Definition – Sore throat refers to any painful sensation localized to the pharynx or surrounding anatomy. The developmental ability of young children to identify and define their symptoms varies and the physician must pay careful attention to the patient and the caretaker in order to clarify the exact nature of the complaint.
●Causes – The etiology of sore throat varies by age and can further be divided by conditions that are life-threatening, common, or less common.
●History – Key historical variables that may assist in the diagnosis of a specific cause of sore throat include respiratory distress, fever, fatigue, and the rapidity of the onset of symptoms.
●Physical examination – Careful oropharyngeal examination often provides the etiology for the sore throat (eg, viral pharyngitis, streptococcal pharyngitis, or peritonsillar abscess).
●Ancillary studies – Ancillary studies that may be useful frequently in selected patients include testing for streptococcal disease by antigen detection or culture and a heterophile test and white blood cell count with differential for infectious mononucleosis.
●Algorithmic approach – The tendency of most clinicians is to assume that one of the common organisms is the cause of pharyngitis in the child with a sore throat. Before settling on infectious pharyngitis, however, the clinician should first consider several more serious disorders such as epiglottitis, retropharyngeal and lateral pharyngeal abscesses, peritonsillar abscess, severe tonsillar hypertrophy (usually as an exaggerated manifestation of infectious mononucleosis), diphtheria, and Lemierre’s syndrome.
Patients who do not have one of the life-threatening conditions discussed above and do not have another easily identifiable cause of sore throat (eg, foreign body) are likely to have infectious pharyngitis. Infectious pharyngitis evokes a spectrum of inflammatory responses that range from minimal injection of the mucosa to beefy erythema with exudation and edema formation. The three relatively common causes are Streptococcus species, respiratory viruses, and infectious mononucleosis.
●COVID-19 – Sore throat occurs with COVID-19 in children, and diagnostic testing is warranted for those with nonexudative pharyngitis and fever, whenever possible and according to local criteria
