Doctors cannot accurately diagnose strep in all cases by examination of the throat only. Some of the worst appearing throat infections are caused by viruses, not strep, and can make children quite ill. This illness is most common in children between 4-15 years old. Children under 2 years usually do not get strep throat. Children under 4 years may not get a throat infection from strep, but may instead get a respiratory infection with low grade fever, congestion and swollen glands.
Scarlet fever is strep throat with a rash.
Certain strains of Group A Strep produce a toxin which causes the classic red, sandpaper-like rash. The rash is only occasionally bothersome. It may peel as it resolves. The hands may also peel dramatically after the child is better. The illness is treated the same as strep throat without the rash, and is generally really not more serious.