Learn about the causes and treatment of tonsillitis, a common cause of sore throat in children.
Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck.
Most cases of tonsillitis are caused by infection with a common virus, but bacterial infections also may cause tonsillitis.
Because appropriate treatment for tonsillitis depends on the cause, it's important to get a prompt and accurate diagnosis. Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed only when tonsillitis occurs frequently, doesn't respond to other treatments or causes serious complications.
Tonsils are fleshy pads located at each side of the back of the throat.
Tonsillitis most commonly affects children between preschool ages and the midteenage years. Common signs and symptoms of tonsillitis include:
In young children who are unable to describe how they feel, signs of tonsillitis may include:
It's important to get an accurate diagnosis if your child has symptoms that may indicate tonsillitis.
Call your doctor if your child is experiencing:
Get immediate care if your child has any of these signs:
Tonsillitis is most often caused by common viruses, but bacterial infections also can be the cause.
The most common bacterium causing tonsillitis is Streptococcus pyogenes (group A streptococcus), the bacterium that causes strep throat. Other strains of strep and other bacteria also may cause tonsillitis.
The tonsils are the immune system's first line of defense against bacteria and viruses that enter your mouth. This function may make the tonsils particularly vulnerable to infection and inflammation. However, the tonsil's immune system function declines after puberty — a factor that may account for the rare cases of tonsillitis in adults.
Risk factors for tonsillitis include:
Inflammation or swelling of the tonsils from frequent or ongoing (chronic) tonsillitis can cause complications such as:
If tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria isn't treated or if antibiotic treatment is incomplete, your child has an increased risk of rare disorders such as:
The germs that cause viral and bacterial tonsillitis are contagious. Therefore, the best prevention is to practice good hygiene. Teach your child to:
To help your child prevent the spread of a bacterial or viral infection to others:
Your child's doctor will start with a physical exam that will include:
With this simple test, the doctor rubs a sterile swab over the back of your child's throat to get a sample of secretions. The sample will be checked in the clinic or in a lab for streptococcal bacteria.
Many clinics are equipped with a lab that can get a test result within a few minutes. However, a second more reliable test is usually sent out to a lab that can often return results within several hours or a couple of days.
If the rapid in-clinic test comes back positive, then your child almost certainly has a bacterial infection. If the test comes back negative, then your child likely has a viral infection. Your doctor will wait, however, for the more reliable out-of-clinic lab test to determine the cause of the infection.
Your doctor may order a CBC with a small sample of your child's blood. The result of this test, which can often be completed in a clinic, produces a count of the different types of blood cells. The profile of what's elevated, what's normal or what's below normal can indicate whether an infection is more likely caused by a bacterial or viral agent. A CBC is not often needed to diagnose strep throat. However, if the strep throat lab test is negative, the CBC may be needed to help determine the cause of tonsillitis.
Whether tonsillitis is caused by a viral or bacterial infection, at-home care strategies can make your child more comfortable and promote better recovery.
If a virus is the expected cause of tonsillitis, these strategies are the only treatment. Your doctor won't prescribe antibiotics. Your child will likely be better within seven to 10 days.
At-home care strategies to use during the recovery time include the following:
Treat pain and fever. Talk to your doctor about using ibuprofen (Advil, Children's Motrin, others) or acetaminophen (Tylenol, others) to minimize throat pain and control a fever. Low fevers without pain do not require treatment.
Unless aspirin is prescribed by a doctor to treat a particular disease, children and teenagers should not take aspirin. Aspirin use by children to treat symptoms of cold or flu-like illnesses has been linked to Reye's syndrome, a rare but potentially life-threatening condition.
If tonsillitis is caused by a bacterial infection, your doctor will prescribe a course of antibiotics. Penicillin taken by mouth for 10 days is the most common antibiotic treatment prescribed for tonsillitis caused by group A streptococcus. If your child is allergic to penicillin, your doctor will prescribe an alternative antibiotic.
Your child must take the full course of antibiotics as prescribed even if the symptoms go away completely. Failure to take all of the medication as directed may result in the infection worsening or spreading to other parts of the body. Not completing the full course of antibiotics can, in particular, increase your child's risk of rheumatic fever and serious kidney inflammation.
Talk to your doctor or pharmacist about what to do if you forget to give your child a dose.
Surgery to remove tonsils (tonsillectomy) may be used to treat frequently recurring tonsillitis, chronic tonsillitis or bacterial tonsillitis that doesn't respond to antibiotic treatment. Frequent tonsillitis is generally defined as:
A tonsillectomy may also be performed if tonsillitis results in difficult-to-manage complications, such as:
A tonsillectomy is usually done as an outpatient procedure, unless your child is very young, has a complex medical condition or if complications arise during surgery. That means your child should be able to go home the day of the surgery. A complete recovery usually takes seven to 14 days.
If your child is experiencing a sore throat, difficulty swallowing or other symptoms that may indicate tonsillitis, you'll likely start with a visit to your family doctor or your child's pediatrician. You may be referred to a specialist in ear, nose and throat disorders.
Your doctor is likely to ask you a number of questions about your child's condition. Be prepared to answer the following questions:
Questions you may want to ask your doctor include the following: