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A sore throat is a common symptom in children and is often due to a cold. If your child has a high fever, sore throat, difficulty swallowing and no cough or sniffle, you can suspect tonsillitis. If your child has a sore throat without fever, sniffle or cough or any other symptoms, there is rarely any disease behind it.

The stages of the common cold

Most colds follow the same pattern. First you get a sore throat. Then comes the runny nose, coughing and sneezing. The fever often comes on the second or third day. The throat pain sits for a few days, while the runny nose, which is first translucent and becomes more colored, sits for a few weeks. The cough can sit for up to three to four weeks after each cold. Children of preschool age can have on average between 6 to 10 colds per year. In 9 out of 10 cases, the child is able to fight the cold off themselves. As a parent, all you need to think about is giving your child love and comfort. Give them painkillers if they appear to be in pain. Clear the nostrils and give saline nasal drops if the nasal congestion is persistent. If you want, you can give 1-2 teaspoons of honey (to children over 1 year) in the evening to soothe the coughing.

Should I go to the pediatric emergency room?

No. Not if the baby can breathe and eat. In this case, there’s nothing more anyone can do at the children’s emergency room that you can’t do at home. In the children’s emergency room, there are a lot of stomach viruses and even more cold viruses. So there is a risk that you go home with more viruses than when you arrived. Cough medicines on prescription have no proven effect. There are no medications that help against cold viruses.

In addition, the children’s emergency room is not a child-friendly place. In the children’s emergency room, your child sits in the waiting room among other coughing, vomiting children. Often with a malfunctioning TV showing children’s programs in the background and questionably clean toys laying about on the floor.

If your child has difficulty breathing and you do not have inhalations that work well enough at home, go to the children’s emergency room.

If your child has a fever and is under three months of age, or is dull and feeling unwell, you may need to go to the pediatric emergency room. But if the child over three months of age, feels quite well between fever peaks, then you can stay at home.

Should I go to the medical center if my child has a cold?

No. Not if the child can breathe and eat. In this case, there’s nothing more anyone can do at the children’s emergency room that you can’t do at home. In the children’s emergency room, there are a lot of stomach viruses and even more cold viruses. So there is a risk that you go home with more viruses than when you arrived. Cough medicines on prescription have no proven effect. There are no medications that help against cold viruses.

Otitis

Some colds are complicated by otitis. You can identify this when the fever does not go away after a few days, or they have a sore ear and are whiny. Sometimes the eardrum bursts and pus drains out of the ear.

If the child has suspected otitis, provide pain relief. Let the child sleep with their head slightly elevated, and seek a medical center when convenient.

What about tonsillitis?

Streptococcal tonsillitis, or strept throat, is characterized by high fever (almost always above 38.5C or 101.3F) and a sore throat, which hurts every time the child swallows. No coughing, no sniffing, no sneezing. In the surroundings, there are often others who are sick with streptococcal infections eg. with tonsillitis, inflammed cuticles, impetigo or scarlet fever.

Tonsillitis, glandular fever and swollen lymph nodes in children

If this is true for your child, you are right to seek the medical center. There, the doctor should take a quick test for streptococcus with a stick in the throat, and prescribe Penicillin VK for ten days if it’s positive. In adults, there is evidence to show that antibiotic therapy reduces the risk of throat abscess. Throat abscess is rare in children and there are no reliable studies to show whether the risk of throat abscess decreases with antibiotic treatment. Antibiotic therapy reduces the risk of infection within the family.

Doctor’s shouldn’t prescribe the more tasty Amoxil for suspected tonsillitis. Sometimes the throat infection is caused by EBV virus instead. Then it is called glandular fever. If you give Amoxil to someone who has glandular fever, there is a risk that the person will break out into a terrible itchy, measles-like rashes all over the body.

Isn’t it safest to take streptococcus tests even if the child coughs and sneezes?

No, actually, it’s not. Between 5 to 25 out of 100 children have streptococcus in their throats even when they are healthy. And they’ll certainly have it when they have a cold. Then the streptococcal sample will turn out positive. No beneficial effect has been shown in treating this carrier with antibiotics (e.g. Penicillin VK) except in cases where the infection passes around the family and a family member gets tonsillitis time and time again.

What about CRP?

CRP is a protein that the body forms in response to inflammations. During a high fever caused by bacteria, CRP is often increased after a few days. Generally, CRP is low in fever-free healthy children. If your child has a typical cold, I can’t see that CRP adds anything positive. Instead it adds a painful prick to the finger. If the child has suspected tonsillitis, a CRP test does not add anything at all. Antibiotic treatment is determined by whether the streptococcus quick test (taken with a stick in the throat – really unpleasant!) shows streptococcus or not.

Sure, I use CRP sometimes, but only if I suspect a bacterial infection behind the fever. It may be useful to know that otitis usually does not cause increased CRP even if it is bacterial. If your doctor or nurse at the emergency room or health center wants to do a blood test on your child: ask why. Will the answer determine how the doctor interprets your child’s infection? Will it determine the advice or treatment the child receives? If it does, then it’s reasonable. But if the blood test is made more or less out of formality, then your child can be spared the pain.

In summary:

Children with the common cold are best cared for at home by their parent. Comfort and love, painkillers and hot or cold drinks, is what the child needs most. Free access to ice cream! Children who do not cough, sneeze nor have a runny nose, but have a sore throat and a fever more than 38.5C or 101.3F may have tonsillitis. Seek the medical center for a streptococcal test. Antibiotics are recommended if the test is positive.

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