The throat, or pharynx, is a tubelike passageway that separates into the breathing and digestive tracts. It is made of smooth muscle and lined with a mucous membrane. The throat facilitates speech by changing shape to allow the formation of vowel sounds. It also contains openings for the hearing (eustachian) tubes, nasal space (posterior pares), larynx, gullet (esophagus), and the tonsils.

Most sore throats are caused by viruses or bacteria. Other causes may be a local irritation, such as exposure to cigarette smoke, environmental pollutants, dust, or dry winter air. A long episode of screaming may give rise to a sore throat. A sore throat can also be caused by an abscess in the back of the throat or on the tonsils.

Childhood sore throats occur most often in late winter and early spring. A sore throat may be accompanied by a head cold, runny nose, or ear infection. The majority of sore throats are minor viral illnesses that can be treated easily at home. However, about one-third of childhood sore throats are diagnosed as "strep" throat, an infection caused by the bacteria Streptococcus. The strep bacteria is highly contagious and persistent. Strep throat can run through a family like wildfire. The distinguishing signs and symptoms of strep infection, as opposed to a viral infection, are not always consistent. Definitive diagnosis of a strep infection must therefore be based on a throat culture. But there are some general features that can help you make an initial evaluation of your child's sore throat.

If your child's symptoms are characteristic of a strep infection, call your physician. Your doctor can then diagnose your child's condition by performing a throat culture and prescribe appropriate treatment. Because the streptococcus bacteria is so highly contagious, it may be wise to check other family members for strep symptoms, too. If left untreated, a strep infection can lead to a number of complications. The most serious of these is rheumatic fever, an inflammatory disease that can cause heart damage. If you have a child who has already had a case of rheumatic fever, call your physician immediately if she develops a sore throat of any kind.

A strep infection may also be accompanied by scarlet fever. This illness begins with a fever, sore throat, headache, and possibly vomiting. Twelve hours to two days after symptoms begin, the child will develop a characteristic red rash that feels like fine sandpaper to the touch. The rash usually appears first on the neck, under the arms, behind the knees, and in the groin area, and then it spreads to the extremities. It lasts for about seven days, after which the skin begins to peel or flake off. Another common sign of scarlet fever is a red, swollen "strawberry tongue." If you suspect your child's sore throat may be related to a case of scarlet fever, call your physician.

Conventional Treatment
A throat culture provides the only conclusive diagnosis of streptococcus infection. Using a swab, the physician gently removes mucus from the back of the throat for examination. In a modern laboratory, a culture can be done very quickly, and the results can be in your doctor's hands within twenty-four hours. A chemically based test, known as "quick-strep," can give a tentative answer in fifteen to twenty minutes. This test is only 85- to 90-percent accurate, however, and will miss a few cases. A quick-strep test should therefore always be backed up with a regular throat culture, especially when the initial results are negative. A newer test, called Strep OIA, also gives a result in fifteen minutes, but is more sensitive. According to the manufacturer, BioStar Medical Products, it yields accurate results and no backup throat culture is required.

When to Call the Doctor About a Sore Throat If your child has a fever over 102°F or other symptoms of a strep infection, see your doctor. Only a doctor can accurately diagnose a strep throat. (See Strep Infection Versus Viral Infection Chart Below) If your child has, or has recently recovered from, a step throat and develops renewed fever, joint pain or swelling, muscle spasms or twitching, a flat, painless rash, and/or bumps on her joints, scalp, or spine, contact your doctor right away. These an signs that she may be developing rheumatic fever. If your child's sore throat is accompanied by a red, slightly rough rash on her neck, arms, legs, and/or groin area, or a red, swollen tongue, call your doctor promptly. These are symptoms of scarlet fever. If your child has ever had rheumatic fever or scarlet fever in the past, you should consult your doctor whenever she gets a sore throat, no matter what the suspected cause, to protect against further complications. If anyone else in your household has had either of these diseases in the past, he or she should also con suit with a health care practitioner concerning measures to protect against further illness or complications.

If the diagnosis is strep, an antibiotic will be prescribed. Penicillin is usually the antibiotic of choice. Your physician may prescribe a course of penicillin in pill form, to be taken over a ten-day period, or he or she may opt for a one-dose injection of penicillin. If your child is allergic to penicillin, erythromycin is the preferred alternative. If pills are prescribed, it is important that the entire ten-day course be taken to ensure complete eradication of the bacteria.

Your doctor may recommend a three-day wait before treating your child with antibiotics. There are both potential risks and benefits involved in initiating immediate antibiotic treatment for acute strep throat, as opposed to waiting three days before beginning treatment. A 1987 article in The Journal of Pediatric Infectious Diseases reported that discomfort and fever were reduced more quickly in children who were given antibiotics immediately, but these children suffered a higher incidence of reinfection. Children whose treatment was delayed for three days took longer to get better, but showed higher resistance to developing another case of the disease. Some doctors now believe that this is because immediate treatment with antibiotics inhibits the immune system by slowing the production of antibodies needed to fight off the existing infection. It appears that if the body is permitted to initiate healing on its own, it maybe more able to mobilize the defenses required to heal itself in the long run. You may wish to discuss with your doctor the possibility of using natural treatments for the first few days instead of starting with antibiotics immediately.

