Tonsillitis
Sore throat - tonsillitis
Tonsillitis is inflammation (swelling) of the tonsils.
If your child often has a sore throat, trouble swallowing, and ear pain, she may have a problem with her tonsils. So, what causes tonsillitis? The tonsils are small, dimpled, golf ball-like nodes on either side of the back of your child's throat. They normally help to filter out bacteria and other germs to prevent infection in the body. If the tonsils become so overwhelmed with bacteria from strep throat or a viral infection, they can swell and become inflamed, causing tonsillitis. Your child's doctor will look in your child's mouth and throat for swollen tonsils. The tonsils will probably be red and may have white spots on them. The lymph nodes in your child's jaw and neck may be swollen and tender to the touch. The doctor may test your child's blood for infection. If bacteria are the cause, your child will probably need to take antibiotics, either in a shot or in pill form. If your child needs to take antibiotic pills, make sure she takes all of the medicine. To comfort your child, give her cold liquids and popsicles. Gargling with salt water can help. She can also take over-the-counter medicine like acetaminophen or ibuprofen for her pain and fever. Tonsillitis usually improves two or three days after treatment starts. The infection usually goes away too, but some people may need to take antibiotics for longer. If your child has a great many repeated infections, surgery may be recommended to remove her tonsils, but this is no longer a common reason to have the tonsils out.
The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).
Structures of the throat include the esophagus, trachea, epiglottis and tonsils.
Strep throat is the most common bacterial cause of sore throat. Because strep throat can occasionally lead to rheumatic fever, antibiotics are given. Strep throat often includes a fever (greater than 101 degrees Fahrenheit or 38.3 degrees Centigrade), white draining patches on the throat, and swollen or tender lymph glands in the neck. Children may have headache and stomach pain.
If your child often has a sore throat, trouble swallowing, and ear pain, she may have a problem with her tonsils. So, what causes tonsillitis? The tonsils are small, dimpled, golf ball-like nodes on either side of the back of your child's throat. They normally help to filter out bacteria and other germs to prevent infection in the body. If the tonsils become so overwhelmed with bacteria from strep throat or a viral infection, they can swell and become inflamed, causing tonsillitis. Your child's doctor will look in your child's mouth and throat for swollen tonsils. The tonsils will probably be red and may have white spots on them. The lymph nodes in your child's jaw and neck may be swollen and tender to the touch. The doctor may test your child's blood for infection. If bacteria are the cause, your child will probably need to take antibiotics, either in a shot or in pill form. If your child needs to take antibiotic pills, make sure she takes all of the medicine. To comfort your child, give her cold liquids and popsicles. Gargling with salt water can help. She can also take over-the-counter medicine like acetaminophen or ibuprofen for her pain and fever. Tonsillitis usually improves two or three days after treatment starts. The infection usually goes away too, but some people may need to take antibiotics for longer. If your child has a great many repeated infections, surgery may be recommended to remove her tonsils, but this is no longer a common reason to have the tonsils out.
Causes
The tonsils are lymph nodes in the back of the mouth and top of the throat. They help to filter out bacteria and other germs to prevent infection in the body.
A bacterial or viral infection can cause tonsillitis. Strep throat is a common cause.
The infection may also be seen in other parts of the throat. One such infection is called pharyngitis.
Tonsillitis is very common in children.
Symptoms
Common symptoms may be:
- Difficulty swallowing
- Ear pain
- Fever and chills
- Headache
- Sore throat, which lasts longer than 48 hours and may be severe
- Tenderness of the jaw and throat
Other problems or symptoms that may occur are:
- Problems breathing, if the tonsils are very large
- Problems eating or drinking
Exams and Tests
Your health care provider will look in the mouth and throat.
- The tonsils may be red and may have white spots on them.
- The lymph nodes in the jaw and neck may be swollen and tender to the touch.
A rapid strep test can be done in most providers' offices. However, this test may be normal, and you can still have strep. Your provider may send the throat swab to a laboratory for a strep culture. Test results can take a few days.
Treatment
Swollen tonsils that are not painful or do not cause other problems do not need to be treated. Your provider may not give you an antibiotic. You may be asked to come back for a checkup later to assess your progress.
If tests show you do have strep, your provider will give you an antibiotic. It is important to finish all of your antibiotic doses as directed, even if you feel better. If you do not take them all, the infection can return.
The following tips may help your throat feel better:
- Drink cold liquids or suck on fruit-flavored frozen bars.
- Drink fluids, and mostly warm (not hot), bland fluids.
- Gargle with warm salt water.
- Suck on lozenges (containing benzocaine or similar ingredients) to reduce pain (these should not be used in young children because of the choking risk).
- Take over-the-counter (OTC) medicines, such as acetaminophen (Tylenol) or ibuprofen to reduce pain and fever. DO NOT give a child aspirin. Aspirin has been linked to Reye syndrome.
Some people who have repeated infections may need surgery to remove the tonsils (tonsillectomy).
Outlook (Prognosis)
Tonsillitis symptoms due to strep will often get better within 2 or 3 days after you start the antibiotics.
Children with strep throat should be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.
Possible Complications
Complications from strep throat may be severe. They may include:
- Abscess in the area around the tonsils
- Kidney disease caused by strep
- Rheumatic fever and other heart problems
When to Contact a Medical Professional
Contact your provider if there is:
- Excess drooling in a young child
- Fever, particularly 101°F (38.3°C) or higher
- Pus in the back of the throat
- Red rash that feels rough, and increased redness in the skin folds
- Severe problems swallowing or breathing
- Tender or swollen lymph glands in the neck
References
Chi DH, Tobey A. Otolaryngology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 24.
Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillectomy in children (update) - executive summary. Otolaryngol Head Neck Surg. 2019;160(2):187-205. PMID: 30921525
Wetmore RF. Tonsils and adenoids. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 411.
Version Info
Last reviewed on: 10/31/2022
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
