Facts About Strep Throat in Babies and Toddlers

Strep throat symptoms in infants tend to be mild or hard to notice. The child may have a low fever, seem irritable, or refuse to feed or sleep. Physical signs include a thickened or bloody nasal discharge or a fine, red rash on the child’s legs, arms, and torso. A medical examination may reveal redness in the throat or swollen neck glands.

Symptoms of strep throat in two-year-old toddlers are typically similar but are often more defined. Mild fever, thick or bloody nasal discharge, and swollen neck glands are still seen. In some cases, a child may lack an appetite or outright refuse to eat. Children who can speak may tell their parents their stomachs hurt instead of their throats.

Around age three, the symptoms of strep throat begin to manifest similarly to the infection in an adult. The mild fever usually becomes a high fever of over 102 degrees F. Swollen glands become more noticeable and there may be pus on the tonsils. Children at this age also experience the extremely sore throat that is characteristic of strep throat.

Strep throat is usually the result of an infection involving bacteria called group A Streptococcus. These bacteria live in the nose and throat, making them easily transmissible through coughs, sneezing, talking, and even breathing. Infectious bacteria spread more easily when people gather in groups, such as in schools and daycares.

In most cases, doctors will use a throat swab to diagnose strep throat. However, most medical experts will avoid using throat swabs for children under age three, except when there is confirmed exposure to a strep-positive person. This is common practice for many reasons, including the rarity of strep in infants.

Antibiotics are the typical treatment method for strep throat. However, strep throat is rare in infants as the majority of cases of sore throat are not due to bacterial infections. In older children, strep throat can have significant complications, like acute rheumatic fever. However, these complications don’t occur in children under age three. Because of this, doctors will usually let the infection run its course to avoid antibiotic resistance.

Despite the widespread belief that complications of strep throat do not develop in infants and toddlers, some doctors disagree. For example, there are anecdotal reports of complications like wheezing, pneumonia, ear infections, perforations of the eardrum, and personality changes. This has led to a push for more research into the effects of strep throat on young children.

Some children have strep throat multiple times with quick succession. Because the infection is rare in infants, some caretakers worry that this could indicate immune system issues. However, this is unlikely. The more likely conclusion is that the child has regular interactions with strep carriers, either at home, daycare, or school. While tonsillectomies were once the go-to treatment for recurrent strep throat infections, today most doctors only use antibiotics.

Because a strep throat infection requires exposure to the bacteria, avoiding crowds and sick individuals is the easiest way to protect against it. When preventing strep throat in infants and toddlers, hand hygiene is particularly important. Cough or sneeze into an elbow or a tissue. Additionally, wash the hands regularly, but especially before preparing food or handling a child.

If a doctor does not recommend treatment with antibiotics for a child with strep throat, caretakers can help alleviate the symptoms at home. Swap toddlers to softer foods like soups, broths, and applesauce that will not irritate their throats. Some children also find cool foods soothing, while acidic substances like orange juice may cause pain. Many people with strep throat find humidifiers provide moderate relief. Children with strep throat should drink plenty of water.