If a strep throat is ruled out, your child's sore throat is most likely caused by a viral infection. If this is the case, antibiotics are ineffective and therefore not appropriate. Medical science has not yet discovered medications that fight most viral infections effectively. Fortunately, most viruses are self-limiting, even though viral infections can be quite uncomfortable. Treatment for a viral infection is aimed at helping the child stay as comfortable as possible.

A pain reliever, such as acetaminophen (found in Tylenol, Tempra, and other medications), helps to control fever and ease the pain of a sore throat, as well as any other accompanying aches and pains.

Do not give aspirin to a child or teenager with a sore throat unless your doctor specifically recommends it. Most sore throats are caused by viruses, and the combination of a viral infection and aspirin has been associated with Reye's syndrome, a dangerous liver disease.

Chloraseptic, available in lozenge or spray form, is an oral anesthetic and antiseptic that can help relieve the pain of a sore throat. Follow the directions on the product label.

Dietary Guidelines
An ice-cold fruit-juice popsicle can be an effective temporary anesthetic for a sore throat.

Encourage your child to take plenty of fluids. Warm miso soup and chicken soup are excellent.

Reduce the amount of sugar, refined carbohydrates, and dairy products in your child's diet.

Encourage your child to eat lots of simple whole grains, fresh vegetables, and fruits.

Nutritional Supplements
For age-appropriate dosages of some nutritional supplements, see Dosage Guidelines for Nutritional Supplements and Herbs.

Vitamin C is both antibacterial and anti-inflammatory. Dissolve 1 teaspoon (1,000 milligrams) of buffered vitamin-C powder in 8 ounces of water. Have your child sip this throughout the day, for the first forty-eight hours of a sore throat.

Herbal-based, sugar-free lozenges fortified with vitamin C or zinc, a mineral that speeds healing, are very helpful. Give your child one lozenge every hour, as needed, up to a total equivalent to two doses of zinc daily, for up to one week.
Note: Excessive amounts of zinc can result in nausea and vomiting. Be careful not to exceed the recommended dosage.

Bioflavonoids help to ease inflammation in the throat and fight infection. Give your child one dose, three or four times a day, for the first three to four days.

Give your child one dose of beta-carotene, twice a day, for the first forty-eight hours.

Strep Infection Versus Viral Infection

Although not all viral or strep infections cause identical symptons, there are some general tendencies to look for when your child has a sore throat. Review the following symptons to see which match your child's condition. If you suspect a strep throat infection, contact your child's doctor. Only a throat culture can accurately confirm a diagnosis of strep.
Sign	Strep Infection	Viral Infection
Age	Most common in children over three years of age.	Possibly at any age.
Onset	Comes on suddenly. One minute, the child seems fine-the next, tired, listless, and complaining.	Comes on gradually, escalating from a mild scratchiness to a full-fledge sore throat.
Symptons	A very painful sore throat, often accompanied by headache, stomach pain, vomiting, and/or tender or very firm lymph nodes. There can be much difficulty swallowing. The child will look and feel very sick.	A sore, thick, or scratchy-feeling throat that may be accompanied by cough, headache, runny nose, some difficult swallowing, and/or conjunctivitis.
Fever	A temperature that escalates to as much as 104oF is possible.	Mild to moderate fever.
Tonsils	Most likely red and swollen with white splotches.	May or may not be swollen; may or may not have a white coating.

Herbal Treatment
For age-appropriate dosages of some nutritional supplements, see Dosage Guidelines for Nutritional Supplements and Herbs.

Echinacea and goldenseal combination formula is important for helping to clear any kind of infection. Both of these herbs stimulate the immune system. Give your child one dose, every two hours, during the acute phase. Then reduce the dosage to one dose, three times a day, for up to one week.
Note: You should not give your child echinacea on a daily basis for more than ten days at a time, or it can lose its effectiveness.

Garlic is antibacterial and supports the immune system. Choose an odorless form, which will be better tolerated by children. You can give it to your child in whole capsule form, or dissolve the liquid in hot water or soup. Follow the dosage directions on the product label and give it to your child until she is better.

Brew a sore throat tea. In 1 quart of water, boil some or (preferably) all of the following: 1 tablespoon of licorice root, 1 tablespoon of hyssop, 2 tablespoons of slippery elm bark, and 1 teaspoon of sage. Licorice and slippery elm soothe irritated mucous membranes and ease a sore throat. Hyssop and sage detoxify the blood. Give your child one dose of tea, three times daily, for a couple of days or until she feels better. She can also gargle with this tea when it has cooled.
Note: Licorice should not be given to a child with high blood pressure.

