Strep Throat vs. Sore Throat in Kids: Symptoms, Testing and When to Call
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Strep Throat vs. Sore Throat in Kids: Symptoms, Testing and When to Call

Quick answer: Strep throat vs. sore throat comes down to the cause. Most sore throats in kids are caused by viruses, usually come with cold symptoms like a cough, runny nose or hoarse voice, and get better on their own in about a week without antibiotics. Strep throat is a bacterial infection caused by group A Streptococcus. It usually starts suddenly with throat pain, pain when swallowing, fever and swollen neck glands, often without a cough or runny nose, and it is most common in children 5 to 15. You can’t tell the two apart by looking: only a strep test can confirm strep, and if it’s positive, your child needs antibiotics.

Sore throats are one of the most common reasons parents call the pediatrician, especially during the school year. According to the CDC, only about 3 in 10 children with a sore throat actually have strep. This guide explains how strep throat and a viral sore throat differ, how testing works, how to ease throat pain at home, and which symptoms mean you should call the doctor or go to the ER.

What’s the difference between strep throat and a sore throat?

“Sore throat” is a symptom, not a diagnosis. It can come from many things, and the American Academy of Pediatrics (AAP) and CDC agree that viruses are the most common cause. The same viruses that cause colds and the flu often make the throat red, scratchy and painful. Allergies and smoke exposure can also irritate the throat.

Strep throat is different. It’s an infection of the throat and tonsils caused by group A Streptococcus bacteria (also called Streptococcus pyogenes). The AAP explains that in strep, the tonsils themselves are usually very inflamed. Unlike a viral sore throat, strep is treated with antibiotics, both to help your child feel better and to prevent rare but serious complications.

A third term you may hear is tonsillitis, which simply means swollen, inflamed tonsils. Both viruses and strep can cause it.

Who gets strep throat?

  • School-age kids most of all. The CDC says children 5 to 15 are most commonly affected.
  • It’s rare in children under 3. The AAP notes that in infants and toddlers, viruses are by far the most common cause of a sore throat. Strep is uncommon under 2 unless a brother or sister has had it.
  • Season: it’s most common in winter and early spring, according to the AAP.
  • Close contact matters. Strep often spreads within households and in crowded places like schools and daycare centers. Symptoms usually start 2 to 5 days after exposure.

Strep throat vs. sore throat: symptoms to compare

Signs that point toward strep throat (according to the CDC and AAP):

  • A sore throat that starts very quickly
  • Pain when swallowing
  • Fever
  • Red, swollen tonsils, sometimes with white patches or streaks of pus
  • Tiny red spots on the roof of the mouth
  • Swollen, tender glands (lymph nodes) in the front of the neck
  • In children especially: headache, stomach pain, nausea or vomiting
  • A fine, red rash that feels like sandpaper. This is called scarlet fever, and it’s caused by the same bacteria.

Signs that point toward a virus instead:

  • Cough
  • Runny or stuffy nose
  • Hoarse voice
  • Red, watery eyes (pinkeye)
  • Mouth ulcers or blisters. Painful blisters in the mouth along with spots on the hands and feet suggest hand, foot and mouth disease.

The CDC’s guidance for clinicians says children with clear viral symptoms like these usually don’t need a strep test at all. Kids with a viral sore throat often have a mild fever and aren’t very sick overall.

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What about babies and toddlers? Children under 2 usually can’t tell you their throat hurts. The AAP says they may refuse favorite foods, drink less or cry during feedings instead.

These clues help, but they overlap, and a doctor can’t confirm strep just by looking. That’s why a test is the only way to know for sure.

How doctors test for strep throat

  • Rapid strep test: your pediatrician swabs the back of the throat and tonsils. Results are ready in about 10 to 15 minutes. A positive result means strep.
  • Throat culture: if the rapid test is negative in a child 3 or older, the CDC recommends confirming it with a throat culture, to make sure strep isn’t missed. The swab is grown in a lab and is usually read about a day later.

