Is It Strep... or Not?

Uncategorized Nov 30, 2022

"I'm POSITIVE My Child Has Strep Throat! Please call in antibiotics ASAP!"  

Every pediatrician has experienced this phone call more times than they can possibly count. Often nights & weekends, funny enough...

If you've ever been that parent and you were asked why you were sure it was strep, you may have said: 

  • It's SO painful, it must be strep.
  • It looks so RED, it must be strep.
  • I see white spots, it has to be strep!

Turns out, VIRUSES are the most common cause of all these symptoms, in both adults and children. And repeat after me, "Antibiotics Don't Kill Viruses!".

So how's a parent to know for sure?? Let's dig in a bit.

It's true that strep throat, caused by Group A β-hemolytic streptococcus (GABHS), is the most common BACTERIAL cause of sore throat. Symptoms also often include: 

  • Sudden onset of fever over 100.4 F
  • Tender neck glands
  • Swollen tonsils & painful swallowing

If your child has all 3 of these, they definitely need to get checked.

Strep throat in children can also cause headache, abdominal pain and fatigue, sometimes even vomiting and congestion too. Not. Fun. 

Here is some happy news: 

  • Strep is very rare under 3 years old.
  • Only 5% of sore throats under 5 years old are caused by Group A Strep.
  • Without a fever over 100.4 and swollen tonsils, it is highly unlikely to be strep in any age! 

By day 3 of a viral sore throat, it's starting to feel better. Yay!

By day 3 of strep, not so much...

It's safe to wait til that 3rd day of sore throat to get checked *as long as your child is looking better when fever comes down and drinking well*.

Now, children 5 to 16 yrs old are more likely to have strep with a sore throat - about 30% of the time - but bullet point 3 is still the key. ⤴️   

"OK Doc, so how do we know for sure whether it's strep??"

We Test.

Most offices have rapid antigen detection tests (RADT)... the dreaded throat swab. They are about 90% accurate, give or take, so there is still a chance of strep even if it's negative.

To be 100% sure, we'll do a second swab (hopefully at the same time as the first!), and send it to the lab for a culture. It takes 2-3 days for the result to come back.

Tick Tock...

Soon we will all have quicker, perfectly accurate (and affordable 🙏) strep testing in our offices, so none of us have to wait so long for the right answer..


Putting it all together:

  • You CANNOT tell it's strep throat by what it looks like.
  • Home care with warm/cold/room temperature tea with honey, lots of rest and tincture of time will take care of most sore throats
  • If there is fever over 100.4, painful swallowing and swollen tonsils, have your child checked. Especially if it's day 3 and getting worse.

Remember we're not your doctors so make sure to get customized medical advice from them if you have concerns.

Be well,

Your ThriveWell Pediatricians
Dr. Miles & Dr. Sant 


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