Strep Throat In Kids: What Parents Need To Know


      Strep has become something most of us deal with at some point in our lives. As parents of infants, its hard to know when your baby has strep, or more so “how dangerous is it for a baby to have strep?” Thankfully, we have the help of Dr. S. Terez Malka who is a physician at Duration Health and is double Board-Certified in Pediatrics and Emergency Medicine to give us some insight.

How is strep throat different from group B strep

They’re two different bacteria! Group A strep is a bacteria that causes strep throat. Group B strep is a different type of strep bacteria.  Group B strep lives harmlessly in the vagina of about 1 in 4 women and generally does not cause any problems for them.  However, if group B strep is present at the time of a vaginal birth, the mother should be treated with antibiotics during labor to prevent the baby from getting a bloodstream infection during the birth process.  If a baby gets a group B strep infection, it does not cause a sore throat or strep throat- it causes a bloodstream infection which leads to fever or a low body temperature, low blood sugar, or lethargy.    

Do babies get strep throat? 

It is extremely rare for babies or toddlers to get strep throat. Most babies still have immunity from their mothers that protects them from a strep throat infection and they have very small tonsils that are not likely to get infected.  Strep bacteria can cause some other illnesses for babies and toddlers such skin infections and scarlet fever, but strep throat is so rare under age 3 that the American Academy of Pediatrics and the CDC recommend that children under 3 not be tested for strep throat. Most throat infections in babies and toddlers are caused by viruses.      

At what age does strep become more common in kids? 

Strep is most common between ages 5 and 15.  Younger and older children who are in contact with children in that age range may have a higher risk of strep and other common illness if they are exposed by a sibling.  Strep throat almost never affects infants or toddlers under 3 years old.    

What causes strep throat in kids? 

Strep throat is a bacterial throat infection caused by a bacteria called Group A streptococcus.  In some children, this bacteria does not cause any symptoms.  But in some, it can multiply in the tonsils and cause the classic symptoms of strep throat.  Children can pass it to one another by direct contact or by respiratory droplets that are spread by coughing or sneezing.      

Why do babies only get strep rarely? 

Strep bacteria can cause some infections in babies, like skin infections, but do not cause strep throat in children under 3 for several reasons. First, babies and toddlers have smaller, undeveloped tonsils, and the strep bacteria does not multiply in them.  Also, babies and toddlers may have some immunity to strep bacteria from their mother that can last for many months.  

Can babies get strep throat from parents?

Children under 3 do not get strep throat because they have small, less developed tonsils, and have antibodies to strep from their mother.  A baby exposed to a parent or sibling with strep throat is at risk for other infections, like skin infections or scarlet fever, but is not at risk for strep throat.  Strep throat is so rare in children under 3 that they should not be tested for strep when they have a sore throat. Sore throats in babies and toddlers are almost always caused by viruses.

What are the symptoms of strep in kids? Do these vary based on age (i.e. babies, toddlers and kids)?

  Group A strep can cause several different types of infection.  Children ages 5 and older get classic strep throat- whose symptoms include: fever > 100.4, swollen, painful lymph nodes in the neck, and a sore throat with enlarged, red tonsils and pus on the tonsils.  If a child has a cough, congestion, hoarseness, or sores on their tonsils, these are typically caused by a virus, and are signs that the infection is not strep throat. In toddlers, group A strep usually causes different infections, but not strep throat.  These include skin infections such as cellulitis or impetigo, with symptoms of fever, warm, red, painful areas of skin, or sometimes red sores with a honey-colored crust. Scarlet fever is a common infection in toddlers caused by group A strep bacteria – the symptoms include a rough, sandpapery, skin-colored or pink rash to the torso and sometimes face, a high fever, and a red appearing tongue. It can cause a sore throat, congestion, and cough as well. In babies, strep throat does not occur, but Group A strep can cause skin infections such as cellulitis or impetigo, or sepsis- a bacterial infection in the blood.  Any infant under 3 months old with a fever should be seen by a doctor, who will test their blood for bacteria.  Skin infections caused by strep can cause red, warm, swollen, painful areas of skin, or a red sore-like rash with a honey-colored crust and sometimes a fever.  

When should parents see a doctor for Strep? 

  While strep throat gets better on its own in most cases, treating it with antibiotics can help it to get better a few days faster and prevents a serious complication called rheumatic fever, which can lead to lifelong heart problems.  If your child is over 3 years old and has a sore throat along with fever, pus on the tonsils, or swollen lymph nodes, they should see a doctor and be tested for strep. Children under three with a fever that lasts longer than 3-4 days, or symptoms of scarlet fever such as high fever with a sandpapery rash to their torso, reddened, bumpy tongue, and sore throat, should see their doctor.  While strep throat usually goes away on its own, and antibiotics are used to prevent complications, scarlet fever needs to be treated with an antibiotic. Infants under 3 months old with any fever over 100.4 need to be seen by a doctor right away.  

What is a strep rash in babies? Why does it happen? 

There are several different types of rashes that can be caused by group A strep bacteria.  Toddlers and younger children (<5-6) can get a disease called scarlet fever- this causes a very fine, rough, sandpapery rash to the torso and sometimes face, a high fever, reddened or bumpy tongue, and sometimes sore throat and cough. Strep bacteria can also cause cellulitis- an area of warm, red, painful, swollen skin, sometimes with a fever, or impetigo- a rash that consists of red sores with a honey-colored crust, with or without a fever. In very rare cases, strep can cause a serious skin infection called scalded skin syndrome. This causes a fever and large areas of blistery, peeling skin, and is a medical emergency.

 How is strep throat in babies diagnosed? 

Babies do not get strep throat infections because their tonsils are not developed enough to be infected.  For that reason, babies and children under three years old should not be tested for strep throat.  Sore throats in babies and toddlers are generally caused by viral infections. Strep bacteria can cause other types of infections in babies, such as cellulitis, impetigo, or scarlet fever, and your doctor can recognize these by their classic symptoms and does not usually need to do any test to diagnose them. If your baby has a rash that is concerning for strep that has some pus, your doctor can test the pus or open sores for strep bacteria.  Babies under 3 months old with a fever, and very ill infants and toddlers admitted to the hospital with a fever will often have their blood tested for bacteria, including strep bacteria.  

Do doctors give strep tests to babies and toddlers? Why or why not? 

  A well-trained doctor with proper pediatric education should not be performing strep tests on any children under age 3, except in very rare cases.  Some providers without pediatric training will give strep tests to babies, but this is not a good idea.  Strep bacteria do not cause strep throat in children under age 3.  They cause different types of infections that a doctor can recognize by the symptoms.  Most throat infections in babies and toddlers are caused by viruses, not strep bacteria, and testing these babies and toddlers is uncomfortable, and can lead to false positive tests and unneeded antibiotics, which can cause serious side effects.  

How is strep throat treated in babies? Toddlers? Kids? 

Babies and toddlers do not get strep throat. If they have a different illness caused by strep bacteria, these can usually easily be treated with antibiotics.  Some minor strep skin infections respond very well to a prescription antibiotic ointment, while other strep infections, such as cellulitis or scarlet fever, will need an oral antibiotic. In rare cases, more severe strep infections will need an IV antibiotic. In children over age three with a positive strep test and symptoms of strep throat, there are several effective antibiotics including penicillin, amoxicillin, and cephalosporin antibiotics like cephalexin (Keflex).  In most cases, your child will need 10 days of antibiotics to prevent complications, though their symptoms will usually get better faster than that.  If your child is allergic to first-line antibiotics, your doctor may prescribe a different family of antibiotics, like azithromycin or clindamycin. Strep throat infections will usually get better on their own without treatment, but an antibiotic can help symptoms to go away a day or two faster and prevent serious complications. Your doctor should never prescribe an antibiotic for strep throat without doing a strep test first and getting a positive result.  Over 60-75% of sore throats in children are caused by viruses and do not need an antibiotic.  

How can parents prevent strep and keep their little ones healthy? 

Strep is passed from child to child by respiratory droplets.  Teaching your children not to share food and drinks, to avoid touching their face or putting objects in their mouth, and to wash or sanitize their hands regularly can help them to avoid being exposed to these infectious droplets.  You can help your child prevent spreading strep throat by teaching them to cover their coughs and sneezes and wash or sanitize their hands regularly.  Any child with a fever or symptoms concerning for strep throat should stay out of school until their fever has resolved and if they are strep positive, until they have been on antibiotics for 24 hours.   5-15% of children carry strep bacteria in their throats. This means that they test positive for strep but are not infected.  Therefore, it is very important that they only get a strep test when they have classic symptoms of strep throat and are in the correct age range for strep throat (> age 3). If they have a lot of cough, hoarseness, or sores on their throat, or are under age 3, their sore throat is far more likely to be a viral illness, and they should not be tested for strep in that case.  That could lead to a false-positive diagnosis and unneeded antibiotics. Another thing to know is that the rapid strep test only catches about 3 out of four cases of strep throat.   Your doctor should always send a throat culture if the rapid strep test is negative to see if any strep bacteria grow in the lab.  Your child should never receive antibiotic treatment for strep throat unless they have a positive rapid test or throat culture.  There is no harm to waiting a few days for the throat culture result before starting treatment. Treating sore throats with antibiotics when they are not caused by strep will not help your child feel better any faster and can cause antibiotic resistance and other complications.
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