Strep throat in kids: signs, swab tests, antibiotics and going back to school

Most sore throats are caused by viruses and clear up on their own within a few days, HealthHub says. Strep throat in kids is a bacterial infection, and a doctor confirms it with a throat swab. The pattern that points to strep is a sore throat that comes on suddenly, with fever and tender neck glands but no cough or runny nose. If the swab is positive, your child needs antibiotics, and at least 24 hours of them before going back to school.

What to do when your child has a sore throat, step by step

1. Check your child against the strep pattern SingHealth lists: a sudden sore throat that hurts to swallow, tender glands in the neck, a high fever and no runny or blocked nose.
2. Look for signs of a cold as well, because CDC says a cough, runny nose, hoarse voice or pink eye point to a virus.
3. Book a GP or polyclinic visit if the strep pattern fits. The doctor swabs the back of the throat, and SingHealth says a rapid test gives a result within minutes.
4. Offer cool drinks and soft food while you wait, and ask your pharmacist about paracetamol or ibuprofen at the dose on the label.
5. Avoid giving aspirin, which SingHealth says children should not have because of the risk of Reye's syndrome.
6. Give every dose of any antibiotic the doctor prescribes. HealthHub says to finish the full course even when your child feels better, or the infection can come back.
7. Keep your child home for at least the first 24 hours of antibiotics, the minimum HealthHub gives after a positive strep test.
8. Tell the preschool or school, then write the antibiotic times down for grandparents or your helper so nobody misses a dose.
9. Keep cups, spoons and food separate at home. CDC says strep often spreads within a household, and people fall ill 2 to 5 days after exposure.
10. Go back to the doctor if your child gets worse. SingHealth says to return when symptoms last more than a few days or make it hard to eat, drink or breathe.

Viral sore throat or strep throat?

Most of the time it's a virus. HealthHub says strep is the most common bacterial cause of a sore throat, and that children are more likely to have it. CDC puts strep at around 3 in 10 children with a sore throat, most often between 5 and 15 years old. It's rare under 3.

The table draws on CDC, SingHealth, HealthHub and the NHS. Use it to decide whether to see a doctor, since only a doctor can diagnose strep. SingHealth says viral and bacterial infections can cause similar symptoms, which is why the throat swab matters.

Strep in children under 3

CDC says strep throat is rare under 3, so a toddler's sore throat is usually viral. Young children can't always tell you their throat hurts, though. SingHealth says refusing to eat or drink can be the first sign of tonsillitis at this age. HealthHub notes that children may complain of tummy pain. CDC lists headache, vomiting and stomach pain among the less common strep symptoms, especially in children.

For a baby with a fever, go by age first. A KKH infectious disease doctor, writing on HealthXchange, lists being under 3 months old as a reason to get care straight away. Our guide to baby fever and when to worry and the fever checker take you through the rest.

Scarlet fever: strep throat with a rash

Scarlet fever is caused by the same group A strep bacteria. The KKH doctor on HealthXchange describes fever, a strawberry tongue and a rash that feels like sandpaper. According to the NHS, the rash appears 12 to 48 hours after the first signs. It starts on the chest and tummy, then spreads.

On brown skin the colour change can be hard to see, but the NHS says you can still feel the rough, raised bumps. A white coating forms on the tongue and peels off, and the tongue underneath is red and bumpy. As the rash fades, the skin may peel like sunburn.

A GP treats scarlet fever with antibiotics, the same as strep throat. NHS advice is to stay off nursery or school for 24 hours after the first dose; in Singapore, your doctor's MC sets the date. Other illnesses can also cause a fever with a rash, so let the doctor see it. Our guides to baby rashes and Kawasaki disease symptoms cover some of them.

Soothing a sore throat at home

Antibiotics clear the bacteria. The comfort care below helps whether it's strep or a virus:

• Cool drinks and soft food, which the NHS suggests for scarlet fever.
• Warm soup or broth if your child prefers something warm, as SingHealth suggests.
• Small drinks offered often, since SingHealth says plenty of fluids helps prevent dehydration.
• Ice lollies for children old enough to manage them. The NHS warns against giving young children anything small and hard to suck, because of the choking risk.
• Skip the salt-water gargle, which the NHS says children should not try.
• Rest and a break from talking, both on HealthHub's list. Keep your child away from second-hand smoke too.
• A humidifier if the room air feels dry, since HealthHub lists dry indoor air as a cause of sore throats.
• Pain relief from the pharmacist, at the dose on the label. Our guide on how to give medicine to a baby covers syringes and measuring.

