How long should a sore throat last before going to the doctor

What is a sore throat?

A sore throat means that your throat hurts. It feels irritated or scratchy. You may feel mild discomfort or a burning pain. A sore throat may feel worse when you swallow. Possible complications from a sore throat include ear and sinus infections. Another complication is an abscess (buildup of pus) near your tonsils.

Symptoms of a sore throat

A sore throat means that your throat hurts and is irritated, swollen, or scratchy. It usually hurts worse when you swallow. Depending on the cause of your sore throat, symptoms include:

• Fever
• Headache
• White spots on your throat or tonsils
• Red, swollen tonsils
• Swollen glands in your neck
• Skin rash

In some cases, additional symptoms include:

• Abdominal pain (usually in children)
• Vomiting (usually in children)
• Joint or muscle pain

What causes a sore throat?

Most sore throats are caused by viruses, such as the cold or flu virus. Some of the more serious causes of sore throat include tonsillitis, strep throat, and mononucleosis (mono). Other causes include smoking, mouth breathing at night while you sleep, pollution, and allergies to pets, pollens and molds. General anesthesia during surgery can cause a sore throat.

How is a sore throat diagnosed?

Your doctor will do a physical exam. They will look at the back of your throat. Your doctor may swab the back of your throat. This is called a throat culture. It is done to collect a sample of bacteria. This also is used in a rapid strep test. This is a quick test to diagnose strep throat. The test won’t tell if your sore throat is caused by something other than strep. The results of a throat culture takes between 24 and 48 hours. If your doctor thinks you may have mono, they will probably do a blood test.

Can a sore throat be prevented or avoided?

The best way to avoid a sore throat is to avoid getting sick. Avoid catching or spreading the viruses and bacteria that cause a sore throat. Wash your hands regularly. Avoid touching your eyes or mouth. Cover your mouth when coughing or sneezing.

Sore throat treatment

If your sore throat is cause by the flu, your doctor may prescribe antiviral medicine. Antibiotics don’t work on viruses. Most sore throats caused by a cold or flu-type virus go away in a week to 10 days.

If your sore throat is caused by bacteria, your doctor will prescribe an antibiotic. You will feel better in a few days. It is important to take all of your antibiotics. This reduces the risk that your sore throat will return.

Symptoms caused by mono can last for 4 weeks or more. The treatment for mono is rest and reduced exercise.

If a sore throat is caused by allergies, your doctor may talk to you about allergy triggers. He or she may recommend medicine for the allergy.

If your sore throat is caused by tonsillitis, you may need an operation. This is called a tonsillectomy. The surgery removes your tonsils. Most people who have tonsillitis don’t need surgery. You might need surgery if you get severe tonsillitis often. You may need surgery if your tonsils are too big.

Living with a sore throat

Easing the pain of a sore throat is all you can do beyond treatment. The best remedies include:

• Take over-the-counter pain medicine. This includes brand names such as Tylenol, Motrin, and Aleve. Do not give children younger than 18 aspirin. Aspirin may cause Reye’s syndrome. This can be fatal.
• Gargle with warm salt water. Mix 1 teaspoon of salt with 1 cup of water and stir.
• Suck on an over-the-counter throat lozenge. Hard candy works too.
• Eat a popsicle.
• Use a humidifier in your bedroom. Move it to other rooms you spend time in.
• Drink liquids to keep your throat from getting dry. Also, this helps prevent dehydration.

Questions to ask your doctor

• Will hot drinks make my sore throat worse?
• Does honey help ease the pain of a sore throat?
• Should I go to work or school if I have a sore throat?
• Can a dry room cause a sore throat?
• Can certain medicines cause a sore throat?

Is this your child's symptom?

