Can a Two-Year-Old Get Strep Throat?
Yes, a two-year-old can technically develop strep throat, but it is uncommon, presents differently than in older children, and routine testing is generally not recommended for this age group. 1
Why Testing Is Usually Not Recommended
Diagnostic studies for GAS are not indicated for children <3 years old because the incidence of streptococcal pharyngitis and the classic presentation are uncommon in this age group, and acute rheumatic fever is extremely rare in children under 3 years of age. 1
Key Clinical Considerations:
Low prevalence: Group A Streptococcus (GAS) pharyngitis is most commonly observed in children 5-15 years of age, not in toddlers 1
Rare complications: Reports of acute rheumatic fever (ARF) in children <3 years of age are very rare 1. Of 541 new cases of ARF reported from Salt Lake City, only 5% involved individuals <5 years of age, with a median age of 4 years 1
Different presentation: GAS infection in children <3 years old is often associated with fever, mucopurulent rhinitis, excoriated nares, and diffuse adenopathy, while exudative pharyngitis (the classic "strep throat" presentation) is rare in this age group 1
When Testing May Be Considered
Selected children <3 years old who have specific risk factors, such as an older sibling with confirmed GAS infection, may be considered for testing. 1
Risk Factors That Warrant Consideration:
- Household contact with a confirmed case of GAS pharyngitis 1
- Exposure to an older sibling with documented strep throat 1
- Atypical presentation with concerning features 1
Clinical Reasoning
The low usefulness of diagnostic testing in children under 3 stems from multiple factors 1:
Immune system priming: It may take repeated exposures to GAS or priming of the immune system before there is an immune response to streptococcal pharyngitis that can lead to rheumatic fever 1
Self-limited disease: Most pharyngitis in this age group is viral and self-limited 1
Avoiding unnecessary antibiotics: Testing young children without clear indication may identify asymptomatic carriers rather than true infections, leading to unnecessary antibiotic use and contributing to antimicrobial resistance 1
Common Pitfalls to Avoid
Do not routinely test or treat pharyngitis in children <3 years old without specific risk factors or atypical presentations 1
Do not assume classic strep throat symptoms (exudative pharyngitis, tonsillar enlargement) will be present in toddlers—they typically present with rhinitis and nasal excoriation instead 1
Do not prescribe antibiotics empirically for sore throat in this age group without confirmed diagnosis, as viral etiologies are far more common 1