Can Babies Get Strep Throat?
Strep throat is incredibly common among children. In fact, according to Johns Hopkins Medicine, it’s the culprit causing 30 percent of sore throats among kids. But can babies get strep throat too? And is strep in babies and toddlers as common as strep in older children? Here, pediatricians break down everything to know, including signs to look out for and treatment options for strep in babies.
Infants can get strep throat, but it’s extremely rare, says Sarah Terez Malka, MD, a pediatrician with Duration Health, a health and medication resource for travelers. Most babies have protective antibodies and immunity from their moms, Malka explains. Plus, due to the small size of an infant’s tonsils, it’s harder for strep bacteria to multiply and create an infection.
While strep throat is rare among kids under 3 years of age, it becomes more common between the ages of 5 and 15. “Younger and older children who are in contact with children in that age range may have a higher risk of strep if they’re exposed by a sibling,” Malka adds. That said, most sore throats in babies and toddlers are to be blamed on viruses rather than bacteria.
Strep throat is caused by the Group A B-hemolytic Streptococcus (GAS) bacteria, says Ruben Espinoza, MD, a pediatrician with Banner Medical Group. Typically, children get strep throat by coming into contact with someone else who has the GAS bacteria. “It can spread through direct contact like sharing a cup, touching an infected surface or through respiratory droplets,” he says (for example, coughing and sneezing). According to the Centers for Disease Control and Prevention (CDC), it may take up to five days after exposure for someone to become sick with strep throat.
It’s important to note that while strep in babies and toddlers is rare, exposure of the GAS bacteria can cause other manifestations of the illness for them, like scarlet fever and skin infections.
Group A vs. Group B strep
Wondering if Group A strep is connected to Group B strep? Though they share a common name, it’s two different types of bacteria, Malka says. Group B strep is a different strep bacteria that’s harmless and lives in the vaginal tracts of approximately 25 percent of women. However, if it’s present during vaginal birth, it could cause problems for baby, such as a bloodstream infection, fever and lethargy.
Can babies get strep throat from parents?
Yes, children can get strep throat from older siblings or their parents if they’re asymptomatic carriers, or from a setting like daycare if there’s an outbreak, Espinoza says. However, Alexis Phillips-Walker, DO, a pediatrician at Memorial Hermann Medical Group Pediatrics in Atascocita, Texas, cautions that this happens on rare occasions only. “If parents are concerned, they should wear masks to avoid spreading droplets and avoid sharing food or drinks with their children. It’s best, if parents are able to, to limit contact until after 24 hours of an antibiotic course to prevent the spread,” she says.
For some children, exposure to GAS bacteria may not cause any symptoms, but others may experience the “classic symptoms of strep throat,” Malka says. According to experts, symptoms typically seen in school-aged kids 5 and older include:
- A fever over 100.4 degrees Fahrenheit
- Swollen, painful lymph nodes in the front of the neck
- Sore throat
- Pain when swallowing
- Enlarged, red tonsils
- White patches or streaks of pus on the tonsils
- Tiny, red spots on the roof of the mouth
- Headache
- Stomach pain
- Nausea and vomiting
- Decreased appetite
While babies very rarely get infected with GAS, some signs of strep in babies include fever with fussiness and poor appetite, Phillips-Walker says, rather than “typical throat symptoms that appear in older children.”
Wondering when to see a doctor? Phillips-Walker says that parents should see their pediatrician if their child:
- Is under the age of one with a fever of 100.4 degrees Fahrenheit or more
- Is over the age of one with a fever higher than 101 degrees Fahrenheit
- Has a fever for more than two consecutive days
- Is fussier than normal
- Complains of throat pain, stomach pain, headache or other symptoms
Strep rash in babies
Along with strep throat, the group A strep bacteria can cause other illnesses and skin rashes in kids. “GAS sometimes can make a toxin, which causes the rash,” Espinoza explains. One of these illnesses is scarlet fever, Malka says, which includes symptoms like:
- Pink rash with rough, sandpaper-like skin on the torso, arms, legs or face
- High fever
- Reddened or bumpy tongue
- Possible sore throat
Other types of skin infections the GAS bacteria can cause include:
- Cellulitis: This presents as an area of warm, red, painful and swollen skin, Malka says. It may also be accompanied by a fever.
- Impetigo: This is “a rash that consists of red sores with a honey-colored crust, with or without a fever,” Malka says.
- Scalded Skin Syndrome: This is a serious skin infection that occurs in rare circumstances. It causes a fever and large areas of blistery, peeling skin and is a medical emergency, Malka says.
