Toddlers can get strep throat, but it is statistically less common than in older children. Strep throat is caused by the bacterium Group A Streptococcus (GAS), which is the most frequent bacterial cause of sore throats in children. The highest incidence occurs in school-aged children, typically between the ages of five and fifteen years old. While possible, the infection is considered rare in children under three. When toddlers contract GAS, the symptoms often present differently than the classic sore throat seen in older individuals.
Why Strep is Different in Toddlers and How Symptoms Present
Strep throat is less frequent in toddlers because they generally have less exposure to the bacteria compared to school-aged children, and their immune systems are still developing. For children under three, the infection rarely manifests as classic acute pharyngitis, which includes a very sore throat, pain upon swallowing, and significant tonsillar pus. This atypical presentation may be due to the way the bacteria interacts with younger tissue.
Instead of a sudden, severe sore throat, strep infection in this age group often presents with more nonspecific and subtle symptoms that can easily be mistaken for a common cold. Toddlers may experience prolonged low-grade fever, increased fussiness, irritability, and a noticeable lack of appetite. They frequently develop gastrointestinal symptoms such as stomach pain, nausea, or vomiting, which are less typical in older patients.
A persistent, thick, or bloody nasal discharge is a common sign of Group A Strep in very young children. This nasal involvement, often accompanied by an irritated area around the nostrils, is not usually seen with strep in older individuals. In some cases, the infection may appear as a skin issue, causing an impetigo-like rash around the nose or mouth, referred to as streptococcal pyoderma.
Testing Procedures and Treatment for Young Children
When a strep infection is suspected, a healthcare provider takes a sample from the back of the throat using a sterile swab. The initial test is usually a Rapid Strep Test (RST), which provides results within minutes by detecting bacterial antigens. Although convenient, the RST has a risk of false negatives, meaning it may indicate the absence of strep when the infection is present.
For symptomatic children, especially those under five, a negative RST is often followed up with a throat culture. The culture involves sending the swab to a laboratory to see if the bacteria grow. This is a more definitive, though slower, method, with results taking up to two days. This two-step process helps prevent missing a true strep infection.
If the diagnosis is confirmed, the standard treatment involves a ten-day course of oral antibiotics, typically Penicillin or Amoxicillin. It is important to complete the entire duration of the antibiotic regimen, even if symptoms quickly improve, to fully eradicate the bacteria. For children with a penicillin allergy, alternative antibiotics like cephalosporins or macrolides may be prescribed instead.
Serious Complications and Managing Contagion
The primary purpose of treating a strep infection with antibiotics is to prevent rare but serious complications. The two most concerning risks are rheumatic fever, which can cause long-term damage to the heart valves, and post-streptococcal glomerulonephritis, which affects kidney function. Treating the infection within nine days of symptom onset significantly minimizes the risk of developing rheumatic fever.
Strep is highly contagious and spreads through respiratory droplets from coughing or sneezing, or by touching contaminated surfaces or shared items. Caregivers should focus on frequent handwashing and avoid sharing utensils, drinks, or toys to limit the spread within the household. A child is no longer considered contagious and can return to daycare or group settings after they have been on antibiotics for at least 24 hours and their fever has resolved.
Parents should contact their doctor if a toddler shows signs of dehydration, such as significantly decreased urination, or if they have difficulty swallowing or breathing. Other warning signs include a stiff neck or extreme lethargy, which could indicate a more severe or invasive infection. Prompt communication with a healthcare provider ensures the infection is properly managed and monitored.