UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Evaluation of sore throat in children

Author
Gary R Fleisher, MD
Section Editors
George A Woodward, MD
Jan E Drutz, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

This topic will review conditions that can cause the symptom of sore throat. The discussion will include pertinent features of the history and physical examination and an algorithmic approach to common and life threatening conditions. The approach and treatment of children with infectious pharyngitis are discussed in more detail elsewhere. (See "Group A streptococcal tonsillopharyngitis in children and adolescents: Clinical features and diagnosis" and "Sore throat in children and adolescents: Symptomatic treatment" and "Treatment and prevention of streptococcal tonsillopharyngitis".)

DEFINITION

Sore throat refers to any painful sensation localized to the pharynx or surrounding anatomy. The developmental ability of young children to identify and define their symptoms varies and the physician must pay careful attention to the patient and the caretaker in order to clarify the exact nature of the complaint.

Sore throat can be the symptom of a disease process that does not directly affect the pharynx. Occasionally, young patients with dysphagia that results from disease in the area of the esophagus or with difficulty swallowing because of a neuromuscular disorder may verbalize these sensations as a sore throat or their symptoms may be interpreted by a caretaker as a sore throat.

CAUSES

The etiology of sore throat varies by age (table 1) and can further be divided by conditions that are life-threatening, common, or less common.

Life-threatening conditions

Epiglottitis — The incidence of epiglottitis, a well-appreciated cause of life-threatening upper airway infection, has declined significantly since the introduction of vaccination against Haemophilus influenzae type b. This disease manifests with a toxic appearance, high fever, stridor, and drooling. Sore throat occurs in many cases, but is only rarely the primary complaint. (See "Epiglottitis (supraglottitis): Clinical features and diagnosis".)

                    
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Sep 2017. | This topic last updated: Sep 21, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Centor RM. Expand the pharyngitis paradigm for adolescents and young adults. Ann Intern Med 2009; 151:812.
  2. Righini CA, Karkas A, Tourniaire R, et al. Lemierre syndrome: study of 11 cases and literature review. Head Neck 2014; 36:1044.
  3. Ridgway JM, Parikh DA, Wright R, et al. Lemierre syndrome: a pediatric case series and review of literature. Am J Otolaryngol 2010; 31:38.
  4. Goldenberg NA, Knapp-Clevenger R, Hays T, Manco-Johnson MJ. Lemierre's and Lemierre's-like syndromes in children: survival and thromboembolic outcomes. Pediatrics 2005; 116:e543.
  5. Ramirez S, Hild TG, Rudolph CN, et al. Increased diagnosis of Lemierre syndrome and other Fusobacterium necrophorum infections at a Children's Hospital. Pediatrics 2003; 112:e380.
  6. Breese BB. A simple scorecard for the tentative diagnosis of streptococcal pharyngitis. Am J Dis Child 1977; 131:514.
  7. Wald ER, Green MD, Schwartz B, Barbadora K. A streptococcal score card revisited. Pediatr Emerg Care 1998; 14:109.
  8. Wiesner PJ, Tronca E, Bonin P, et al. Clinical spectrum of pharyngeal gonococcal infection. N Engl J Med 1973; 288:181.
  9. Komaroff AL, Aronson MD, Pass TM, et al. Serologic evidence of chlamydial and mycoplasmal pharyngitis in adults. Science 1983; 222:927.
  10. Barron KS. Kawasaki disease in children. Curr Opin Rheumatol 1998; 10:29.
  11. Horwitz CA, Henle W, Henle G, et al. Clinical and laboratory evaluation of infants and children with Epstein-Barr virus-induced infectious mononucleosis: report of 32 patients (aged 10-48 months). Blood 1981; 57:933.
  12. Fleisher GR, Paradise JE, Lennette ET. Leukocyte response in childhood infectious mononucleosis. Caused by Epstein-Barr virus. Am J Dis Child 1981; 135:699.
  13. Fleisher G, Lennette ET, Henle G, Henle W. Incidence of heterophil antibody responses in children with infectious mononucleosis. J Pediatr 1979; 94:723.
  14. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:e86.