Tonsils are lumps of tissues located on either side at the back of the throat. Also known as palatine tonsils, they protect the body from infections (1). Tonsillitis is a condition where the tonsils get inflamed due to infection, bacterial, or viral.
It can occur in children of any age but is mostly seen in school-going children from preschool to teenage. Pain during swallowing fluids is usually one of the first signs.
If left untreated, the infection may spread beyond the tonsils into the neck and chest, and cause airway obstruction. Thus, it is important to diagnose and treat tonsillitis early. In this post, we bring you the signs, types, and treatments for tonsillitis in children.
How Does Tonsillitis Look In Children?
Tonsillitis causes the tissue on either side of the uvula to become red and swollen. Sometimes, there could be white or yellow spots on the tissue.
Tonsillitis is contagious and can spread if an infected person sneezes or coughs near your child. The incubation period can vary depending on the pathogen. It can take a day to five days for the symptoms to emerge.
Signs And Symptoms Of Tonsillitis In Children
There are three types of tonsillitis, acute, chronic, and recurrent, with the symptoms differing for each type. However, there are a few common symptoms which include (2):
- Sore throat
- Rough voice
- Difficulty in swallowing
- Enlarged and tender lymph glands near the neck
- Bad breath
- Red and swollen tonsils
- Stiff neck
- White or yellow patches on the tonsils
- Ear pain
Types Of Tonsillitis
1. Acute tonsillitis
This type is the most common in children, with symptoms lasting up to ten days or less. It is characterized by sore throat, difficulty in swallowing, grey or white coating on the tonsils, and fever with a temperature higher than 38.3°C (100.94°F) (rectal) (3).
This can be treated with prescription antibiotics. A few home remedies might also help relieve the symptoms.
2. Chronic tonsillitis
When the symptoms last longer than ten days, then it could be chronic tonsillitis. Additional symptoms such as bad breath, swollen and tender lymph nodes near the neck might appear. The infection may also spread to the connective tissues of the neck and chest, resulting in tonsil stones. Tonsil stones are hardened dead cells, saliva, and food that gets built up in the tonsils’ crevices.
The pediatrician might recommend a tonsillectomy (a surgical procedure to remove the tonsils) in the case of chronic tonsillitis.
3. Recurrent tonsillitis
Your child is said to have recurrent tonsillitis when they have any one of the following:
- Seven or more episodes of tonsillitis in a year.
- Five or more episodes of tonsillitis in two years.
- Three or more episodes of tonsillitis in three years.
If the recurrent tonsil infection is due to bacteria, then the standard treatment option is a tonsillectomy (4). Tonsillectomy is usually done in children under the age of six when there is recurrent tonsillitis due to bacterial infection (3). Otherwise, a less risky partial tonsillectomy is the first line of therapy.
Risk Factors And Complications Of Tonsillitis
The following are the common risk factors for tonsillitis in children.
- Studies suggest that recurrent tonsillitis could be because of the microorganisms creating biofilms and repository of infections within the folds of the tonsils (5).
- A study pointed out that children with impaired development of anti-SpeA antibodies in their immune systems have lower resistance to Streptococcal bacteria, causing repeated episodes of tonsillitis (6).
- Children in close contact with those with infections, school-going children, and those who spend substantial time at daycare are usually at an increased risk (7).
Swollen and enlarged tonsils might lead to the following complications.
- Increased possibility of respiratory tract infections, such as common cold.
- Middle ear infections and glue ear as the enlarged tonsils restrict the flow of air to and from the middle ear.
- Severe enlargement of the tonsils causes breathing pauses and obstructive sleep apnea in about 2% of children with tonsillitis (8).
Causes Of Tonsillitis In Children
Tonsils are lymphoid organs that protect the airway and the lungs by trapping germs that enter the body. Sometimes, these germs enter the folds of tonsils and create a repository which leads to infection.
Viruses and bacteria are common causes of tonsillitis. Acute and mild viral tonsillitis may subside on its own in a week or two, but if your child is showing severe symptoms or if the infection is recurring, then they might need medical intervention.
The Epstein-Barr virus is said to cause both mononucleosis and tonsillitis. So, if your child has mononucleosis, then there is a chance of them developing tonsillitis as a secondary infection.
Bacteria are said to be the cause of about 15-30% of tonsillitis cases (9). Streptococcus pneumoniae and Streptococcus aureus are the two types of bacteria that cause tonsillitis. The Streptococcus pneumoniae can stay inside the body without causing infection and might get transmitted from adults to children (10).
The symptoms of both forms of tonsillitis are similar, and the exact cause can only be determined through medical testing. If tonsillitis is caused by common cold and flu viruses, the symptoms tend to be mild (11). Bacterial tonsillitis due to streptococcus bacteria tends to display severe symptoms, along with a bad breath.
