A sore throat is just that. Some toddlers will identify it clearly, with a perfunctory “My throat hurts.” Others will complain of mouth pain, itching in the neck, or a spicy taste. Most will be fussy.
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Some sore throats are so mild that they cause little pain and eating and drinking are not affected. But other sore throats are severe, limiting the amount a toddler can eat or drink.
The most common cause of a sore throat in a toddler is infection. The infection may be caused by either a bacteria or a virus. Among bacteria, Group A beta-hetnolytic streptococcus (GABHS, more commonly known as strep throat) is the number one culprit.
GABHS is one particular type of streptococcal infection. Other types of strep can also be found in the mouth and throat, but they generally don’t cause illness.
Strep throat can cause any or all of the following: sore throat, swollen glands in the neck, fever, abdominal pain, nausea, vomiting, headache, and rash. The rash has a distinct appearance and texture, looking and feeling like fine red sandpaper. When a child has strep throat with the accompanying rash, the illness is called scarlet fever.
Many parents assume that a sore throat automatically means a strep infection. This is far from the truth. In fact, only 20 percent of sore throats are caused by GABHS. In other words, antibiotics are appropriate in only one out of every five cases of sore throat.
Viruses are much more likely to cause sore throat than are bacteria. Seasonal viruses that may result in a sore throat also tend to be associated with upper respiratory symptoms, such as runny nose, congestion, and cough. These viruses include the Cox-sackie virus.
One form of Coxsackie causes the painful hand-foot-mouth disease, which has as its hallmark blistering of the hands, feet, and back of the throat. Another form of Coxsackie causes herpangina, with blisters and ulcers in the front half of the mouth. Fever is not uncommon in children with Coxsackie.
Epstein-Barr virus (also known as mononucleosis or mono) and cytomegalovirus (CMV) also cause a sore throat, along with swollen lymph nodes in the neck, fatigue, and usually headache. Adenovirus causes a sore throat and watery, red eyes.
It can be hard to tell when a bacterial infection is the cause of a sore throat and when a virus is to blame. In general, if your child has hoarseness, diarrhea, pinkeye, or blisters and sores in the front half of his mouth along with a sore throat, he probably has a virus. Strep throat rarely causes any of these symptoms.
A sore throat can be caused by things other than an infection. Injury to the throat happens when a sharp-edged piece of food (such as a tortilla chip) scrapes the tissue at the back of the mouth and down the esophagus. The pain will continue until the tissue heals, which can take a few days. Sometimes a foreign object (such as a fish bone) becomes lodged in the back of the throat. Discomfort will continue until it is swallowed or removed. Swallowing hot food also can cause local injury, and the pain will continue until the burn heals.
Postnasal drip is another source of a sore throat. When fluid drips from the nose down the back of the throat, it tickles and often generates a cough. The drip itself can be irritating, and the cough also can cause soreness.
Sore throats often result from dryness. In a particularly dry climate — including a household where there is dry heat running — it is not uncommon to feel pain at the back of the throat. Drinking liquids or running a humidifier usually helps. This type of sore throat also tends to get better with time: as the day goes on, the dryness typically resolves.