• Pain or discomfort of the throat
• Made worse when swallows
• Rare symptom before 2 years old
• Not caused by an injury to the throat

Causes of Sore Throat

• Colds. Most sore throats are part of a cold. In fact, a sore throat may be the only symptom for the first 24 hours. Then a cough and runny nose occur.
• Viral Pharyngitis. Some viruses cause a sore throat without other symptoms. A cough and runny nose don't become part of the illness. An antibiotic won't help.
• Strep Pharyngitis. Group A Strep is the most common bacterial cause. It accounts for 20% of sore throats without any cold symptoms. Pus is seen on the tonsils. Peak age is 5 to 15 years. An antibiotic is helpful.
• Mono. Infectious Mono mainly occurs in teens and young adults. The main symptoms are sore throat, fever and widespread swollen lymph nodes. Like Strep, Mono also has pus on the tonsils. Patients with Mono also may have a large spleen. It's located in the upper left side of the stomach. Mono is diagnosed with special blood tests.
• Post-nasal Drip. Drainage from a sinus infection can cause a sore throat. The throat clearing that goes with the drainage may cause most of the irritation. The sinus infection is more likely to be viral than bacterial.
• Mouth Breathing. Breathing with the mouth open during sleep can cause a sore throat. After eating breakfast, it often goes away.
• Abscess of Tonsil (Serious). A bacterial infection of the tonsil can spread to the surrounding tissues. The main symptoms are severe trouble swallowing, fever and one-sided throat pain. It's also hard to fully open the mouth. The peak age is teens.
• Epiglottitis (Very Serious). A bacterial infection of the flap of tissue above the vocal cords. It normally covers the windpipe during swallowing. The main symptoms are severe sore throat, drooling, spitting and fever. It can shut off the airway. Needs a 911 response.

Strep Throat: When to Suspect

• Symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting.
• Cough, hoarseness, red eyes, and runny nose are usually not seen with Strep throat. These symptoms point more to a viral cause.
• Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat.
• Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep.
• If you think your child has Strep, call your doctor.
• Your doctor will do a Strep test. If the test is positive, they will start treatment. There is no risk from waiting until a Strep test can be done.
• Standard treatment is with antibiotics by mouth.

Symptoms in Infants and Toddlers

• Children less than 2 years of age usually don't complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings. Their symptoms are usually better covered using Drinking Fluids - Decreased care guide.

When to Call for Sore Throat

Call 911 Now

• Severe trouble breathing (struggling for each breath, can barely speak or cry)
• Purple or blood-colored spots or dots on skin with fever
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Trouble breathing, but not severe
• Great trouble swallowing fluids or spit
• Can't open mouth all the way
• Stiff neck or can't move neck like normal
• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
• Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• Fever over 104° F (40° C)
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent. Note: a Strep test alone is not urgent.

Contact Doctor Within 24 Hours

• Sore throat pain is severe and not better 2 hours after taking ibuprofen
• Large lymph nodes in the neck
• Pink rash that's widespread
• Earache or ear drainage
• Sinus pain (not just congestion) around cheekbone or eyes
• Fever lasts more than 3 days
• Fever returns after being gone more than 24 hours
• Age less than 2 years old
• Close contact to a person with Strep within last 7 days
• Sores on the skin
• You think your child needs to be seen, but the problem is not urgent (or needs a Strep test)

Contact Doctor During Office Hours

• Sore throat is the main symptom and lasts more than 48 hours
• Sore throat with cold/cough symptoms lasts more than 5 days
• You have other questions or concerns

Self Care at Home

• Viral throat infection suspected

Care Advice for Sore Throats

1. What You Should Know About Sore Throats:
   • Most sore throats are just part of a cold and caused by a virus.
   • A cough, hoarse voice or nasal discharge points to a cold as the cause.
   • Most children with a sore throat don't need to see their doctor.
   • Here is some care advice that should help.
2. Sore Throat Pain Relief:
   • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
   • Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
   • Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
   • Medicated throat sprays or lozenges are generally not helpful.
3. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
4. Fever Medicine:
   • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Note: Fevers less than 102° F (39° C) are important for fighting infections.
   • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
5. Fluids and Soft Diet:
   • Try to get your child to drink adequate fluids.
   • Goal: Keep your child well hydrated.
   • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
   • Solid Foods: Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solid foods.
   • Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces.
6. Return to School:
   • Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities.
   • Most often, having just a sore throat is not a reason to miss school.
   • Children with Strep throat need to be taking an antibiotic for at least 12 hours.
7. What to Expect:
   • Most often, sore throats with a viral illness last 4 or 5 days.
8. Call Your Doctor If:
   • Sore throat is the main symptom and lasts more than 48 hours
   • Sore throat with a cold lasts more than 5 days
   • Fever lasts more than 3 days or goes above 104° F (40° C)
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/26/2022

Last Revised: 09/18/2022

Copyright 2000-2022. Schmitt Pediatric Guidelines LLC.

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