When To Take Your Child To The Doctor?
If your child has the following symptoms, then it is best to take them to a doctor.
- Has a sore throat for more than two days
- Has trouble swallowing
- Feeling sick and weak
- Shows trouble breathing
- Starts to drool
Diagnosis Of Tonsillitis
The healthcare provider examines your child’s throat and neck, and ask questions about the child’s medical history and symptoms. They examine your child’s tonsils for swelling, redness, or white spots. In some cases, a throat culture or rapid strep throat test or both may be recommended.
Infection can also be confirmed through a blood test that shows a high amount of white blood cells.
Treatment For Tonsillitis
Acute and mild tonsillitis caused by viruses are benign, and the symptoms usually subside in a week or two. But if it is a bacterial infection or if the symptoms are severe and do not subside on their own, your child’s doctor might prescribe beta lactam antibiotics, such as penicillin or cefuroxime. Studies suggest that antibiotic treatment might prevent the spread of infection beyond the tonsils, thus reducing the risk of inflammation of the ear and sinusitis (3).
It is important to complete the entire course of the prescribed antibiotics, even if the symptoms disappear, as the infection might return. In recurrent bacterial and viral infections, your doctor may recommend tonsillectomy after considering the child’s age and other health factors.
Home Remedies For Tonsillitis
Along with the treatment prescribed by your child’s doctor, you can try some home remedies to relieve the symptoms of tonsillitis. Do note that most of these remedies lack scientific evidence, and it is best to take the pediatrician’s opinion before trying any of them.
- Make sure your child gets lots of rest.
- Ask them to drink fluids frequently.
- Serve them soft foods that do not hurt the throat.
- Some children might find warm foods, such as soups, soothing, while cold food items, such as popsicles, might soothe the throat in some children.
- You can use a cool-mist humidifier in your child’s room. The humidifier can make breathing easier and relieve throat irritation.
- You may give over-the-counter medicines, such as acetaminophen or ibuprofen, for pain relief after consulting the doctor. Never give aspirin to children (12).
Prevention Of Tonsillitis In Children
The best way to prevent tonsillitis is to keep the child away from those with tonsillitis or other upper respiratory system infections. You may also take the following preventive measures.
- Train your children to practice basic hygienic habits like washing hands and to close their mouth while coughing or sneezing.
- Maintain good hand hygiene outdoors by using a hand sanitizer.
- If there is an outbreak of infection, then encourage your child to wear a mask at school or daycare.
- Discourage sharing of utensils with others since pathogens can transmit through saliva.
- Immunization against pathogens, such as the flu virus, can reduce the risk of infections, including tonsillitis.
Frequently Asked Questions
1. How do I know if my child’s tonsils need to be removed?
Tonsillectomy or surgical removal of tonsils is mostly recommended in the case of chronic or recurrent bacterial tonsillitis, or when the swollen tonsils cause severe complications, such as the blockage of airways (13). Your child’s doctor may try other non-invasive treatment methods, such as antibiotics, to provide relief without the need for surgery. If the child needs tonsillectomy, the doctor will consider the age of the child and other health factors.
Tonsils work as defensive organs, and their removal may make the child’s body susceptible to infections. Therefore, the doctor may consider tonsillectomy only when the benefits of surgery outweigh potential risks.
2. Can my child get strep throat even after the removal of tonsils?
According to Dr. Troy Madsen of the University of Utah, your child may still get a strep throat infection even if their tonsils are removed. However, the possibility of strep throat will be less (14).
Tonsillitis may start with sore throat symptoms, but in the absence of proper diagnosis and timely treatment, it can pave the way to other complications. It is necessary to monitor your child’s symptoms carefully and take them to a healthcare provider on time. Also, it is important to teach them basic hygienic habits to protect them from such infections.
2. Tonsillitis; Brenner
3. Klaus Stelter, Tonsillitis and sore throat in children; NCBI
4. Tonsillitis; University of California, Irvine
5. Muhamad Abu Bakar et al., Chronic tonsillitis and biofilms: a brief overview of treatment modalities; NCBI
6. Jennifer M. Dan et al.; Recurrent group A Streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant TFH cells; Science Translational Medicine
7. Pharyngitis and Tonsillitis in Children; University of Rochester
8. Enlarged tonsils and adenoids: Overview; Institute for Quality and Efficiency in Health Care; NCBI
9. Tonsillitis; ENT Health
10. Chateen I Ali Pambuk, Acute Tonsillitis in children: Causes and Types; Acta Scientific Microbiology
11. Tonsillitis; NHS inform
12. Tonsillitis; MedlinePlus; U.S National Library of Medicine
13. When a Child’s Tonsils Need to Come Out; Stanford Children’s Health
14. 4 Tell-tale Signs You Have Strep Throat; Health University of Utah
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