Is it just a cold, or could it be strep?


Let’s talk about sore throats. “Mooommm! My throat hurts!” It’s what every parent dreads hearing.

It can be confusing trying to figure out if it’s a cold or seasonal allergies or whether you need to worry about the infamous strep throat.

Most sore throats are caused by viruses and not the group A streptococcus bacteria that causes strep throat. Typically, children have other viral symptoms such as a runny nose, cough and watery eyes along with a virus. These sore throats will improve with time and don’t require any antibiotics.

Strep throat is mainly spread from respiratory secretions (snot) and is easily spread person to person in childcare settings and schools. It’s common here at the Cook Children’s Willow Park office for me to see multiple kids from the same school in a short period of time.

Group A strep typically causes large red tonsils that sometimes have pus and enlarged lymph nodes in the neck. Symptoms can include headache, stomachache, vomiting and sometimes a sand-papery pink rash. Occasionally, there are small red spots called petechiae that can be seen on the roof of the mouth or back of the throat. It is unusual for children under the age of 3 to have strep throat, and even more unlikely for them to develop the complications of an untreated strep infection.

When your child has sore throat without other viral symptoms, we often will do a rapid strep test at your office visit. The specimen is obtained by swabbing the tonsils with a cotton swab – nobody likes this very much! If the test is positive, antibiotics are required to clear the infection and prevent complications, such as peritonsillar abscess and acute rheumatic fever, which can cause damage to the heart valves. Don’t panic; even untreated, a very small percentage (around 1 percent) of people may go on to develop this complication and it can be prevented by treating within nine days of onset of symptoms.  If the rapid test is negative, sometimes we send a throat culture to verify no bacteria will grow in the lab.

Studies don’t support the notion that you have to get a new toothbrush after a strep infection. Because you should be changing them every three months anyway, go ahead and get a new one if you’re close to that mark.  According to newer studies, your child can return to school or daycare the day after antibiotics are started, as long as they receive the first dose of antibiotics before 5 p.m., and are fever-free for 24 hours. Most children feel better quickly after starting antibiotics! It’s not uncommon for children to have a streptococcal sore throat several times per year. Frequent or recurrent infections may need further investigation that your pediatrician will discuss with you in detail.

The moral to this story is that it’s OK to watch a sore throat for a few days at home, especially if there are other cold symptoms. Treat pain with over-the-counter medicine like acetaminophen (Tylenol®) or ibuprofen (Motrin®) and encourage your child to drink cold liquids. If things aren’t improving after a few days or if the throat pain is severe or associated with difficulty swallowing, then an office visit is recommended.

I look forward to meeting you soon!

Devona Martin, M.D.

Dr. Martin joined the Willow Park practice in 2016 after working as a hospitalist for four years at Cook Children’s Medical Center. She attended Baylor University in Waco, Texas, where she was a university scholar, spent a semester in The Netherlands studying the history of medicine and graduated with honors. Dr. Martin received her medical training and completed her pediatric residency at Texas Tech University Health Sciences Center in Lubbock, Texas. She was inducted into the Alpha Omega Alpha honor society and served as chief resident. She has a special interest in medically complex patients and is passionate about the prevention of child abuse. She is board certified in pediatrics and a fellow of the American Academy of Pediatrics. A mother of three, Dr. Martin loves her job helping families and is currently welcoming new patients. Visit Cook Children’s Willow Park today!