CDC and IDSA Guidance on Strep Pharyngitis in Children Under 3 Years
Diagnostic testing for Group A Streptococcal (GAS) pharyngitis is NOT routinely recommended for children under 3 years of age. 1
Key Rationale for Not Testing
The Infectious Diseases Society of America provides clear guidance that children under 3 should generally not be tested for strep throat based on several important factors:
- Acute rheumatic fever (ARF) is extremely rare in this age group, with reports from Salt Lake City showing only 5% of 541 ARF cases occurred in children under 5 years, with a median age of 4 years among those affected 1
- The classic presentation of streptococcal pharyngitis is uncommon in children under 3 years 1
- GAS infection in this age group typically presents differently, with fever, mucopurulent rhinitis, excoriated nares, and diffuse adenopathy rather than exudative pharyngitis 1
- The overall incidence of streptococcal pharyngitis is low in children under 3 years 1
When Testing MAY Be Considered
Selected children under 3 years with specific risk factors may warrant testing, including: 1
- Children with an older sibling who has confirmed GAS infection 1
- Other high-risk epidemiological circumstances 1
Clinical Features Suggesting Viral Etiology (No Testing Needed)
Testing should be avoided when clinical features strongly suggest viral pharyngitis: 1, 2
Management Approach for This Age Group
Focus on symptomatic treatment rather than antibiotics: 2
- Acetaminophen or NSAIDs for moderate to severe symptoms or fever control 2
- Avoid aspirin in all children due to Reye syndrome risk 2
- Ensure adequate hydration and rest 3
Common Pitfalls to Avoid
- Do not routinely test or treat pharyngitis in children under 3 years unless specific risk factors are present 1
- Do not prescribe antibiotics empirically for sore throat in this age group without confirmed diagnosis and appropriate indication 2
- Recognize that most pharyngitis in this age group is viral and self-limited 1