Parents should be concerned about a sore throat that does not improve after a sip of water after arising from sleep, or one that is accompanied by a headache, high fever, stomachache, vomiting, or severe tiredness. The presence of a red, somewhat rough-to-the-touch rash is also a concern, as strep infection along with a rash is known as scarlet fever (but this is no more dangerous than strep throat without a rash).
An urgent call to the doctor's office or emergency room visit is appropriate if the child has extreme difficulty swallowing that causes drooling, or the child is having difficulty breathing.
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