Pharyngitis in children

Overview

Pharyngitis is a sore throat caused by inflammation of the pharynx, the tube at the back of the mouth and nose. It is often called a sore throat and usually gets better on its own.

Yes, pharyngitis is one of the most common reasons children visit a doctor, especially during the winter months.

Pharyngitis can affect anyone, but children between 5 and 15 years old are most likely to get strep throat. Younger children and teens also get viral sore throats often.

Symptoms

Common symptoms

• Sore throat
• Pain when swallowing
• Red, swollen tonsils
• White patches or pus on the tonsils (more common with bacteria)
• Swollen lymph nodes in the neck
• Fever
• Headache

Symptoms in children

• Fussiness or irritability
• Refusing to eat or drink
• Drooling (especially in very young children)
• Upset stomach or vomiting (more common with strep)
• High fever (over 38°C/100.4°F) in bacterial cases

Symptoms in older adults

• Pharyngitis is less common in older adults, but when it occurs the symptoms are similar: sore throat, pain swallowing, and hoarseness.
• Older adults may have a higher risk of complications like dehydration from difficulty swallowing.

Causes

Main causes

• Viruses: most cases are caused by common cold viruses, influenza, Epstein-Barr virus (glandular fever), and others.
• Bacteria: group A Streptococcus (strep throat) is the most common bacterial cause, but other bacteria can also cause pharyngitis.
• Less common causes: allergies, dry air, smoking, or acid reflux.

Risk factors

• Close contact with someone who has a sore throat or cold
• Age: children 5–15 years are at higher risk for strep throat
• Season: pharyngitis is more common in late winter and early spring
• Crowded settings like schools and daycare centers

When to see a doctor

See a doctor urgently if:

• If your child has trouble breathing, drooling, or cannot swallow their own saliva (go to emergency department immediately)
• If your child has a fever over 38.5°C (101.3°F) and seems very ill, is not responding, or has a stiff neck

Book a routine appointment if:

• Your child has a sore throat that lasts more than 5–7 days without improving
• You notice white patches on the tonsils or a sandpaper-like red rash
• Your child has a fever for more than 3 days
• Your child has recurrent sore throats (several times in a year)

Diagnosis

A doctor will examine your child's throat, feel their neck for swollen glands, and listen to their breathing. They may also ask about symptoms and whether anyone else in the family is sick.

Tests that may be done

• Rapid strep test: a swab of the throat gives results in minutes. It checks for group A Streptococcus.
• Throat culture: a swab sent to a lab to confirm bacteria. Results take 1–2 days.
• Blood tests: rarely needed, but may be done if glandular fever is suspected.

What to expect at your appointment

The doctor will gently touch the back of your child's throat with a cotton swab. This can cause a brief gagging sensation but is not painful. The whole visit usually takes 10–15 minutes.

Treatment

Treatment depends on the cause. Viral pharyngitis gets better with home care. Bacterial pharyngitis (strep) requires antibiotics to prevent complications and to shorten the illness.

Self-care at home

• Give your child plenty of fluids (water, warm tea with honey for children over 1 year old, or ice pops) to prevent dehydration.
• Offer soft, soothing foods like soup, yogurt, or applesauce.
• Use a cool-mist humidifier in the room to ease dry throat.
• Encourage rest and sleep to help the immune system fight the infection.
• For children over 1 year old, a teaspoon of honey can help soothe the throat (never give honey to babies under 1 year due to risk of infant botulism).

Medical treatments

Doctors may recommend over-the-counter pain relievers such as paracetamol or ibuprofen (given in age-appropriate doses) to reduce fever and pain. For bacterial pharyngitis, a course of antibiotics (usually penicillin or amoxicillin) is prescribed. Always finish the full course even if symptoms improve. Never give aspirin to children under 16 because of the risk of Reye's syndrome.

When is surgery considered?

Surgery to remove the tonsils (tonsillectomy) is rarely needed. It may be considered if a child has very frequent severe sore throats (usually 7 or more in a year, or 5 per year for 2 years) or complications like a peritonsillar abscess that does not drain. This decision is made by an ear, nose, and throat (ENT) specialist.

Living with this condition

Most children can return to school or daycare after the fever is gone and they feel well enough to swallow and eat normally. For strep throat, they are usually no longer contagious after 24 hours on antibiotics.

Lifestyle tips

• Teach your child to wash hands often, especially before eating and after coughing or sneezing.
• Avoid sharing cups, utensils, or toothbrushes.
• Encourage your child to cough or sneeze into their elbow to prevent spreading germs.

Diet and exercise

Make sure your child drinks enough fluids. Soft foods are easier to swallow. Avoid spicy, acidic, or rough foods (like chips) that could irritate the throat. Gentle play and activity are fine once your child feels better, but avoid strenuous exercise until fully recovered.

Mental health and emotional wellbeing

A sore throat can make children feel irritable and uncomfortable. They may be frustrated if they can’t eat normally. Reassure them with extra cuddles and quiet activities like reading or puzzles.

Prevention

Not always, but you can reduce the risk. Good hand hygiene, avoiding close contact with sick people, and not sharing personal items help prevent the spread of viruses and bacteria that cause pharyngitis.

Vaccines

There is no vaccine for pharyngitis specifically, but the flu vaccine can help prevent one common viral cause. Ensure your child’s routine vaccines are up to date.

Screening programmes

There is no routine screening for pharyngitis in healthy children. Testing is only done when symptoms suggest a bacterial infection.

Complications

If left untreated

• If bacterial strep throat is not treated, rare but serious complications can occur, such as rheumatic fever (which can affect the heart) or glomerulonephritis (a kidney disease).
• Peritonsillar abscess (a collection of pus behind the tonsils) can cause severe pain, difficulty opening the mouth, and trouble breathing.
• Ear infections and sinusitis can also develop.

Long-term outlook

The outlook for children with pharyngitis is excellent. Most recover fully within a week with rest and fluids. Even strep throat, when treated with antibiotics, resolves without lasting problems. Complications are very rare, especially with proper medical care.

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