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Evaluation of sore throat in children

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


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.

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 to the child with infectious pharyngitis is discussed in more detail elsewhere. (See "Group A streptococcal tonsillopharyngitis in children and adolescents: Clinical features and diagnosis".)


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 [1]. This disease manifests with a toxic appearance, high fever, stridor, and drooling [2,3]. Sore throat occurs in many cases, but is only rarely the primary complaint. (See "Epiglottitis (supraglottitis): Clinical features and diagnosis".)

Retropharyngeal abscess — Retropharyngeal abscesses can cause sore throat and usually occur in children less than four years of age [4]. Other complaints include neck pain and fever. There may be difficulty swallowing and respiratory distress. The posterior location of the abscess makes it difficult to visualize on physical examination. Imaging is often required to confirm the diagnosis. (See "Retropharyngeal infections in children".)


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Literature review current through: Jul 2017. | This topic last updated: Aug 14, 2015.
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