By Dr Tariq Jagnarine

Family Med, Endocrinology/Diabetes
Sore or scratchy throats are rarely a medical emergency on their own, but can still be troubling for new and veteran parents alike. The first step is to observe a baby’s symptoms and keep a close eye on them. Let the baby’s doctor know about all the baby’s symptoms. That will help a doctor determine if the baby needs to come in or to be seen or if to keep them at home to rest.
Always seek medical help right away if the baby is having difficulty breathing or swallowing.

There are several common causes of sore throat in babies.
• Common cold
A sore throat in infants is often caused by a viral infection like the common cold. The main symptoms of a cold are nasal congestion and a runny nose. These may be in addition to the sore throat symptoms. On average, babies may have up to seven colds in their first year of life as their immune system develops and matures. If a baby has a cold, consider keeping them home from childcare if:
• They have a fever. A good rule of thumb, and a rule at most childcare facilities, is to keep the baby home while they have an active fever and for an additional 24 hours after the fever breaks.
• They seem uncomfortable. If the baby is crying a lot or seems unlike their normal self, consider keeping them home.

• Tonsillitis
Infants can experience tonsillitis or inflamed tonsils. Tonsillitis is usually caused by a viral infection. If the baby has tonsillitis, they may not be interested in feeding. They may also:
• Have difficulty swallowing
• Drool more than usual
• Have fever
• Have a scratchy-sounding cry
The paediatrician may prescribe infant acetaminophen or infant ibuprofen if needed. If the baby is already eating solids, they’ll need to stick with soft foods.
• Hand, foot, and mouth disease
Hand, foot, and mouth disease is caused by various viruses and is common in children under 5. Symptoms may include a fever, sore throat, and mouth pain. The baby may have blisters and sores in their mouth, too. These may make it difficult to swallow. Parents will likely also see a rash of red bumps and blisters on the baby’s hands, feet, mouth, or buttocks.
The paediatrician may recommend fluids, rest, and infant acetaminophen or infant ibuprofen if needed.
Hand, foot, and mouth disease is very contagious. Keep the child home from childcare facilities until the rash has healed, which may take 7 to 10 days. Even if they are no longer acting as though they are sick after a few days, they’ll continue to be contagious until the rash has healed.
• Strep throat
Strep throat is a type of tonsillitis that is caused by a bacterial infection. While it’s uncommon in children under age 3, it’s still a possible cause for sore throat. Symptoms of strep throat in infants may include fever and very red tonsils with swollen lymph nodes on their necks.
If you suspect the baby has strep throat, contact a physician. They can perform a throat culture to diagnose it. They may prescribe antibiotics if needed.
If the baby is under 3 months, call their doctor at the first signs of a sore throat, such as refusing to eat or remaining fussy after eating. Newborns and infants under 3 months don’t have a fully developed immune system, so their paediatrician may want to see or monitor them.
If the baby is over 3 months, call the paediatrician if they have other symptoms in addition to seeming to have a sore or scratchy throat including:
• Temperature over 100.4°F (38°C)
• Persistent cough
• Unusual or alarming cry
• Isn’t wetting their diapers as usual.
• Ear pain
• Rash on their hand, mouth, torso, or buttocks
Always seek emergency medical care right away if the baby is having difficulty swallowing or breathing. Also seek emergency medical care if they have unusual drooling, which may mean they’re having trouble swallowing.

Some home remedies may be helpful for an infant with a sore throat.
• Humidifier
Setting up a cool-mist humidifier in the baby’s room may help ease sore throat symptoms. If the baby has a stuffy nose, the humidifier may help them breathe easier.
• Suction (for 3 months to 1 year)
Babies can’t blow their noses. Instead, parents can use a suction bulb to suck out nasal mucus. Saline drops may help loosen up the mucus to make it easier to remove it with suction.
• Frozen liquids (for older infants)
If the baby has already started solids, give them a frozen treat to soothe their sore throat. Try giving the baby a formula Popsicle or frozen breast milk in an infant Popsicle mould. Observe them while they try this frozen treat to watch for signs of choking.
• Honey?
It’s not safe to give honey to an infant under 1 year. Don’t give the baby honey water or any other remedies that contain honey. It can cause infant botulism.

• The treatment for the infant’s sore throat will depend on what’s causing it. If it’s caused by a common cold, the paediatrician will likely not recommend medication unless they have a fever.
• Antibiotics may be needed if the baby’s sore throat is caused by a bacterial infection like strep. The paediatrician will be able to diagnose the baby and prescribe antibiotics if needed.
• Over-the-counter cold and cough medications aren’t recommended for babies. They won’t cure cold symptoms and, in some cases, may make the child sick.
• The only exception is if the baby has a fever. For babies over 3 months, talk to the paediatrician about giving the baby acetaminophen or ibuprofen for a fever, if needed. They can also let you know the correct dose that’s safe for the baby.
• Only use diphenhydramine (Benadryl) if the paediatrician specifically recommends it. It generally isn’t safe for infants.

If a sore throat is caused by a cold, the baby will likely recover within 7 to 10 days. It may take slightly longer for the baby to recover if the sore throat is caused by hand, foot, and mouth disease, or from tonsillitis or strep throat.

It may not be possible to prevent sore throats completely, especially if they’re caused by the common cold. But taking the following measures may help reduce the risk of the little one getting sick again:
• Keep the baby away from other infants, siblings, or adults showing signs and symptoms of a cold or sore throat as much as possible.
• If possible, avoid public transportation and public gatherings with a newborn.
• Clean the baby’s toys and pacifiers often.
• Wash the hands before feeding or touching the baby.
• Adults can sometimes catch a sore throat or cold from infants. To prevent this, be sure to wash your hands often. Teach everyone in the household to cough or sneeze into the crook of their arm, or into a tissue that’s then tossed out.
Once the baby is fully recovered and back to their smiling self, resume all day-to-day activities – from walks to the park to playing with siblings.