Sore Throat
What are the medical terms?
- Pharyngitis is literally defined as ‘inflamed throat’ and is the term used for insurance billing for any sore throat diagnosis.
- Tonsillitis describes inflamed tonsils. This is a subset of pharyngitis and includes inflamed tonsils caused by bacteria (treatable) or viruses (not treatable).
- Strep Tonsillitis is an inflamed throat caused by the streptococcus germ
What are the causes of sore throat or pharyngitis?
- Dry Air
- The problem: This is a very common cause of throat discomfort and morning complaints. In the fall and winter, the humidity level in the home drops to less than half the summer level. This is mostly due to the effects of dry heat. Humidifiers built into forced air heating systems only partly correct this dryness. Steam heat is associated with the driest form of heat. The dehumidified air causes the nasal passages and throat to become dry and uncomfortable. Anyone with nasal congestion caused by a cold, will breathe through their mouth all night which will make things even worse.
- The solution: Individual humidifiers in each bedroom will increase sleep (and morning) comfort through the entire winter. For an early morning sore throat, try something to drink (especially warm drinks) and a steamy shower. Usually this will bring moisture to these areas and kids will note a significant improvement. Adding a humidifier to the furnace will help the entire house.
- Return to school: There is no need to miss school if the sore throat improves this easily.
- Post Nasal Drip
- The problem: The congestion and mucous from either a cold or from seasonal allergies can cause a sore throat. The mucous relentlessly drips down the back of the throat, causing both discomfort and a cough. A cough causes mechanical irritation to the throat. Nasal congestion causes mouth breathing, which makes the sore throat worse. And none of these are a reason to miss school! (Unless the cold has also caused fever and fatigue!)
- The solution: Since the problem is Chinese water torture to the throat from the constant dripping, focus on soothing the throat by using hard candy, lozenges, tea&honey, and a humidifier. When allergies contribute to the post nasal drip, they can be managed with a dose of Benadryl™ or generic diphenhydramine at bedtime.
- Return to school: Once again, there is no reason to miss school unless the cold that caused the post nasal drip is making your child miserable.
- Viruses
- The problem: There are many viruses that cause sore throats. The most common are: adenovirus, influenza, Para influenza, enterovirus, and the Epstein-Barr virus. Many of these have hundreds of sub-groups. As a result, each season and even within a season, a child can have multiple viral infections. Each infection is a new learning lesson for the immune system. Following are short descriptions of some of the more distinctive viral patterns.
- Enterovirus. Also known as “Coxackie” or “ Hand-Foot-Mouth virus. The classic symptoms are painful viral blisters (sores) in the mouth, with a sore red throat. There is almost always fever the first few days (this is the contagious period). A few scattered red spots may appear on the body; in some cases blistery bumps will appear on the palms of the hands and soles of the feet. If you see blisters on the tongue, lips or throat, it is safe to say that it is enterovirus and not strep; a visit is usually not needed. The onset is usually in early spring or late summer. Treatment focuses on comfort. No antibiotics will cure a virus. Controlling the fever and pain with ibuprofen and acetaminophen are the first steps. Cold milk, ice cream, ice, and other soft cold items are also helpful avoid sweet foods like apple juice as well as acidic foods like orange and cranberry products. Focus on taking in enough fluids (ice cream counts).
- Influenza. (“The Flu”). The word “flu” is used for many things, but the real thing is an illness caused by the influenza viruses. Onset of the flu is usually fairly sudden, and occurs from late January to April. In addition to a very sore throat with large red tonsils, there is a combination of fever, headache, congestion, cough, stomach pain, body aches, nausea and vomiting. These symptoms last for 5-10 days. It is normal for flu fevers to last 1 week. Treatment again focuses on support and comfort. Kids need a lot of rest, fever medicine, and fluids. A strep test is not necessary.
- Mono. This is the most common term for “Infectious Mononucleosis,” which is caused by the Epstein-Barr virus. This illness typically shows a fever for 1-2 weeks, general malaise, an inflamed sore throat, and enlarged spleen. It occurs sporadically throughout the year. Although it used to be called the “kissing disease”, it is now more typically spread by the close contact found in schools as well as by not having good hand washing. Blood-work is required for diagnosis, and is not done unless there is a prolonged unexplained illness. There is usually not a rush to make the diagnosis, since treatment only involves supportive care, rest, and avoidance of contact sports.
- Common Colds. These are also part of the jumble of viruses already mentioned, but it is important to point out that even a mild cold can have a few days of sore throat. (See section on “Colds” for further information.)
- The solution: There is no treatment for a viral infection. Each virus has its own symptomatic period. The key to treatment is to help the child’s symptoms improve. This is best accomplished with acetaminophen or ibuprofen (Tylenol or Motrin) for fever and discomfort and a humidifier, Vicks Vapo Rub and honey in warm tea (for children over 12 months) for the cough and congestion.
- Return to school: Children with viruses may return to school as soon as they are no longer feeling ill and when they have stopped coughing.
- Strep Throat
- The problem: These sore throats are caused by an infection with the streptococcal bacteria. When trying to distinguish bacterial infections such as strep throat which will respond to antibiotics from viral infection which will have to get better on their own, there are 3 signs and 3 symptoms for which to look. Children with 5 of 6 signs and symptoms, should be checked for strep.
- Objective signs to look for
- Fever greater than 102
- Swollen neck glands
- Pus on the tonsils
- Subjective symptoms to look for
- Headache
- Sore throat
- Abdominal pain
- The diagnosis must be done in the office. Children must see a doctor or nurse practitioner for an evaluation and a throat swab. Fortunately in our office we have an advanced rapid diagnostic system, which will give you the results within 10 minutes. This system is so accurate there is usually no need to wait for overnight testing.
- The solution: Treatment of strep throat requires antibiotics, and will only be given for positive lab results! Please finish the entire treatment to avoid recurrences. Amoxicillin is the most commonly used first line of treatment for a strep throat. Resistance to amoxicillin is rare. When a child is diagnosed with one strep throat after another, it is more commonly caused by a new infection caused by exposure to other children in school or day care.
- Return to school: Typically, one requires 24 hours of antibiotics before return. We have found that when diagnosed in the afternoon, a child may often return the following morning if given a dose in the afternoon, a dose around midnight and a dose in the morning, if and only if, he or she is feeling better.
When to come in?
- When there is a strong possibility of a strep infection (see above for signs and symptoms.
- When the symptoms have lasted for more than a week (it is more likely to be a sinus infection)
- When there has been a fever for more than 5 days
- When the child is absolutely miserable
- When you are worried.
Additional tips!
- You have 9 days to treat a strep infection before worrying about complications such as rheumatic heart disease
- Diagnosing and treating a strep infection too early (in the first few hours), makes a child more vulnerable to a recurrence.
- Children under 3 years are very unlikely to get a strep infection and children under 2 years even more unlikely.
- When completing treatment, please replace the child’s toothbrush. Strep bacteria can remain on a toothbrush for almost 2 weeks, longer than the typical treatment.
When to come in:
- When there is a probability of a strep infection. See the description above. Look for: sore throat longer than 24 hours with headache, belly pain, fever, and swollen glands. It is very unusual to get a new cold (runny nose) and strep throat at the same time. (See sections on colds and post-nasal drip).
- Prolonged severe illness, or when you are worried.
- Allergy treatment-call first, a visit may not be needed.