Strep Throat 101

Sore throat is probably one of the most annoying upper respiratory symptoms, in my honest opinion. Next to stuffy nose and cough, that is. There are loads of reasons kids get sore throats. The most common concern for my patients and their parents, is strep throat.


Strep throat is the most common cause of BACTERIAL sore throat in kids. The emphasis is added, because it’s not the most common cause of sore throat in kids. That would be viral illness, but we’ll save that differentiation for another blog.


There is definitely a “strep season” in the winter months, but we really see it all year round. It’s most common in school-aged kids. But, it can happen in any kid, even those under two. Especially if there is someone else at home who has strep throat already.


Now, when I say strep throat, I am speaking specifically about group A beta-hemolytic streptococcus. There are other strains of strep, group C or group G, but they don’t cause the long-term side effects like group A does. So, “WE” (the medical community in general) don’t test for it. And yes, I will circle back to this, but first, let’s talk about strep throat symptoms.




It’s usually pretty sudden, and kids complain of sore throat, headache, and belly pain. Some kids will throw up, have fever, stinky “strep breath,” and have a decreased appetite. Other things I notice are “strep lymph nodes,” the ones on the front of the neck, called anterior cervical lymph nodes, broken blood vessels on the soft palate (called palatal petechiae), and a sandpaper rash (called a scarlatiniform rash). And, the symptoms resolve in 3 – 5 days, wait for it, ON. THEIR. OWN. Mind blown.


Ok, so. Here is what I have learned after taking care of many kids with strep throat:


1: This is what the textbook says, and while yes, some kids present like this, it’s an average. In my experience, when a parent says, “Mary always looks like this when she has strep,” it almost always turns out Mary had strep. My rule of thumb is, even if a child doesn’t meet the textbook requirements, I still screen for strep. Especially if the parents are concerned.


2: Kids can have more than one illness at a time. I realize this is not groundbreaking news, but hear me out: guidelines say kids with stuffy nose, cough, and/or diarrhea don’t have strep, and that’s just not my experience. One disclaimer: strep carriers will test positive for strep, and won’t get better on typical strep treatment because they don’t actually have strep throat. Strep throat gets better with Amoxicillin. Always. There is no “resistant” strep and your kid isn’t  “immune” to Amoxicillin because he’s been on it so many times.


3: There are a lot of studies touting “clinical scores” to help predict strep throat infection. I can count on one hand the number of times I have treated kids with “clinical strep throat.” Not because I’m a jerk. It’s because the throat culture frequently comes back negative (meaning the kid didn’t actually have strep throat despite having all of the symptoms) and the risks of early, but unnecessary, antibiotic treatment do not outweigh the benefits of waiting for test results. Antibiotics do not differentiate between good bacteria and bad bacteria, so they have an impact on a child’s microbiome and overall health. AND, when we wait the 2-3 days for a strep culture to return, a child’s immune system actually has an opportunity to mount a response to strep bacteria, create antibodies, and potentially PREVENT future infection.


The bottom line?

I care about your child. I want to do what is best for your family. Let’s work together to figure out what is best, because you know your child better than anyone else, and I know “the research.”




The goals of treating strep throat are getting better faster, preventing both short- and long-term complications, and preventing infection spread.


1: Get better faster: this brings us back to my point earlier. There are several different strains of strep bacteria that can all cause bacterial strep throat. All of these germs die when treated with penicillin (or Amoxicillin when we’re talking about kids). However, strep throat symptoms get better on their own in 3 – 5 days, with or without treatment, and only group A strep causes things like rheumatic heart disease. This is why rapid strep tests only test for group A: because the MAIN goal of treatment is keeping your child’s heart healthy.


2: Complication prevention: strep throat can cause other infections, like ear and sinus infections, and throat abscesses (yuck). It can also mess with your child’s immune system and cause things like rheumatic heart disease, kidney problems, and something called reactive arthritis. This is the big-ticket item; it’s the reason we use antibiotics to treat strep throat. We DO NOT want your child to get rheumatic heart disease. Unfortunately, the kidney problems and achey joints that show up 10 days later aren’t prevented by antibiotics.


3: Preventing spread: after one dose of Amoxicillin, kids are no longer contagious. Conversely, when untreated, about 50% of kids can still have strep bacteria to share with others 3-4 weeks later.


Here are my takeaways:

  • We both have your child’s best interest in mind, so let’s work out a plan that works for your family.
  • Sometimes, it’s a good idea to wait for the culture to come back to verify strep throat. That way your kid can begin fighting the illness on his own, and possibly avoid future infections.
  • Kids are no longer contagious after one dose, and typically feel better after 24 hours on antibiotics.
  • Amoxicillin is the best antibiotic choice for strep throat; it’s effective and more gentle than others on the insides. There is no resistant strep bacteria, and your child doesn’t become immune to Amoxicillin just because she’s taken it a lot.


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