest to support a healthy immune system.
Summary
A sore throat in children is a common condition resulting from various causes, ranging from mild viral infections to serious bacterial infections or inflammatory conditions. Accurate diagnosis and timely treatment are essential to prevent complications and ensure effective management. This article provides an evidence-based overview of sore throats in children, detailing common and serious causes, diagnostic clues, additional symptoms, and advice for parents to improve understanding and outcomes.