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CHAPTER 74 ■ SORE THROAT
CHRISTINA LINDGREN, ANDREW M. FINE

INTRODUCTION
Sore throat refers to any painful sensation localized to the pharynx or the
surrounding areas. Because young children, particularly those of preschool age,
cannot describe their symptoms as precisely as adults, the clinician who evaluates
a child with a sore throat must first define the exact nature of the complaint.
Occasionally, young patients with dysphagia (see Chapter 56 Pain: Dysphagia ),
which results from disease in the area of the esophagus or with difficulty
swallowing because of a neuromuscular disorder, will verbalize these feelings as
a sore throat. Careful questioning and examination usually suffices to distinguish
between these complaints.
Although a sore throat is less likely to portend a life-threatening disorder than
dysphagia or the inability to swallow, this complaint should not be dismissed
without a thorough evaluation. Most children with sore throats have self-limiting
or easily treated pharyngeal infections, but a few have serious disorders such as
retropharyngeal or lateral pharyngeal abscesses. Even if the reason for the
complaint of sore throat is believed to be an infectious pharyngitis, several
different organisms may be responsible. Symptomatic therapy, antibiotics, antiinflammatory drugs, or surgical intervention may be appropriate at times. Most
children experience no adverse consequences from misdiagnosis and
inappropriate therapy, but a few may develop local extension of infection or
sepsis, chronically debilitating illnesses such as rheumatic fever, or lifethreatening airway obstruction.

DIFFERENTIAL DIAGNOSIS
Infectious Pharyngitis
Infection is the most common cause of sore throat and is usually caused by
respiratory viruses including adenoviruses, coxsackievirus A (various serotypes),
influenza, or parainfluenza virus (see Chapter 94 Infectious Disease Emergencies
and Tables 74.1 to 74.3 ). Viruses are the causative agents of infectious
pharyngitis in 70% to 85% of patients, especially in adolescents and in children

younger than 2 years of age. Several of the respiratory viruses produce easily
identifiable syndromes, including hand–foot–mouth disease (coxsackievirus) and