Sore throats are common, especially in children between the ages of 5 and 10. For most children, removing the tonsils would not prevent future sore throats. Therefore, tonsillectomy surgery is performed less commonly than in the past.

Sore throats are most often caused by an infection. The vast majority are caused by viruses and will NOT respond to antibiotics.

Strep throat is the most common bacterial cause of sore throat. Because strep throat can occasionally lead to rheumatic fever, antibiotics are given. Strep throat often includes a fever (greater than 101 degrees Fahrenheit), white draining patches on the throat, and swollen or tender lymph glands in the neck, along with headache and stomach pain in children.

A sore throat is less likely to be strep throat if it is a minor part of a typical cold (with runny nose, stuffy ears, cough, and similar symptoms). Since it is clinically difficult to distinguish strep throat from viral sore throat, laboratory tests are often used.

• breathing through the mouth (can cause drying and irritation of the throat)
• common cold
• viral pharyngitis
• influenza
• strep throat (caused by the streptococcal bacteria)
• infectious mononucleosis
• fish, chicken bone, or other foreign substance stuck in the throat. (For emergency actions, see CPR)
• endotracheal intubation (tube insertion)
• local surgery such as tonsillectomy and adenoidectomy

Time is the most important healer for sore throat pain. If the sore throat is caused by a virus, it will clear up on its own.

Cold liquids and over-the-counter pain medications are effective in treating the pain. Aspirin should be avoided in children under 15 years old (because of the risk of Reye's syndrome).

Home remedies such as gargling salt water or drinking honey or lemon tea may help. Analgesic sprays and lozenges may help -- however, they may make the pain of strep throat worse instead of better.

• there is severe difficulty in swallowing, difficulty in breathing, or excessive drooling in a young child.
• there is a temperature of 101 degrees Fahrenheit or greater.
• there are tender or swollen lymph glands in the neck.
• there is pus in the back of the throat.
• there is a fever, a red rash that feels rough, and increased redness in the skin folds.

• time
  • How long has the sore throat been present?
  • Have other family members had recent sore throats?
• quality
  • Is the pain increasing, staying the same, or decreasing?
  • Are you able to swallow saliva, fluids, and food?
  • Is there excessive drooling (infants)?
  • Is the person able to talk?
  • Is the person hoarse?
  • Is the person able to sleep?
• aggravating factors
  • Worse at night?
  • Breathing through mouth?
• relieving factors
  • Is the soreness better in the morning?
  • Is the soreness better with moist air or mist?
  • Is the soreness better with medications?
• other
  • What other symptoms are also present?
    • noisy breathing
    • fever
    • wheezing
    • recent choking
    • allergies
    • rash
  • Has there been a recent injury?
  • Has there been a recent surgery?
  • Are there swollen lymph glands in the neck?
  • Are there sores or pus in back of throat?
  • Is there a sensation of gagging?
  • What medications are being taken?
  • What is the typical daily diet?

• complete blood count
• monospot test (to rule out mononucleosis)
• throat culture and rapid strep test

Treatment
Usually, treatment will be delayed until the culture results are known. Doctors will often begin treatment of a sore throat immediately if there is a family history of rheumatic fever, if the patient has scarlet fever, or if rheumatic fever is commonly occurring in the community at the time. Otherwise, antibiotics should NOT be given without a positive strep test (culture or rapid strep test).

When antibiotics are started, it is important to complete the entire course as directed, even after symptoms improve. Children can return to school or day care 24 hours after antibiotics are started.

For sore throat caused by infectious mononucleosis, rest and home treatment is recommended.

For sore throat caused by bacterial tonsillitis, antibiotic treatment may be recommended. Some tonsillitis is viral and will clear up without treatment. (Surgery is rarely necessary.)