Sore Throat (Pediatric)

Approach to Sore Throat (Pediatric)

1. 🔍 Definition

• Sore throat = อาการปวดบริเวณ pharynx หรือโครงสร้างใกล้เคียง
• ต้องระวัง:
• อาจเป็น referred pain (ear, dental, esophagus)
• เด็กเล็กอาจอธิบายอาการไม่ชัด

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2. ⚠️ Life-threatening causes (ต้อง exclude ก่อน)

จำง่าย: Airway / Deep neck / Systemic severe infection

กลุ่มสำคัญ

• Epiglottitis
• high fever, toxic, stridor, drooling
• Deep neck space infection
• Retropharyngeal abscess (<4 yr)
• Lateral pharyngeal abscess
• Peritonsillar abscess
• uvula deviation, trismus
• Severe tonsillar hypertrophy (EBV)
• Diphtheria
• thick membrane + “bull neck”
• Lemierre syndrome
• septic thrombophlebitis + neck pain + sepsis

Red flags 🚨

• stridor / drooling / respiratory distress
• toxic appearance
• neck stiffness / torticollis
• voice change (hot potato voice)

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3. 🦠 Common causes

3.1 Viral (MOST COMMON)

• Adenovirus → pharyngoconjunctival fever
• Coxsackie → herpangina / HFMD
• Influenza → systemic symptoms
• COVID-19 → sore throat <30%
• HSV → stomatitis (immunocompromised)

👉 clue:

• cough, rhinorrhea, myalgia
• no exudate (often)

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3.2 Bacterial

⭐ Group A Streptococcus (GAS)

• fever
• tonsillar exudate
• palatal petechiae
• anterior cervical LAD

👉 incidence: up to 30% ในเด็กช่วง outbreak

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3.3 Infectious mononucleosis (EBV)

• fatigue เด่น
• posterior cervical LAD
• ± splenomegaly
• risk airway obstruction (rare)

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3.4 Other

• Candida → immunocompromised
• Gonorrhea → sexual exposure
• Irritation (dry air)
• Foreign body (fish bone)
• Systemic disease:
• Kawasaki
• SJS
• PFAPA

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4. 🧠 Key History

Feature	Suggestion
Respiratory distress	airway obstruction
Fever	infection
Fatigue prolonged	EBV
Abrupt onset (hours)	epiglottitis
Recurrent	viral / GAS / PFAPA
Sexual exposure	gonorrhea
Immunocompromised	fungal / atypical

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5. 🩺 Physical Examination (Key findings)

Airway risk

• stridor, drooling → emergency

Local findings

• Tonsillar asymmetry → peritonsillar abscess
• Vesicles → HSV / Coxsackie
• Diffuse mucositis → Kawasaki
• Thick membrane → diphtheria

Other clues

• Ear → otitis media
• Tooth swelling → dental abscess

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6. 🔬 Investigation

Routine

• Rapid strep test ± throat culture
• Monospot / EBV serology
• COVID testing (ตามบริบท)

Imaging (เฉพาะกรณี)

• lateral neck X-ray → epiglottitis / RPA
• CT neck → deep neck abscess

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7. 🧭 Algorithmic approach (Practical)

Step 1: Rule out life-threatening

👉 ถ้ามี:

• airway compromise
• toxic
  ➡️ manage airway + urgent imaging/consult

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Step 2: Look for obvious non-infectious

• foreign body
• referred pain
• irritation

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Step 3: Suspected infectious pharyngitis

มี vesicle → viral (Coxsackie) → symptomatic

ไม่มี vesicle + significant inflammation

➡️ test for GAS

• rapid test
• culture if negative (เด็ก)

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Step 4: Consider special cases

• persistent → EBV
• sexual risk → gonorrhea
• unvaccinated → diphtheria

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8. 💡 Clinical Pearls

• อย่าพลาด airway emergency → สำคัญที่สุด
• viral vs GAS overlap สูง → ต้องใช้ test
• tonsillar asymmetry = abscess จนกว่าจะพิสูจน์ว่าไม่ใช่
• fatigue เด่น → think EBV
• เด็กเล็ก + neck stiffness → suspect RPA

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9. 🧾 Take-home summary (สั้นมาก)

• Most = viral
• Always rule out:
  👉 epiglottitis / deep neck infection / abscess
• GAS = most common bacterial
• EBV = adolescent + fatigue
• Diagnosis = clinical + targeted testing

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