Strep Throat in Kids: Symptoms, Testing, Treatment and When They Can Return to School

Quick answer: strep throat is a bacterial infection of the throat and tonsils caused by group A Streptococcus. It often causes a sudden sore throat, fever, red swollen tonsils with white patches and tender neck glands, usually without a cough or runny nose. Only a rapid strep test or throat culture can confirm it. Antibiotics shorten the illness, reduce spread and prevent rare complications such as rheumatic fever. Most children can return to school after at least 12 hours of antibiotics and once they have had no fever for 24 hours, but follow your doctor’s and school’s guidance.

A sore throat in a child is common, and most are caused by viruses that clear up on their own. Strep throat is different because it needs a doctor’s test and usually antibiotics. Knowing the signs helps you decide when to call, and understanding how it spreads helps you protect the rest of the family. This guide, part of our family safety guide, explains how strep is diagnosed and treated, how to ease your child’s symptoms and when to keep your child home. It is general information and does not replace advice from your child’s doctor.

Sources: Centers for Disease Control and Prevention (CDC) group A strep information for parents and clinicians; American Academy of Pediatrics HealthyChildren.org guidance on strep throat; Mayo Clinic and Nemours KidsHealth patient information. Recommendations about testing, treatment and return to school can vary by situation and region, so follow your pediatrician’s instructions.

What Strep Throat Is

Strep throat is caused by bacteria called group A Streptococcus (group A strep). It spreads through respiratory droplets when an infected person coughs or sneezes, and through contact with saliva or nasal fluid on shared items such as cups and utensils. It is most common in children ages 5 to 15, and it is less common in children under 3. Cases peak from late fall through early spring, when children spend more time indoors and close together at school.

Symptoms of Strep Throat

Common signs in children include:

• Sudden, painful sore throat, often worse when swallowing
• Fever, often 101°F (38.3°C) or higher
• Red, swollen tonsils, sometimes with white patches or streaks of pus
• Tiny red spots on the roof of the mouth (petechiae)
• Swollen, tender lymph nodes in the neck
• Headache
• Stomach pain, nausea or vomiting, especially in younger children
• Body aches and tiredness
• Sometimes a rash (see scarlet fever below)

Signs that point more toward a virus than strep include a runny nose, cough, hoarseness, pink eye and mouth sores. Children with these symptoms usually do not have strep, but only a test can say for sure.

Strep or Viral Sore Throat?

Clue	More likely strep	More likely a virus
Onset	Sudden	Gradual
Cough	Usually absent	Often present
Runny nose	Usually absent	Often present
Fever	Common	Possible
Tonsils	Red with white patches	May be red
Neck glands	Tender	May be mild
Pink eye or hoarseness	Unusual	Common

Because the signs overlap, doctors rely on testing. Do not request antibiotics without a test, since they do not help viral illnesses and can cause side effects.

How Strep Is Diagnosed

A clinician swabs the back of the throat and tonsils. The swab is used for:

• Rapid strep test: results in minutes. A positive result means strep. If the test is negative and your child has symptoms, many doctors send a second swab for a throat culture, because the rapid test can miss some cases in children.
• Throat culture: the swab is grown in a lab for a day or two, and it is more sensitive.

Testing is not recommended for children with symptoms that clearly suggest a virus. Children under 3 are tested only in special circumstances.

Treatment

Strep throat is treated with antibiotics, commonly penicillin or amoxicillin, taken for about 10 days for those regimens. A child with an allergy to penicillin can take another antibiotic. Antibiotics:

• Shorten the illness and help symptoms improve, often within a day or two
• Reduce the time a child is contagious
• Lower the risk of rare complications such as rheumatic fever, which can damage the heart, and abscesses around the tonsils

Give the full course even if your child feels better after a couple of days. Stopping early can allow bacteria to return and raise the risk of complications. If symptoms do not improve after two days of antibiotics, call your doctor.

Home Care and Comfort

While the antibiotic works, you can ease symptoms:

• Fluids: offer water, diluted juice, broth or popsicles. Cold items can soothe the throat.
• Soft foods: yogurt, applesauce, mashed potatoes, oatmeal and scrambled eggs are easier to swallow.
• Pain and fever relief: acetaminophen or ibuprofen as directed by the label or your doctor. Ibuprofen is for children over 6 months. Never give aspirin to a child, because of the risk of Reye syndrome.
• Warm salt water gargles for older children who can gargle without swallowing.
• Rest: sleep helps recovery.
• Humidifier: cool-mist moisture may ease throat irritation.
• Throat lozenges or hard candy for older children only. They are a choking hazard for young kids.
• Avoid irritants such as smoke.

For general fever guidance, see our article on fever in kids and when to call the doctor.

How Long Is Strep Contagious?

Without antibiotics, a child can spread strep for two to three weeks. With antibiotics, most children are no longer contagious after about 12 to 24 hours of treatment, although the CDC advises that children can return when they have been on antibiotics for at least 12 hours and no longer have a fever. Many schools use 24 hours of antibiotics and 24 hours without fever as a guide. Ask your child’s school about its rules. Our guide to when to keep your child home from school covers other illnesses.

Preventing Spread at Home

• Wash hands often with soap and water, especially after coughing or sneezing and before eating.
• Teach children to cough or sneeze into the elbow.
• Do not share cups, plates, utensils or towels.
• Wash dishes in hot, soapy water or the dishwasher.
• Keep the sick child’s items separate when possible.
• Many doctors suggest replacing a toothbrush after the child has been on antibiotics for a day or two, though evidence is limited.
• Wash hands after caring for the child.

