Group A Strep and Scarlet Fever

*** December 2022 Update**

Sore throats are very common at this time of year, and are usually caused by a virus that will get better by itself.

Occasionally, a sore throat with fever may be caused by a type of bacteria called Group A Streptococcus (a.k.a Group A Strep or GAS in short). GAS has been around for years, and many children will have been exposed to it already.

In fact, many of us, including children, carry it around normally without it causing any problems.  However, the very young ones (under 5 years) may not have come into contact with GAS before because they have had less social mixing than usual because of the Covid-19 pandemic. This may be why so many children under 5 years are now contracting the bacteria.

Many get only mild symptoms with it, or may have it without even knowing it and it doesn’t cause any problems. Some children may need simple oral antibiotics for it and a smaller proportion may need hospital treatment.

Luckily, complications from this disease are still very rare but parents and carers are extremely worried because GAS has been in the news because it has been the cause of some children becoming very ill and some sadly dying.

  • Most commonly, children with GAS will have a sore throat and a fever.
  • They will have yellowish-white spots at the back of their throat (their tonsils) and may have red spots at the top of their mouth (their palate).
  • They may complain of pain in their neck, or you may notice that they have tender lumps (lymph nodes) in their neck.
  • They usually don’t have much of a cough or a runny nose.

Some children with GAS develop Scarlet Fever where the children will have the same sore throat and a fever, but also have:

Children with symptoms of GAS or Scarlet Fever will usually need treatment with antibiotics.

A very small number of children will develop complications from this disease. This includes:

  • difficulties breathing
  • dehydration
  • painful limbs and joints
  • very tender skin redness which spreads quickly.

If you notice any of these signs, especially if your child has been diagnosed with GAS, please use our checker to identify where you should take them to be reviewed.

Many of the complications arise because of a recent viral infection which makes the body weaker when fighting this opportunistic bacterial infection. Therefore you can protect your child by making sure they are up to date with all their immunisations and have had their annual flu vaccination if they are over 2 years old.

Keep unwell children off school or nursery and away from vulnerable adults and children. If they have been diagnosed with GAS, they are to remain isolated for at least 24 hours after starting antibiotic treatment.

When should I worry and what should I do?

Where should you seek help?

  • If it is non-urgent, speak to your local pharmacist or health visitor.
  • Or contact you GP practice and a qualified member of the clinical team will assess if your child needs to be seen urgently.​​​​​​ For an urgent out-of-hours GP appointment, call NHS 111.
  • You should only call 999 or go your nearest A&E department in critical or life threatening situations.

For wear and tear, minor trips and everything in between.


You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughscolds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Sound advice

  1. Visit a pharmacy if your child is ill, but does not need to see a GP.
  2. Remember that if your child's condition gets worse, you should seek further medical advice immediately.
  3. Help your child to understand - watch this video with them about going to the pharmacy.

For information on common childhood illnesses go to What is wrong with my child?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

  • Breastfeeding, weaning and healthy eating
  • Exercise, hygiene and safety
  • Your child’s growth and development
  • Emotional health and wellbeing, including postnatal depression
  • Safety in the home
  • Stopping smoking
  • Contraception and sexual health
  • Sleep and behaviour management (including temper tantrums!)
  • Toilet training
  • Minor illnesses

For more information watch the video: What does a health visitor do?

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

All home educated children will have a named School Nurse.

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:-

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

The clinical team in GP surgeries include doctors, advanced nurse practitioners and nurses who are trained to assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP surgery team will arrange a referral to a hospital specialist should you need it.

Sound advice

You have a choice of service:

  1. Doctors/GPs can treat many illnesses that do not warrant a visit to A&E.
  2. Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  1. Many visits to A&E and calls to 999 could be resolved by any other NHS services.
  2. If your child's condition is not critical, choose another service to get them the best possible treatment.
  3. Help your child to understand – watch this video with them about going to A&E or riding in an ambulance

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Alder Hey Children's Charity