Sore Throat in Children: Causes, Symptoms, and Treatment

Viral sore throats in children aged 3-7 are quite common, as children in this age group are at higher risk of developing this condition. School-aged and preschool children spend much time in enclosed spaces and are in constant contact with other children, who may be carriers of infections. The symptoms of a sore throat vary depending on the type of pathogen.

Causes of Sore Throats

True sore throats are caused by bacteria, while viral sore throats are due to various viruses. Infection occurs when the pathogen comes into contact with the throat and begins to multiply. The primary transmission method for viruses is airborne; viruses are spread via nasal mucus or saliva from an infected person when they talk, sneeze, or cough.

Transmission through direct contact, sharing hygiene items, toys, or dishes, as well as through food, is also common. The peak incidence occurs in winter and spring. Viruses can easily enter a weakened immune system, causing pronounced symptoms of intoxication. Children with weakened immune systems, recurring ENT issues, and poor nutrition are particularly at risk. Low immunity, prolonged contact with infected peers, and stress can increase the likelihood of developing a sore throat. Additionally, gastrointestinal issues have been shown to make viral sore throats more common as respiratory and gastrointestinal symptoms often occur together.

Ways Sore Throats Spread Among Children

While sore throats themselves aren’t contagious, the viral and bacterial infections that cause them can be highly infectious. These infections spread through coughing, sneezing, or conversation. Outbreaks of bacterial and viral infections often occur in schools and daycare centers, where children are frequently in close contact. Contact with contaminated surfaces (such as touching a door handle and then one’s face) can also spread infection. Both viral and bacterial sore throats are contagious a few days before symptoms appear.

The virus reaches the mucous membranes of the mouth or nose, mainly through the air, although contact transmission is also possible. If the immune system effectively fights off the infection, the pathogens are suppressed; if not, they settle on the tonsils, causing acute sore throat symptoms. Incubation typically lasts 10-20 days, depending on the pathogen and the individual’s health. Complications may arise if the immune system is weak, allowing the pathogens to spread to bones, joints, and internal organs.

Symptoms of Sore Throat

Sore throats in children are often more severe than in adults, with high fevers, pronounced symptoms of intoxication, and frequent complications. One type can turn into another or may progress slowly.

• Catarrhal Sore Throat: This type starts with dryness, burning, and pain in the throat, which worsens with swallowing. Fever may rise to 30°C (86°F), the child may become lethargic, and complain of malaise and headaches. The tongue usually appears dry with a whitish coating. Lymph nodes may be slightly enlarged and tender. This acute phase typically lasts 5 to 7 days.
• Follicular Sore Throat: Clear signs of intoxication appear, including apathy, weakness, lack of appetite, migraines, and joint pain. Fever with chills, vomiting, confusion, and sometimes seizures may develop. Severe throat pain often radiates to the ear. Symptoms usually intensify over two days, with improvement by the third day as the tonsil surface begins to clear, although swallowing pain may persist for 2-3 days. Full recovery takes about a week and a half.
• Lacunar Sore Throat: This type involves severe intoxication, with inflamed and swollen tonsils and soft palate, which can make it difficult for the child to open their mouth, speak clearly, or eat. The voice may sound nasal, and the child often complains of a bad taste, throat pain, and tender, swollen lymph nodes. Full recovery can take 10-14 days. Often, viral sore throats are accompanied by respiratory symptoms, diarrhea, conjunctivitis, and stomatitis.

Classifications

Sore throats can be classified based on the pathogens responsible for the infection.

• Herpetic Sore Throat: Caused by Coxsackie viruses, echoviruses, herpes simplex, and other pathogens, this type has an incubation period of about 10 days. Symptoms include high fever, fatigue, loss of appetite, and on the second day, red vesicles on the throat’s lining. The vesicles change color over time and eventually burst, leaving erosive areas. Recovery usually occurs within 1-2 weeks, but immunity plays a role, as those with weaker immune defenses may experience longer, wave-like symptom patterns.
• Adenoviral Sore Throat: Transmitted at room temperature, adenoviruses can survive for up to two weeks after recovery. Children with weakened immune systems, or those exposed to crowded environments, are particularly at risk. Symptoms include a slight fever, fatigue, headaches, sore throat, nasal congestion, dry cough, and swollen lymph nodes.
• Influenza Sore Throat: Caused by different flu strains, this type occurs mostly in autumn and winter. Symptoms include a high fever, body aches, dry cough, nasal congestion, and an intensely red throat.

Viral vs. Bacterial Sore Throat: What’s the Difference?

Viral sore throats are seasonal, often occurring during flu outbreaks, and tend to affect the entire throat surface rather than just the tonsils. Children may experience headaches, fatigue, irritability, poor sleep, and loss of appetite. A virus often causes mucus buildup, leading to a runny nose and cough.

Bacterial sore throats, however, do not usually cause coughing or nasal symptoms. Instead, children experience localized throat pain and fever, with inflammation confined to the tonsils, which may have a white or yellow coating. Respiratory symptoms may develop on the third or fourth day.

Diagnosis of Sore Throat

Parents may be tempted to give antibiotics when their child has a fever and severe throat pain, but it’s crucial to consult a doctor for a proper diagnosis. Treatment differs for bacterial and viral sore throats, and antibiotics are ineffective against viruses.

Diagnostic Methods:

• Pharyngoscopy: Examines the throat for redness, swelling, inflammation, and any lesions or specific coatings.
• Blood Tests: Shows elevated white blood cells.
• Biochemical Testing: Helps identify the specific pathogen and prevent complications.
• ELISA: Examines epithelial cells for viral antigens.
• PCR: Identifies viral DNA from a throat or blood sample.

Specialist referrals may be required if complications arise, especially for young children and those with low immunity.

Treating Sore Throats in Children

Specific treatments for viral sore throats focus on reducing symptoms and boosting immune defenses. Antiviral and immunomodulating drugs may be recommended. For example, influenza sore throats can be treated early on with Interferon nose drops and supportive vitamins.

Creating a comfortable environment is essential for recovery:

• Bed rest
• Isolation (especially in cases of herpetic sore throat)
• Optimal air humidity and temperature
• Soft, lukewarm foods
• Plenty of fluids (such as tea with honey or lemon, warm milk, and fruit drinks).

Pain relievers like ibuprofen or acetaminophen may be given to manage fever and discomfort, depending on the child’s age and the doctor's recommendations.

Potential Complications

Secondary infections are the most common complication, especially when immunity is low. Rheumatism, kidney infections, and neuro-infections can also occur. To prevent serious complications, it’s essential to follow medical advice and focus on strengthening the immune system.

Prognosis and Prevention

With timely, accurate diagnosis and treatment, recovery typically occurs within 7-10 days. During the recovery period, balanced nutrition, vitamins, and maintaining overall resistance are key to preventing recurrence.