If both tests are negative, a virus is the likely cause and antibiotics won’t help. The AAP points out that waiting for test results carries no risk, so there’s no need to start antibiotics “just in case.”

A note on how guidance differs: in the U.S., pediatricians test first and treat confirmed strep. In the UK, the NHS says most sore throats get better within a week and antibiotics usually aren’t needed, and doctors there prescribe them only when a bacterial infection seems possible. Follow the advice of your own child’s doctor.

How strep throat is treated

Strep throat is treated with antibiotics. The CDC lists penicillin or amoxicillin as first-line choices, and there are alternatives for children with a penicillin allergy. Your pediatrician will choose the medicine and dose for your child.

  • Give every dose for the full course, even after your child feels better. The AAP says stopping early can let the infection come back or spread.
  • Expect quick improvement. The AAP says fever is usually gone within 24 hours of starting antibiotics, and the sore throat starts to feel better by 48 hours.
  • Antibiotics don’t help viral sore throats. The CDC warns that unneeded antibiotics can cause side effects ranging from rashes to severe allergic reactions and add to antibiotic resistance.

Why treating strep matters

Untreated strep can lead to complications. The CDC lists abscesses (pockets of pus) around the tonsils or in the neck, ear and sinus infections, and, less commonly, a kidney condition (post-streptococcal glomerulonephritis) and rheumatic fever, which can affect the heart, joints, brain and skin. The AAP notes rheumatic fever is rare in the U.S. and in children under 5, and antibiotics lower the risk.

Home care: soothing a sore throat

Whether it’s strep or a virus, these steps can help your child feel more comfortable:

  1. Keep fluids going. Drinking matters more than eating. Cold drinks, milkshakes, ice pops, slushes and sherbet are often easiest to swallow.
  2. Offer soft foods. Skip foods that need a lot of chewing, plus citrus, salty or spicy foods that can sting. Cut food into small pieces if swollen tonsils make swallowing hard.
  3. Try warm liquids for kids over 1 year, such as chicken broth. Some children prefer cold foods instead.
  4. Use honey only after age 1. The CDC says honey can help a cough in people 1 year and older. Never give honey to babies under 12 months.
  5. Treat pain and fever. The CDC says babies under 6 months should get only acetaminophen, while children 6 months and older can have acetaminophen or ibuprofen. Follow the package directions or ask your pediatrician for the right dose for your child’s age and weight. Never give aspirin to children or teens because of the risk of Reye’s syndrome.
  6. Be careful with lozenges and hard candy. The CDC says not to give lozenges to children under 4, and the AAP suggests hard candy only for kids over 6 because of the choking risk. The AAP also says medicated throat sprays and lozenges generally don’t help much.
  7. Salt-water gargles are for older kids. The AAP suggests warm salt-water gargles for children over 8, who can gargle without swallowing.
  8. Run a clean cool-mist humidifier to keep the air moist.
  9. Skip cold medicines in young kids. Over-the-counter cough and cold products aren’t recommended for young children. See our guide to cough and cold medicine for kids.

Most viral sore throats improve within about a week, and the AAP says they can take 7 to 10 days to clear completely.

When can my child go back to school?

For strep throat, the AAP says children can return to school or child care once:

  • They’ve been taking antibiotics for at least 12 hours,
  • Their fever is gone, and
  • They feel well enough to join normal activities.

The CDC’s guidance for clinicians uses a 12 to 24 hour window, so check your school or daycare’s policy. To prevent spread, wash hands often, cover coughs and sneezes, don’t share cups or utensils, and wash dishes after a sick child uses them.