At the first sign that your child may be developing scarlet fever, give her one dose of the Chinese botanical formula yin qiao, twice a day, for two days. This remedy is not helpful after the third day of symptoms.
Note: The liquid extract-is the preferred form because it contains no aspirin. The tablet form should not be given to a child under four years of age.

Yarrow maybe helpful because it promotes sweating and helps to lower fever. Give your child one dose, two to three times a day, as needed, for the first one or two days.

Grapefruit seed extract can be taken internally or used as a gargle. A highly concentrated form, such as Citricidal, Nutrabiotic, or Paramicrocidin, is preferred. Place 5 to 10 drops in a glass of water for a gargle. Or have your child drink 3 to 5 drops of extract in 6 ounces of water, three or four times daily, for up to three days.

Homeopathy
If your child has a mild to moderate fever along with a sore throat, give her Ferrum phosphoricum 6x, three times daily, until the fever is resolved, along with one of the other symptom-specific remedies recommended in this entry.

Apis mellifica is good for the child with swollen, red tonsils and a sore throat that comes on suddenly. This child has little thirst, although the mucous membranes are dry, and there is no coating on the throat. Her tongue may be red. Give this child one dose of Apis mellifica 30x or 9c every hour, up to a total of four doses, as long as symptoms last.

Give your child Belladonna if her tonsils, throat, and uvula are extremely red, and the sore throat came on suddenly. This child will have a fever and possibly dilated pupils. Give her one dose of Belladonna 30x or 9c every hour, up to a total of three doses, as long as symptoms last.

Hepar sulphuris is for the child whose sore throat is accompanied by a cough that brings up thick white or yellow plugs of mucus, and whose throat is coated with mucus. This child feels better with a hot washcloth on her throat. Give her Hepar sulphuris 30x or 9c, three times a day, for two days.

Lachesis will benefit the child with a sore throat that is localized on the left, or one that moves from left to right. The throat and tonsils will be dark red. This child is understandably in a very bad mood; she is in a lot of pain and doesn't want to be touched. Give this child Lachesis 30x or 9c, three times a day, for up to two days.

Lycopodium will help the child with a sore throat that is localized on the right side. The pain may move from the right to left side. This child feels worse during afternoon and early evening, between the hours of 4:00 and 8:00 P.M. Give this child Lycopodium 30x or 9c, three times a day, for up to two days.

If your child's sore throat is accompanied by hoarseness and worsens in the evening, give her one dose of Phosphorus 30x or 9c, three times a day, for up to two days.

Phytolacca is for the child with a very dark, red throat and much pain with swallowing. This child will have swollen glands, with pain that radiates to the ears. Give her Phytolacca 12x or 6c, four times a day, for up to two days.

Acupressure
For the locations of acupressure points on a child's body, see Administering a Acupressure Treatment.

Large Intestine 4 helps to clear infection.

Lung 7 moistens a dry and irritated throat.

General Recommendations
If you suspect that your child's sore throat maybe caused by a strep infection, contact your physician. The only way to ensure proper diagnosis and treatment is with a throat culture.

Encourage rest. A rested body generally heals more quickly than an active one.

Give your child an echinacea and goldenseal combination formula.

Select and administer an appropriate homeopathic remedy.

Give your child vitamin C and bioflavonoids.

Prepare an herbal tea and gargle as described above. Or make a gargle by dissolving 1/4 teaspoon of salt in 4 ounces of water and adding a small pinch each of cayenne pepper, lemon juice, and honey.

Give your child sugar-free lozenges enriched with vitamin C and zinc. Lozenges increase saliva production and help soothe a dry, irritated throat. Avoid lozenges made with unnecessary chemicals and sugar.

Use a cool mist vaporizer to humidify the air. Humidified air soothes irritated respiratory membranes and helps relieve a cough or hoarseness.

To decrease the risk of spreading infection, minimize a sick child's contact with others.

Cough or Fever if your child's sore throat is accompanied by these symptoms.

Be alert for symptoms of scarlet fever (described in the introduction to this entry) or rheumatic fever. These are serious complications that can accompany a streptococcus infection.

Prevention
Protect your child from environmental pollutants and respiratory irritants, such as cigarette smoke and wood smoke. It goes without saying that every child should be strongly discouraged from taking up smoking.

As much as possible, protect children from contact with sick playmates or infected others.

If recurrent strep infections are a problem, consider checking out the family pet. Cats have been known to harbor streptococcus bacteria.

If your child has had a strep infection, be sure to throw out her toothbrush and replace it with a new one.

Dosage Guidelines

Diet

Herbal Medicine

Homeopathy

Bach Flowers

Acupressure