Can infants get strep throat?

Can Infants Get Strep Throat?

Yes, infants can get strep throat (Group A Streptococcal pharyngitis), but it is uncommon in children under 3 years of age and rare in infants under 1 year old. 1, 2

Epidemiology and Risk in Infants

• Strep throat primarily affects children 5-15 years of age, with peak incidence during winter and early spring in temperate climates 1
• In children under 3 years old:
  • GAS pharyngitis is uncommon
  • The classic presentation of streptococcal pharyngitis is rarely seen
  • The risk of developing acute rheumatic fever (ARF) is extremely low 1
• Case reports of streptococcal pharyngitis in very young infants exist but are rare 2
• A meta-analysis found that children under 5 years had a significantly lower prevalence of GAS (24%) compared to the overall pediatric population (37%) 3

Clinical Presentation in Infants

When GAS infection does occur in children under 3 years old, it typically presents differently than in older children:

• Fever
• Mucopurulent rhinitis (runny nose with pus)
• Excoriated nares (irritated nostrils)
• Diffuse adenopathy (swollen lymph nodes)
• Exudative pharyngitis is rare in this age group 1

In contrast, older children with strep throat typically present with:

• Sudden onset of sore throat
• Pain when swallowing
• Fever
• Tonsillopharyngeal erythema (redness)
• Often with lymphadenitis (inflamed lymph nodes) 1

Diagnostic Testing Recommendations

According to the Infectious Diseases Society of America (IDSA) guidelines:

• Diagnostic studies for GAS are not indicated for children under 3 years old because:

  • Acute rheumatic fever is rare in this age group
  • The incidence of streptococcal pharyngitis is low
  • The classic presentation is uncommon 1, 4

• Testing may be considered in select children under 3 years who have specific risk factors:

  • An older sibling with GAS infection
  • Other household members with confirmed streptococcal infection 1, 2

Management Considerations

If GAS pharyngitis is suspected or confirmed in an infant:

• Treatment follows the same principles as for older children
• Penicillin or amoxicillin is the first-line treatment 1
• For penicillin-allergic patients, alternatives include first-generation cephalosporins, clindamycin, clarithromycin, or azithromycin 1

Important Clinical Pitfalls

1. Unnecessary testing: Testing for GAS in infants without specific risk factors leads to detection of carriers rather than truly infected infants 1

2. Overtreatment: Since GAS pharyngitis is uncommon in infants, empiric antibiotic treatment without testing contributes to antimicrobial resistance 4

3. Misdiagnosis: Viral illnesses with pharyngeal symptoms are far more common in infants than GAS pharyngitis, and present with features like cough, rhinorrhea, hoarseness, and oral ulcers 1

4. Family transmission: When parents or older siblings have confirmed strep throat, consider the possibility of transmission to infants in the household 2

In summary, while infants can technically get strep throat, it is uncommon and not routinely tested for unless specific risk factors are present. The focus should be on appropriate diagnosis in high-risk situations while avoiding unnecessary testing and antibiotic use in this age group.