Sore Throat

The differential diagnosis behind your child's sore throat can be quite extensive. It obviously includes infectious causes (e.g. strep throat, other bacteria, and a multitude of viruses), post-nasal drip from an upper respiratory infection (i.e. a URI or cold), and symptoms from allergies, gastroesophageal reflux disease (aka GERD), or even some freaky traumatic event to the neck region. And pending the cause of your child's sore throat, the management will obviously differ. So while we ignore some of the more rare causes of sore throat for the time being and focus in on some of the more common ones, we hope to educate everyone on the best management, pending the underlying etiology for your child's sore throat.

Strep Throat

Although a multitude of strep bacteria exist, the one we are referring to here is Group A streptococcus bacteria (aka Strep pyogenes). The presentation of strep throat usually is with fever and sore throat (including difficulty swallowing) but without the cold symptoms (e.g. cough and runny nose) you would see from a viral cause. Abdominal pain and headache may accompany the symptoms and even some neck pain (from the swollen lymph nodes in the neck region) may occur. If one were to look inside the mouth, besides a red throat, there may be tiny red spots (petechiae) on the soft or hard palate and even whitish patches (exudates) on the tonsils may be noted.

When a rash accompanies strep throat, we call it Scarlet Fever but treatment is the same for both. In fact, treatment for strep throat usually involves a 10-day course of antibiotics (although sometimes we may use a five-day course of zithromax). The reason treatment of strep throat is so very important is the complications from strep can be quite significant. In fact, besides the development of an abscess in the tonsillar region or inflammation of the kidney (poststreptococcal glomerulonephritis), a cardiac complication can also occur — rheumatic fever. Rheumatic fever occurs when nodules form in either your child's joints, skin, or muscles, but most concerning is when they form on the heart muscle and the heart valves. This can lead to permanent scarring of the valves and, well, you probably can get an idea of how serious this might become. Problematic valves can ultimately lead to heart failure. So if any of the symptoms above (particularly without the cold symptoms) are seen in your child, please bring him/her in to see us.

Post-Nasal Drip from an Upper Respiratory Infection

Often this is the reason for your child's sore or irritated throat. What occurs here is that the runny nose from your child's cold is basically going down the back of your child's throat, causing a tickling or a scratchy feeling as it goes and ultimately creating an irritating cough. Now as I know many of you are aware, there is no specific antiviral medicine for colds. It is basically supportive care. So, depending on your child's age, either suctioning or blowing of the nose, pushing the fluids, and maybe a popsicle or two, the only other thing that may be tried is an antihistamine (e.g. Benadryl or Zyrtec). But if it is unclear it is a post-nasal drip triggering the throat irritation, we certainly encourage you to discuss this with one of us before trying a medication on your own.


Simply put, just think of the stomach acid flowing back up the esophagus (the tube that connect the throat with the stomach). The persistent flow of the stomach acid can generate an extremely irritated throat and even some hoarseness, but along with these symptoms, one may also have the feeling of heartburn or a sour taste in the mouth. Treatment measures include over-the-counter and prescription medications, including antacids (Tums, Maalox), H-2 blockers which block acid production (Pepcid, Zantac), or even proton pump inhibitors that also block acid production (Prevacid, Prilosec, Nexium). Sometimes other medications may be tried but if ultimately these measures fail, surgery may be the only option.