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Pediatric Tonsillitis



Tonsils and adenoids are lymph nodes located in the back of the throat and behind the nose. Their job is to help trap bacteria and other germs that cause infections. Sometimes though, tonsils and adenoids can become infected themselves. When this happens it may result in a condition known as tonsillitis.

Expanded Overview

Your child’s pharyngeal tonsils (adenoids) are two glands of tissue visible in the back of the throat. The tonsils function to help your child’s immune system protect the body from infections. When the tonsils become infected with a virus or bacterial infection, it is called tonsillitis - meaning inflammation of the tonsils. Tonsillitis is a very common childhood illness, typically affecting school-aged children, aged four to sixteen.

A complication of tonsillitis is a peritonsillar abscess, which happens when the infection spreads behind the tonsils. When this happens, early treatment is necessary because swollen tissue in the neck and chest can possibly block your child’s airway. 


The main types of tonsillitis include:

  • Acute - symptoms happen suddenly
  • Chronic - symptoms of tonsillitis are constantly present, even after treatment
  • Recurrent - several episodes of acute tonsillitis in one year


Viruses, bacteria, allergens or irritants such as air pollution or cigarette smoke may cause a sore throat. Fungi or chronic postnasal drip may also result in a sore throat. Tonsillitis is the result of either a bacterial or viral infection, sometimes due to strep throat.  If the infection occurs farther down the throat it's known as pharyngitis.

  • Contact with droplets from a sick person’s cough or sneeze may get your child sick.
  • Epstein-Barr virus (EBV) 
  • He/she can also pick up tonsillitis by eating or drinking from the same glass or plate as a sick person. Strep throat is the result of streptococcus bacteria (group A strep) and may be picked up from the above or contact with a group A strep skin infection.
  • Herpes simplex virus
  • Streptococcus pyogenes (strep throat


Tonsillitis is especially common in children. Symptoms may include:

  • Bad breath
  • Ear pain or difficulty breathing (adenoids)
  • Enlarged lymph nodes in neck
  • Fever and/or chills
  • Headache
  • Nausea
  • Scratchy voice
  • Sensitive or sore throat that lasts longer than 48 hours
  • Snoring
  • Trouble swallowing
  • Unusual fussiness (in infants and toddlers)
  • White or yellow coating or patches on the tonsils

Tests and Diagnosis

Tonsillitis is an infection of the tonsils or adenoids. It may be either viral or bacterial. Because symptoms of both types of tonsillitis are the same, a doctor will usually perform a strep test to determine the appropriate treatment.

If you suspect your child may have tonsillitis (or strep), gently place the handle of a spoon on his tongue while he says, "aaahh." Shine a light into his mouth. If the tonsils (two fleshy lumps at the back and sides of the throat) look bright red or swollen — or his/her sore throat lasts more 48 hours — you should take your child to a doctor. If your child resists, or is an infant, you should avoid this test.

You should also see a doctor if your child has difficulty swallowing or is extremely weak or fussy. You should seek immediate care if he has trouble breathing or is drooling.

A doctor will perform a similar procedure to the one above in her office. She will look for unusual redness or white spots on the tonsils, as well as swollen or tender lymph nodes.

Your child’s doctor can usually provide a rapid strep test in her office. For a more accurate test, she may send a throat swab to a lab for a strep culture. In that case, the results may take a few days.


If your child has viral tonsillitis, it will usually go away on its own in a few days. If strep throat caused her tonsillitis, your pediatrician will prescribe antibiotics. Children on antibiotics usually feel better in two or three days. It is important that your child takes the exact dosage of antibiotics over the full amount of time, however, even if her symptoms improve.

Things that may help your child’s tonsillitis include:

  • Drinking cold liquids or warm, bland fluids (not hot)
  • Gargling with warm salt water
  • Lozenges containing benzocaine (not recommended for infants or very young children)
  • Over-the-counter pain medications such as ibuprofen or acetaminophen (NOT aspirin, as it has been linked to Reye’s syndrome in children)
  • Sucking on a Popsicle or eating ice cream

Children on antibiotics should stay out of school or day care for 24 hours to prevent the spread of strep to other kids.


If your child has repeated infections, your child’s doctor may recommend a tonsillectomy — an outpatient surgery to remove the tonsils. Tonsillectomies are one of the most common and safe operations performed on children today. It usually takes just 20 minutes and your child can go home a few hours after the surgery.


Hand washing and avoiding sick people are the best ways for your child to avoid getting tonsillitis.


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