Babies can’t tell you their throat hurts, so you have to read the clues. The most reliable signs are refusing to feed or pulling away during nursing or bottle-feeding, a scratchy or hoarse-sounding cry, increased fussiness (especially around mealtimes), and drooling more than usual. If your baby is under 3 months old, contact your pediatrician at the first sign of any of these symptoms.
Behavioral Signs to Watch For
Because babies communicate through behavior, changes in how they eat and sound are your best indicators. A baby with a sore throat will often start a feeding normally, then pull away or cry partway through because swallowing has become painful. Some babies refuse the breast or bottle entirely. Others will nurse in shorter bursts, taking less milk than usual.
You may also notice your baby drooling significantly more than normal. This happens because swallowing saliva is uncomfortable, so it pools and spills out instead. A change in the sound of their cry, particularly a scratchy or raspy quality that wasn’t there before, is another strong clue. General irritability that doesn’t improve with the usual comforting measures, especially if paired with a fever, points toward throat pain.
What You Might See in Their Mouth
If your baby will let you look, you can gently open their mouth in good light. A sore throat from a viral infection typically shows redness at the back of the throat, and you may see the tonsils looking puffy or swollen. Small red dots on the roof of the mouth can also appear.
Certain infections produce more distinctive patterns. Hand, foot, and mouth disease, which is extremely common in children under 5, causes small red spots that blister on the tongue and inside the cheeks. These sores are painful and are often the reason a baby suddenly stops eating. You’ll usually also see a rash or tiny blisters on the palms, soles of the feet, or sometimes the trunk. Another common culprit, herpangina, produces small grayish-white blisters toward the back of the throat that can be quite painful.
Swollen lymph nodes are another physical sign. You can feel for these by gently pressing along the sides of your baby’s neck, just below the jawline. If you feel firm, tender lumps about the size of a pea or marble, that’s the immune system responding to infection in the throat area.
The Most Likely Causes by Age
In babies and toddlers, the vast majority of sore throats are caused by viruses. The common cold is the top offender, but hand, foot, and mouth disease and other viral infections are close behind. These typically come with a fever, runny nose, and general cold symptoms that develop over 3 to 5 days after exposure.
Strep throat, the bacterial infection parents often worry about most, is rare in children under 3. It’s most common in children between ages 5 and 15. Group A strep causes roughly 20% to 30% of sore throats in school-age children, but in babies, the odds are much lower. Your pediatrician is unlikely to test for strep in a very young infant unless there are unusual circumstances.
How to Help Your Baby Feel Better
Keeping your baby hydrated is the single most important thing you can do. Babies with sore throats may resist feeding because it hurts, but dehydration can develop quickly when a fever is also present. Offer breast milk or formula in smaller, more frequent amounts rather than pushing a full feeding. For babies old enough to drink water (typically 6 months and older), cool fluids can feel soothing on an inflamed throat.
A cool-mist humidifier in the room where your baby sleeps adds moisture to the air and can ease irritation in the throat and nasal passages. Clean the humidifier regularly to prevent mold buildup. If your baby also has a stuffy nose, saline drops and a nasal aspirator can clear congestion, which helps them breathe more comfortably and feed more easily.
For pain and fever, acetaminophen is safe for most young infants. Ibuprofen should not be given to babies under 6 months old. Both are dosed by your baby’s weight rather than age, so check with your pediatrician or pharmacist if you’re unsure of the correct amount. Never give aspirin to a child of any age.
Keep your baby’s sleep environment safe while they’re sick. It’s tempting to prop them up, but infants under 12 months should continue to sleep flat on their backs with nothing extra in the crib.
Signs That Need Immediate Attention
Most sore throats in babies resolve on their own within a week, but a few warning signs require urgent care. Seek emergency medical attention if your baby has difficulty breathing, is drooling excessively and seems unable to swallow at all, or cannot tolerate any liquids. These symptoms can indicate significant swelling in the throat that is blocking the airway.
A fever in a baby under 3 months always warrants a call to your pediatrician, regardless of other symptoms. For older babies, a fever lasting more than a few days, a rash that accompanies the sore throat, or signs of dehydration (fewer wet diapers, no tears when crying, a sunken soft spot on the head) are all reasons to get your baby seen promptly.