December 2022

Sore throats are very common at this time of year, and are usually caused by a virus that will get better by itself.

Occasionally, a sore throat with fever may be caused by a type of bacteria called Group A Streptococcus (a.k.a Group A Strep or GAS in short). GAS has been around for years, and many children will have been exposed to it already.

In fact, many of us, including children, carry it around normally without it causing any problems.  However, the very young ones (under 5 years) may not have come into contact with GAS before because they have had less social mixing than usual because of the Covid-19 pandemic. This may be why so many children under 5 years are now contracting the bacteria.

Many get only mild symptoms with it, or may have it without even knowing it and it doesn’t cause any problems. Some children may need simple oral antibiotics for it and a smaller proportion may need hospital treatment.

Luckily, complications from this disease are still very rare but parents and carers are extremely worried because GAS has been in the news because it has been the cause of some children becoming very ill and some sadly dying.

  • Most commonly, children with GAS will have a sore throat and a fever.
  • They will have yellowish-white spots at the back of their throat (their tonsils) and may have red spots at the top of their mouth (their palate).
  • They may complain of pain in their neck, or you may notice that they have tender lumps (lymph nodes) in their neck.
  • They usually don’t have much of a cough or a runny nose.

Some children with GAS develop Scarlet Fever where the children will have the same sore throat and a fever, but also have:

Children with symptoms of GAS or Scarlet Fever will usually need treatment with antibiotics.

A very small number of children will develop complications from this disease. This includes:

  • difficulties breathing
  • dehydration
  • painful limbs and joints
  • very tender skin redness which spreads quickly.

If you notice any of these signs, especially if your child has been diagnosed with GAS, please use our checker to identify where you should take them to be reviewed.

Many of the complications arise because of a recent viral infection which makes the body weaker when fighting this opportunistic bacterial infection. Therefore you can protect your child by making sure they are up to date with all their immunisations and have had their annual flu vaccination if they are over 2 years old.

Keep unwell children off school or nursery and away from vulnerable adults and children. If they have been diagnosed with GAS, they are to remain isolated for at least 24 hours after starting antibiotic treatment.

When should I worry and what should I do?

Click on the options below to see a list of symptoms and what you should do.

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If your child has any one of the following symptoms, they may require emergency treatment. You should call 999 or take them to your nearest A&E where they can be assessed.

  • your child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs/the notch at the bottom of their neck pulling in and out or they are using their neck muscles to breathe
  • there are long pauses (more than 10 seconds) when your child breathes
  • your child’s skin, tongue or lips are blue
  • your child feels very cold or clammy to touch
  • your child is difficult to wake up or keep awake
  • your child has severe pains in their arms, legs neck or back
  • your child has a very painful, red area of skin, especially if it is getting bigger quickly
  • your baby is under 1 month and has a temperature of 38°C

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If there are no red symptoms (see red tab above), they do not need to go to A&E.

However, if your child has any one of the below amber symptoms, you should seek medical advice today.

You can:

The amber symptoms are as follows:

  • the temperature has lasted more than 5 days
  • your child is feeding or eating much less than normal, especially if they are drooling or appear in pain when swallowing
  • your baby has had a dry nappy for 12 hours or more, or is crying without tears
  • or your child shows other signs of dehydration
    • feeling thirsty
    • dark yellow, strong-smelling pee
    • peeing less often than usual
    • feeling dizzy or lightheaded
    • feeling tired
    • a dry mouth, lips and tongue
    • sunken eyes (dark circles under eyes)
  • your baby is between 1-3 months and has a temperature of 38°C, or is older than 3 months and has a temperature of 39°C or higher
  • your baby feels hotter than usual when you touch their back or chest, or feels sweaty
  • your child is much more sleepy than normal or irritable (unable to settle them with cuddles, toys, TV or snacks – especially if they remain sleepy or irritable despite any fever coming down)
  • your child has a rash that feels like sandpaper or very red lips or tongue (which may look like a strawberry)
  • your child has a fever and a sore throat together with red spots on the roof of their mouth or whitish-yellow spots on the back of their throat and sore lumps under their neck

Important: If your child develops any one of the symptoms in the red tab, follow the advice as described in that section.

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If none of the red or amber features are present (see above tabs), your child does not seem to have any symptoms of serious illness or injury.

You can get general advice on the NHS website or from your local Pharmacy.

Most sore throats are viral and only require simple treatment which you can get at home or from a local pharmacist.

  • Treat with paracetamol and ibuprofen if they seem uncomfortable – this lowers the fever and also helps the pain
  • Fever in itself does not need treatment if the child is well (it is simply the body’s way of fighting the bug)
  • Encourage fluids (ice lollies/lolly-ices work a treat)
  • Most children with a simple sore throat do not need antibiotics, even in the current climate and will get better on their own.
  • If the fever continues for 5 days, please take them to see their GP.

Important: If your child develops any of the symptoms in the red or amber tabs, follow the advice as described in those tabs.