As a parent, it’s tough to decide whether to send your child to school when they’re sick. With a sore throat, fever, and the possibility of strep, you’re left wondering: “Is it safe for them to go to school or should they stay home?” Knowing when it’s okay to send your kids to school when it’s time to rest can help them recover faster and keep their classmates from getting sick too.

What is strep throat?

Strep throat is a bacterial infection of the throat caused by the Streptococcus pyogenes bacterium. Also called streptococcal pharyngitis, it’s most common in children between the ages of 5 and 15, partly because their immune systems are still developing and they spend a lot of time in close contact with others at school, daycare, or home. The infection is also more frequent in winter and early spring, when kids tend to spend more time indoors.

How does strep throat spread?

Strep throat is highly contagious and can spread easily through:

• Respiratory droplets (coughing, sneezing)

• Direct contact with saliva or nasal secretions

• Sharing utensils, drinks, cups, or food

• Close-contact settings like schools or daycares

The length of time strep throat is contagious depends on treatment. Children can spread the infection 2 to 5 days before symptoms appear. Without treatment, strep throat can remain contagious for 2 to 3 weeks. However, once a child starts antibiotics, they are usually no longer contagious after 24 hours after their first dose.

Diagnosing strep throat

Strep throat is most accurately diagnosed with a throat culture, which is considered the gold standard. This test takes about 1–2 days to get results. Another commonly used method is the rapid strep test, or the rapid antigen detection test (RADT), which provides results in about 15 minutes. RADT has high specificity (over 95%), meaning a positive result is very reliable, but its sensitivity is lower (70 to 90%), so it can miss some cases. For children with a negative RADT but strong symptoms of strep, the result should be confirmed with a throat culture.

Symptoms of strep throat 

Recognizing strep throat in kids can be tricky because the symptoms sometimes resemble a common cold. However, there are specific signs to watch for that can help you spot the infection early and get your child the care they need.

• Sudden sore throat

• High fever (especially on the second day)

• Pain with swallowing

• Red, swollen throat and tonsils with yellow or white patches or exudates (patches of pus)

• Tender, swollen lymph nodes in the neck

• Headache

• Nausea

• Vomiting

• Abdominal pain

• Palatal petechiae (small red spots on the roof of the mouth)

If left untreated, strep throat can sometimes lead to a scarlatiniform rash, a sandpaper-like rash that often appears with scarlet fever, or rheumatic fever, an inflammatory condition that can affect the heart, joints, brain, and skin.

On the other hand, if your child has a cough, runny nose, or conjunctivitis (pink eye), it’s more likely a viral infection, not strep throat.

How to treat strep throat

In children, laboratory confirmation is required before starting treatment, as clinical symptoms or scoring systems alone are not reliable. This means that a positive throat culture must be obtained before a doctor can prescribe treatment. 

Strep throat is uncommon in children under the age of three. This is because their immune systems are still developing, and the symptoms of strep throat are largely due to the body’s immune response to the infection. When kids under three get strep throat, their bodies typically do not mount the same type of immune response seen in older children, so they often do not develop the classic symptoms of strep throat. Plus, their anatomy is less developed, which makes strep colonization less likely. For these reasons, routine testing and treatment for strep throat in this age group are not recommended.

If your child is diagnosed with strep throat, the first line of treatment is usually antibiotics, most commonly penicillin or amoxicillin. For children who are allergic to these medications, alternative antibiotics are available. Antibiotics are the preferred treatment because they can shorten the duration of symptoms and prevent potential complications, reducing the risk of spreading the infection to others.

Does strep throat go away on its own?

Yes, strep throat can resolve without treatment, but leaving it untreated increases the risk of complications in children.

What is the second line of treatment?

If the first course of antibiotics doesn’t work, or if strep throat returns soon after treatment, your child may need a different or stronger antibiotic. It’s also possible that your child is a streptococcus carrier, which means they carry the bacteria in their throat without showing symptoms but can still test positive or occasionally spread it to others.

Strep throat prevention

Because strep throat is highly contagious, it’s important to take steps to reduce the risk of spreading it. 

• Getting a prompt diagnosis and starting antibiotics if prescribed

• Encouraging frequent handwashing

• Teaching kids good respiratory etiquette, like covering their mouth and nose during a cough or sneeze

• Reminding kids not to share food, drinks, or utensils

• Disinfecting commonly touched surfaces around the home

• Keeping children home from school or daycare until they are no longer contagious

Can kids go to school with strep throat? 

The short answer is no. Children with strep throat are contagious and can easily spread the infection to others, so keeping your kids home from school or daycare is recommended until treatment begins. Once your child has been on antibiotics for at least 24 hours, is fever-free, and is feeling better, it’s generally safe for them to return to school.

When to consult a pediatrician

Consult your pediatrician if:

• Symptoms do not improve within 48 to 72 hours of starting antibiotics. 

• Symptoms return soon after completing treatment.

• There are concerns about possible complications such as difficulty breathing, neck swelling, difficulty swallowing, or severe pain.

If you have questions about strep throat, reach out to your local or Summer Health pediatrician or pediatric dietitian for support. Summer Health is a pediatric telehealth platform offering 24/7 care, providing answers for everything from urgent concerns to everyday questions about your child’s health.