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Sore throat with white spots - is it strep?

Posted on September 15, 2017 at 7:20 AM

Things you might see in all kinds of sore throats (pharyngitis)

- Throat pain, redness, enlarged tonsils

- Swollen lymph nodes (glands in neck)

- Trouble eating/swallowing, lack of appetite

- Fever

- White spots on tonsils

Viral sore throat

In addition to all those above, they tend to also have:

- Cough, sneezing, and/or runny nose

- Vomiting and diarrhea

- Fever is usually lower than 102

- There are many kinds of viruses that cause sore throat; some specific ones that tend to have white spots are mono and hand-foot-mouth

Treatment of viral sore throat:

- Gargle with salt water

- Drink lots of water, tea, broth

- Eat soft foods like yogurt, applesauce, mashed potatoes

- Take vitamin C, zinc, and echinacea

- Get extra rest

- Tylenol or ibuprofen for pain/fever

Mono (short for mononucleosis)

- A type of viral sore throat

- Children are very tired with this

- White spots on tonsils are flat patches (looks like strep)

- Lymph nodes are swollen and tender, and they may have swollen lymph nodes around their body and not just in the neck (armpits, groin, back of neck, etc.)

- When the spleen is swollen, it can be dangerous to engage in activities where they might fall and/or hit their abdomen (climbing, jumping on furniture/trampolines, contact sports) - children with mono must be kept out of these activities until cleared by a doctor

- Chilren can be tested for mono with a blood test

Hand, foot, and mouth disease

- A type of viral sore throat

- Spots on the tonsils are blisters; they may also have spots on the tongue and roof of mouth

- They may have red spots or blisters (white in the center and red around them) on the palms, soles, arms, and legs - not always there

Strep throat

- A bacterial infection

- Usually higher fever (102-104); children feel very tired when the fever is high

- White spots on tonsils are flat patches (looks like mono); they will usually also have red spots (called petechiae) on the roof of their mouth

- Coated tongue, bad breath (strep-y smell)

- Stomachache, vomiting without diarrhea - sometimes this comes before the sore throat

- Rash that feels rough (like sandpaper) on their trunk/back; might be itchy

- MUST be treated with antibiotics in children under age 6 (because if untreated it can cause rheumatic fever later, which is very serious). In children over age 6 and adults, it doesn’t have to be treated. Reasons to treat: feel better about 24 hours faster (24-48h instead of 48-72), and they can go back to school/work sooner (the next day if started by 5pm) because they are no longer contagious.


- Bacterial infection

- Uncommon because of the DTaP vaccine, but can happen in unvaccinated children

- Large grayish-white spots on tonsils

- Serious swelling of throat and tonsils - can cause suffocation if not treated

How sore throats are spread

- Contact with saliva - sharing food/drinks, kissing on the face, bathroom towels

- Inanimate objects - anything a child puts in their mouth (i.e. toys) needs to be cleaned with soap and water

- Common surfaces - for children who frequently touch their mouths, anything they touch can be contagious (doorknobs, tabletops, knobs on the sink, phones, etc)

When to call a doctor

- When you suspect strep

- When a child is unable or unwilling to drink fluids

- When they have a fever over 101

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