Strep throat is generally diagnosed with a strep test, in which a swab is taken from the throat, Espinoza says. If the test is positive, your pediatrician will prescribe treatment options. However— while the commonly used rapid strep test catches the vast majority of strep cases—if the test is negative, but your provider suspects your child has strep throat, they’ll send the swab to be further tested for GAS bacteria, and results can take a few days, the CDC notes.
Because strep throat is so rare in babies and toddlers, the American Academy of Pediatrics (AAP) says kids under 3 don’t typically require testing when they have a sore throat—they’re really only tested when there’s a high suspicion for it (i.e. they have siblings sick with strep throat). Plus, strep throat usually doesn’t cause long-term complications in babies and toddlers, the way it can for kids over age 3.
It’s also important to note that between 5 and 15 percent of kids carry strep bacteria in their throats. “This means that they test positive for strep, but are not infected,” Malka says. “This is why it is very important that they only get a strep test when they have classic symptoms of strep throat and are in the correct age range for strep throat (over age 3),” she says.
If baby does have a concerning strep rash or pus, your pediatrician may test the sores for strep bacteria, or your pediatrician may be able to make a diagnosis just by sight. For newborns with a fever, as well as very sick infants and toddlers admitted to the hospital, doctors will often test their blood for bacteria, including strep bacteria, Malka says.
Kids with a positive strep test are usually given oral antibiotics like penicillin, amoxicillin and cephalosporin (or azithromycin or clindamycin in case of allergies), Malka says. “While strep throat gets better on its own in most cases, treating it with antibiotics can help it to get better a few days faster and prevents a serious complication called rheumatic fever, which can lead to lifelong heart problems,” she adds. The CDC notes that school-aged kids and teens are most at risk for rheumatic fever, rather than adults. Your pediatrician will usually prescribe a 10-day course of antibiotics to prevent any complications, but many kids will start feeling better much sooner than that.
Malka cautions that pediatricians should never prescribe antibiotics without a strep test: “Over 60 to 75 percent of sore throats in children are caused by viruses and don’t need an antibiotic… Treating sore throats with antibiotics when they are not caused by strep will not help your child feel better any faster and can cause antibiotic resistance and other complications.” (Antibiotics are only given to treat bacterial infections, rather than viral ones.)
For the rare cases of strep throat in babies and toddlers, Phillips-Walker says treatment usually consists of managing symptoms with fever and pain relievers like Tylenol and Motrin. However, babies and toddlers with strep rashes and skin illnesses caused by the GAS bacteria are treated with antibiotic ointments for more minor infections, or oral antibiotics for illnesses like cellulitis or scarlet fever, Malka says. In rare circumstances, more severe cases of strep infections may need an IV antibiotic administered at a hospital.
Because strep throat in kids is caused by passing on the GAS bacteria through respiratory droplets, experts recommend practicing safe hygiene habits when trying to prevent illness. This includes teaching your child to:
- Properly wash their hands
- Not share food, drinks or utensils with someone who’s sick
- Avoid touching their face and putting things in their mouths
- Cover their coughs and sneezes
- Avoid contact with someone who has strep throat until they’ve taken antibiotics for at least 24 hours and are fever-free
- Stay home when sick to avoid infecting others
Watching baby struggle with sickness is never fun, but you can feel confident knowing there are ways to keep your little one happy and healthy. For any specific questions regarding strep in babies and kids, reach out to your pediatrician.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
Plus, more from The Bump:
Ruben Espinoza, MD, is a pediatrician and the division medical director for primary care at Banner Medical Group’s east region in Arizona. He completed his medical degree at Universidad Autonoma De Baja California and his residency at Elmhurst Hospital Center-Mt Sinai Services in New York City.
Sarah Terez Malka, MD, is a board-certified pediatrician and emergency medicine physician with Duration Health. She earned her medical degree from the Ben Gurion Medical School for International Health and completed her residency at University of Indiana School of Medicine.
Alexis Phillips-Walker, DO, is a pediatrician with Memorial Hermann Medical Group Pediatrics Atascocita in Atascocita, Texas. She earned her medical degree at Ohio University College of Osteopathic Medicine in Athens.
Johns Hopkins Medicine, Strep Throat, 2023
Healthy Children (American Academy of Pediatrics), Can Infants Get Strep Throat?, October 2016
Centers for Disease Control and Prevention, Strep Throat: All You Need to Know, January 2023
Centers for Disease Control and Prevention, Scarlet Fever: All You Need to Know, May 2023
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