Red flags & when to go in person for Strep Throat (Suspected)

Audience: pediatric

Strep throat is a common infection in children caused by bacteria called group A Streptococcus. It often causes a sore throat, fever, and difficulty swallowing. Many cases can be initially assessed through telemedicine, where a healthcare provider asks about symptoms and observes the child. However, some signs mean your child should be seen in person for a thorough exam and possible testing. These include severe throat pain, difficulty breathing or swallowing, high fever, or signs of dehydration. Early recognition and treatment can help prevent complications. This guide helps parents and caregivers understand when to seek in-person care for a child suspected of having strep throat, what to expect during telemedicine visits, and how to prepare for them. Remember, telemedicine is a helpful tool but not a substitute for urgent or emergency care when red flags are present.

Red flags — go in person / ER

• Difficulty breathing or noisy breathing — seek emergency care immediately.
• Inability to swallow saliva or drooling — urgent in-person evaluation needed.
• High fever (above 39°C or 102°F) not improving with fever reducers — see healthcare provider in person.

What telemedicine can do

• Initial symptom assessment and history taking.
• Visual inspection of throat if lighting and camera quality allow.
• Providing guidance on symptom management and when to seek in-person care.
• Prescribing antibiotics if diagnosis is confirmed and local regulations permit.

What telemedicine cannot do

• Performing throat swab tests to confirm strep infection.
• Evaluating airway obstruction or severe breathing difficulties.
• Assessing dehydration severity requiring IV fluids.
• Managing complications like abscesses or severe infections requiring surgery.

What is Strep Throat?

Strep throat is an infection caused by bacteria called group A Streptococcus. It mainly affects the throat and tonsils, causing pain, redness, and sometimes white patches. It is common in children and spreads through close contact or coughing and sneezing.

Common Symptoms to Watch For

Typical symptoms include a sore throat, fever, headache, swollen lymph nodes in the neck, and difficulty swallowing. Some children may also have stomach pain, nausea, or a rash. Symptoms usually develop quickly over 1 to 3 days.

When to Seek In-Person Care

Certain signs mean your child should be evaluated in person right away:

If any of these occur, seek emergency or urgent care immediately.

How Telemedicine Can Help

A healthcare provider can use telemedicine to ask about symptoms, see your child’s throat if possible, and decide if testing or treatment is needed. Telemedicine is useful for initial assessment and follow-up but cannot replace physical exams or throat swabs needed to confirm strep throat.

Preparing for a Telemedicine Visit

Before the visit, have your child’s temperature taken and note symptoms and their duration. Find a quiet, well-lit place where the provider can see your child’s throat clearly. Have a list of current medications and any allergies ready to share.

After the Telemedicine Visit

Follow the provider’s advice on medications and care at home. Watch your child closely for any worsening symptoms or new red flags. If symptoms do not improve within 48 hours or get worse, seek in-person care promptly.

How to prepare for your tele-visit

• Measure and record your child's temperature.
• Note the start date and progression of symptoms.
• Find a quiet, well-lit area for the video call.
• Have your child's current medications and allergy information ready.
• Prepare to show your child's throat using the camera if possible.
• Write down any questions or concerns to discuss with the provider.

After your tele-visit

• Administer prescribed medications as directed.
• Encourage rest and fluid intake to prevent dehydration.
• Monitor your child’s symptoms closely for improvement or worsening.
• Use fever reducers as recommended by the provider.
• Seek in-person care if red flags or worsening symptoms appear.
• Follow up with your healthcare provider if symptoms persist beyond 48 hours.

FAQs

Can strep throat be diagnosed without a throat swab?

While some symptoms suggest strep throat, a throat swab test is the most reliable way to confirm the infection. Telemedicine providers may recommend an in-person visit for testing if strep is suspected.

Is strep throat contagious?

Yes, strep throat spreads easily through respiratory droplets when an infected person coughs or sneezes. Good hand hygiene and avoiding close contact help reduce spread.

How soon can antibiotics help my child feel better?

Antibiotics often start improving symptoms within 24 to 48 hours. It's important to complete the full course even if your child feels better sooner.

When should I be worried about complications?

If your child develops difficulty breathing, swallowing, persistent high fever, rash, or signs of dehydration, seek immediate medical attention as these may indicate serious complications.

Can my child return to school or daycare during treatment?

Children with strep throat are usually contagious until they have taken antibiotics for at least 24 hours and their fever has resolved. Follow your healthcare provider’s advice on when it is safe to return.

Sources

1. Strep Throat — MedlinePlus, U.S. National Library of Medicine.
2. Group A Streptococcal (GAS) Disease — Centers for Disease Control and Prevention (CDC).
3. Pharyngitis (Sore Throat) in Children — American Academy of Pediatrics.
4. Strep Throat and Scarlet Fever — Mayo Clinic.

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical evaluation, diagnosis, or treatment. If your child shows any red flags or worsening symptoms, seek immediate in-person medical care.