When to Suspect Strep in Children under Three Years

November 22, 2009

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When to Suspect Strep in Children under Three Years

by Dr. Ed Kaplan
reviewed by Lynn Cates, M.D., F.A.A.P.

You probably already know that strep can cause a sore throat and fever, but you may not be aware that strep respiratory infections in children one to three years old may not have the characteristic sore throat and high fever seen in school-age children and adults. For that reason, strep infections can be missed in young children. If you know that your young child has been exposed to strep before coming down with a respiratory infection, you should have her evaluated by her healthcare provider. Strep infections at this age typically have the following symptoms:

Symptoms suggestive of strep throat in infants and toddlers

Onset of illness is not as rapid or severe as that seen in older children.
Fever usually will be low grade (99-100 degrees Fahrenheit).
Irritability and lack of appetite are common.
Commonly, there will be a clear discharge from the nose.
Sometimes the nasal drainage is accompanied by a skin infection between the upper lip and the nostrils.
There may be no sore throat or difficulty swallowing.
There may be no swollen lymph glands underneath the jaw, and in the front and sides of the neck.

Symptoms that are uncommon with strep throat
Respiratory tract symptoms such as cough, sneezing, runny nose, and a low-grade temperature of 99 or 100 Fahrenheit are uncommon with strep infections. Children with these symptoms usually do not have streptococci in their throats unless, coincidentally, they happen to be a streptococcal carrier. Similarly, diarrhea is not characteristic of group A streptococcal infections.

Infections that look like strep throat
Some other infections that may be confused with streptococcal sore throat in children (and, sometimes, in adults) include infectious mononucleosis (mono), ear infections (particularly in younger children), and a number of viral respiratory infections. Diphtheria used to be included, but this disease is extraordinarily uncommon in the United States at the present time. Outbreaks of diphtheria are occurring in other parts of the world (such as countries of the former Soviet Union), so diphtheria should be considered in children with a history of travel or exposure to travelers.


RELATED INFORMATION

			Diagnosing Strep Throat
			Strep Infections

Created December 23, 2000
Reviewed February 24, 2001

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