Siblings and parents without symptoms generally do not need testing, but people who develop a sore throat should be checked.

Other Causes of a Sore Throat

Most sore throats in children are not strep. Other common causes include:

• Common cold and other respiratory viruses: usually with cough, congestion and a runny nose.
• Flu: high fever, body aches and exhaustion.
• Mononucleosis: seen more in teens, with extreme tiredness and swollen glands.
• Allergies and postnasal drip: an itchy, scratchy throat that is worse in the morning.
• Dry air or irritants: smoke, dry indoor air in winter and shouting.
• Hand, foot and mouth disease: painful sores in the mouth and throat, often with a rash on the hands and feet.
• Croup or epiglottitis: rare but serious, with noisy breathing and drooling. These need emergency care.

If your child’s sore throat is severe or does not match the usual pattern, call your doctor instead of guessing.

Giving Antibiotics to Young Children

Many kids dislike the taste of liquid antibiotics, and the full course can be a challenge. These tips can help:

• Ask the pharmacist about flavoring options.
• Give the dose with the syringe provided, aimed at the inside of the cheek, and not straight at the back of the throat.
• Follow with a favorite drink or a bite of applesauce, unless the label says to take it on an empty stomach.
• Keep the medicine refrigerated if the label says so.
• Use a calendar or phone alarm so doses are not missed.
• Make sure you know whether it is once, twice or three times a day.
• Throw away leftover liquid after the course, since antibiotics should not be saved for later.

Some antibiotics can cause stomach upset or diarrhea. Call your doctor if your child develops a rash, hives, swelling of the face or trouble breathing, since these may be signs of an allergic reaction. Trouble breathing is an emergency.

Strep in Babies and Toddlers

Strep throat is uncommon in children under 3. Younger children who are infected tend to have a runny nose, fever, irritability and poor appetite instead of the classic sore throat. Because rheumatic fever is very rare in this age group and tests can be hard to interpret, doctors usually test only when there is a clear reason, such as exposure to strep in the household. If your baby or toddler is hard to feed, has a fever or seems unusually sleepy, call the doctor, since many illnesses can cause these signs.

Talking to Your Child and the School

A sore throat can make a child grumpy and worried about missing school. Explain that the medicine will help and that staying home keeps friends healthy. Tell the school if the diagnosis is strep, because some schools notify families when there is a cluster of cases. Ask the teacher for makeup work so your child does not feel behind. Keep your child home until the fever is gone and the antibiotic has been working for the time recommended by your doctor or school.

Scarlet Fever

Some children with strep develop scarlet fever, which adds a rash. The rash appears as a red, sandpaper-like feel on the neck, chest and underarms, and may spread. The face can look flushed with a pale ring around the mouth, and the tongue may look red and bumpy, like a strawberry. Scarlet fever is treated with the same antibiotics as strep throat. Call your doctor if you see this rash with a sore throat.

Complications to Know About

Most cases clear up without problems when treated. Rare complications include:

• Rheumatic fever: an inflammatory illness that can follow untreated strep and affect the heart, joints and brain.
• Post-streptococcal glomerulonephritis: kidney inflammation that can cause dark urine and swelling.
• Peritonsillar abscess: a collection of pus near the tonsil that causes severe throat pain, trouble opening the mouth and a muffled voice.
• Ear and sinus infections.

Contact a doctor right away if your child has trouble swallowing saliva, a stiff neck, severe pain on one side of the throat, a swollen joint or dark urine.

When to Call the Doctor

Call your pediatrician if your child has:

• A sore throat with fever and no cough or runny nose
• A sore throat lasting longer than 48 hours
• Contact with someone who has strep
• A rash with sore throat
• Trouble swallowing or refusing fluids
• Signs of dehydration, such as little urine, dry mouth or no tears

When to Seek Emergency Care

Go to the emergency room or call 911 if your child:

• Has trouble breathing or is making high-pitched noises when breathing
• Is drooling and cannot swallow
• Has a very stiff neck or cannot open the mouth
• Is extremely sleepy, hard to wake or confused
• Has signs of severe dehydration

What About Repeated Strep?

Some children seem to get strep many times. Sometimes they are carriers who have strep bacteria in the throat but are not sick, and the illness is a virus. If your child has frequent infections, ask your doctor about testing and about whether a tonsil specialist visit makes sense. Do not ask for repeated antibiotics without confirmation.

After Your Child Recovers

• Make sure the full antibiotic course is finished.
• Wash bedding and towels.
• Ask your doctor if any follow-up is needed.
• Make sure vaccinations are up to date, including flu vaccines, since flu can raise risk of throat infections. See our guide to flu season and kids’ vaccines for more.

Frequently Asked Questions

How do I know if my child has strep throat?

Only a rapid strep test or throat culture can confirm it. Sudden sore throat, fever, red tonsils with white patches and no cough suggest strep.

Is strep throat contagious?

Yes. It spreads by droplets and shared items. With antibiotics, most children are not contagious after at least 12 hours of treatment and when the fever is gone.

Can strep throat go away without antibiotics?

It may improve, but antibiotics are recommended to reduce complications and spread. Always follow your doctor’s advice.

When can my child go back to school after strep?

Usually after at least 12 hours of antibiotics and no fever, though many schools require 24 hours. Check your school’s policy.

Can adults get strep from children?

Yes. Adults can catch strep, so wash hands, avoid sharing items and see a doctor if you have symptoms.