When to call the doctor

Call your pediatrician or schedule a visit if your child:

  • Has a sore throat with fever, headache, stomachache, swollen neck glands or a sandpaper-like rash
  • Has a sore throat that isn’t improving after a few days, or keeps getting worse
  • Is under 5 and has a sore throat that worries you
  • Is drooling because swallowing hurts, or is drinking much less than usual
  • Shows signs of dehydration: no urine in over 8 hours, dark urine, a very dry mouth or no tears
  • Has a fever above 104°F (40°C)
  • Has joint swelling or pain, or pink, tea- or brown-colored urine
  • Has been on antibiotics for strep more than 48 hours and still has a fever, or more than 3 days and the sore throat isn’t better
  • Gets sore throats again and again
  • Is younger than 3 months with a temperature of 100.4°F (38°C) or higher. The CDC says to contact a provider right away. (See when to call the pediatrician about a fever.)

When to go to the ER / call 911

Call 911 if your child:

  • Is struggling to breathe, or can barely speak or cry
  • Has fainted or is too weak to stand
  • Has purple or blood-colored spots on the skin along with a fever

Go to the ER or get care right away if your child:

  • Can’t swallow any fluids or has new drooling
  • Makes a high-pitched sound when breathing in (stridor)
  • Has a stiff neck or can’t move their neck normally
  • Can’t fully open their mouth
  • Looks or acts very sick

The AAP notes that severe trouble swallowing, drooling and breathing problems can be signs of a more serious throat infection, such as epiglottitis or an abscess, that needs urgent care.

Do kids with repeated strep need their tonsils out?

Not usually. The AAP says tonsil removal used to be common after repeated sore throats, but today it’s recommended only for the most severely affected children, and antibiotics are usually the best approach even for repeated strep. If your child gets strep often, talk with your pediatrician, who may refer you to a pediatric ENT.

Not sure if your child’s symptoms are a cold, the flu or something else? Our guide to cold vs. flu vs. RSV vs. COVID in kids can help, and flu in kids covers flu-specific warning signs.

Frequently Asked Questions

How can I tell if my child has strep throat or just a sore throat?

Strep throat usually starts suddenly with throat pain, pain when swallowing, fever and swollen neck glands, often without a cough or runny nose. A sore throat with a cough, runny nose, hoarse voice or pinkeye is more likely caused by a virus. Symptoms overlap, so only a strep test can tell for sure.

Can strep throat go away on its own?

Strep throat symptoms may fade without treatment, but untreated strep can lead to complications such as abscesses near the tonsils and, rarely, rheumatic fever. Pediatricians treat confirmed strep with antibiotics, which also help children feel better faster.

Is strep throat contagious?

Yes. Strep throat spreads through close contact, often within households, schools and daycares. Children can usually return to school once they have been on antibiotics for at least 12 hours, have no fever and feel well enough to participate, according to the AAP. Check your school’s policy.

How long does a sore throat last in kids?

Most viral sore throats in children get better within about a week and may take 7 to 10 days to clear completely, without antibiotics. With strep throat, antibiotics usually bring the fever down within 24 hours and ease throat pain within 48 hours.

Can toddlers and babies get strep throat?

Strep throat is uncommon in children under 3, and viruses cause most sore throats at that age. Toddlers can still get strep, especially if a sibling has it. Babies and toddlers may show a sore throat by refusing food or drinks or crying during feedings, so call your pediatrician if you’re concerned.

What can I give my child for a sore throat?

Offer plenty of fluids, ice pops and soft foods, and warm broth for kids over 1. For pain, babies under 6 months should get only acetaminophen, and children 6 months and older can have acetaminophen or ibuprofen; follow the package or your pediatrician for dosing. Never give aspirin, don’t give honey under age 1, and avoid lozenges in children under 4.

When is a sore throat an emergency?

Call 911 or go to the ER if a child with a sore throat is struggling to breathe, can’t swallow fluids or is drooling, makes a high-pitched sound when breathing in, has a stiff neck, can’t open their mouth fully, or looks very sick. These can be signs of a serious throat infection.

Related guides

Sources

This article is for general information and is not a substitute for advice from your child’s doctor. In an emergency, call 911.

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