Keep a thermometer and children's pain relief at home so you're ready next time. Our baby medicine and first aid kit checklist lists what to stock.

Why finishing the antibiotics matters

Strep can get better without treatment. Even so, SingHealth says antibiotics are often prescribed to lower the risk of complications and shorten the illness, and CDC says they help children feel better faster.

Those complications are rare. SingHealth says untreated strep can lead to rheumatic fever or post-streptococcal glomerulonephritis, a kidney problem, and that these can affect the heart, joints, skin or kidneys. The infection can also spread beside the tonsil and form a pocket of pus called an abscess. SingHealth lists trouble swallowing, drooling, a stiff neck and difficulty breathing as signs of one.

Your child may feel better before the bottle is empty. HealthHub says to finish the full course anyway, because stopping early can let the infection come back, and SingHealth adds that it helps prevent antibiotic resistance. If you miss a dose, ask the pharmacist what to do. And if your child falls ill again weeks after scarlet fever, tell the doctor. The NHS lists that as a possible sign of a complication such as rheumatic fever.

Going back to preschool or school

HealthHub's tonsillitis page, written by NUH, says a child who tests positive for strep throat needs at least 24 hours of antibiotics before going back to school. Your doctor's MC sets the actual date. SingHealth also asks parents to keep sick children at home so the germs don't spread to others.

Let the centre or school know when the swab comes back positive. For the bigger picture on bugs in group care, read why your child keeps getting sick at childcare. A sore throat with mouth ulcers and spots on the hands or feet may be HFMD instead, and our HFMD guide has its own return rules.

When to see a doctor

Most sore throats can wait for a GP or polyclinic. HealthHub says to see a doctor if a sore throat isn't better in 1 week or gets worse, or if it comes with earache, a rash or a fever above 38 degrees C. Get help straight away if you see any of these:

• Drooling, or your child can't swallow. SingHealth lists excessive drooling in children as a reason to seek care immediately.
• Trouble breathing, or a high-pitched sound when breathing in, which the NHS calls stridor and treats as an emergency.
• Difficulty opening the mouth, which SingHealth also says needs care immediately.
• A stiff or swollen neck, listed by both SingHealth and HealthHub.
• Signs of dehydration, such as peeing less than usual or extreme tiredness (SingHealth).
• Poor feeding, lethargy, a change in alertness or shortness of breath, which the KKH doctor on HealthXchange calls reasons to go at once.
• Any fever in a baby under 3 months, from the same KKH list.
• Joint pain or swelling alongside a sore throat (HealthHub).

For these red flags, go to KKH Children's Emergency or NUH Children's Emergency. Call 995 if your child is struggling to breathe, has a seizure or can't be woken; SCDF lists breathlessness, seizures and loss of consciousness as emergencies. For everything else, our paediatrician map finds a clinic near you.

Frequently asked questions

Is strep throat contagious?

Yes. CDC says strep often spreads within a household, and people usually fall ill 2 to 5 days after exposure. HealthHub says your child needs at least 24 hours of antibiotics before going back to school. Until then, keep cups and cutlery separate and wash hands often with soap and water.

Can toddlers get strep throat?

They can, but CDC says it's rare under 3, and most sore throats in toddlers are viral. If your toddler won't eat or drink, has a high fever or seems unwell, see a doctor and let them decide whether to test.

Will strep throat go away without antibiotics?

Sometimes it does. SingHealth says bacterial throat infections may improve without treatment, but antibiotics are often prescribed to lower the risk of complications and shorten the illness. Your doctor decides whether your child needs them.

How accurate is a rapid strep test?

It's quick, but it can miss cases. SingHealth says a rapid antigen test gives results within minutes, and a negative result is sometimes checked with a throat culture, which takes 24 to 48 hours. Your doctor will tell you if a swab is going to the lab.

Why does my child keep getting strep throat?

SingHealth says throat infections pass easily between children in childcare centres and schools. It also says repeat infections, or a past abscess, can need a specialist's review. HealthHub's NUH page says a doctor may suggest taking a child's tonsils out after more than six serious throat infections in one year.