What is the treatment for a sore throat in a toddler?

Treatment of Sore Throat in Toddlers

For toddlers with sore throat, symptomatic treatment with either ibuprofen or paracetamol (acetaminophen) is recommended as first-line therapy, while antibiotics should be reserved only for cases with strong evidence of bacterial infection. 1

Diagnostic Approach

• Sore throat in toddlers is most commonly viral in origin, occurring as part of the common cold 1
• Clinical assessment should focus on identifying features that suggest bacterial pharyngitis, particularly Group A β-hemolytic streptococcus (GABHS) 2
• The Centor clinical scoring system can help identify children with higher likelihood of streptococcal infections, though its utility is lower in very young children than in adults 1
• In patients with high likelihood of streptococcal infections (3-4 Centor criteria), rapid antigen testing (RAT) can be considered 1
• If RAT is performed and negative, throat culture is not necessary 1

Symptomatic Treatment

• Either ibuprofen or paracetamol (acetaminophen) is recommended for relief of acute sore throat symptoms in toddlers 1, 3
• These medications help reduce pain, inflammation, and fever associated with sore throat 3, 4
• Adequate hydration should be maintained, and soft, cool foods may provide additional comfort 2
• Zinc gluconate is not recommended for use in sore throat 1
• There is inconsistent evidence supporting herbal treatments or other complementary therapies for sore throat 1

Antibiotic Treatment

• Antibiotics should not be used in patients with less severe presentation of sore throat (0-2 Centor criteria) 1
• For toddlers with suspected bacterial pharyngitis based on clinical features or positive testing, antibiotic therapy may be considered 1, 5
• If antibiotics are indicated:
  • Penicillin V, twice or three times daily for 10 days, is the recommended first-line treatment 1
  • Amoxicillin can be used as an alternative in younger children due to taste considerations and availability as syrup or suspension 1, 6
  • Treatment should continue for a minimum of 48 to 72 hours beyond symptom resolution 6

Special Considerations

• Watchful waiting is recommended for recurrent throat infection if there have been <7 episodes in the past year, <5 episodes per year in the past 2 years, or <3 episodes per year in the past 3 years 1
• Tonsillectomy should not be considered for isolated sore throat episodes in toddlers but may be an option for very frequent, documented recurrent infections or other specific indications 1
• Children with a toxic appearance, difficulty breathing, drooling, or inability to swallow may have more serious conditions (such as peritonsillar abscess or epiglottitis) and require immediate medical attention 2, 3

Common Pitfalls to Avoid

• Overuse of antibiotics for viral sore throats, which contributes to antibiotic resistance 5, 7
• Failure to distinguish between viral and bacterial causes of sore throat 2, 3
• Inadequate pain management, which can lead to poor oral intake and dehydration 3, 4
• Relying solely on clinical appearance without appropriate testing when bacterial infection is suspected 5, 7
• Using antibiotics to prevent complications like rheumatic fever in low-risk patients, which is not recommended 1, 7