Tonsillitis (Sore Throat) in Children

It is infection of the tonsils which gives a sore throat.

Children will have a sore throat and swollen lymph glands in the neck. They often have a fever and can be generally unwell. The sore throat may cause pain with swallowing.

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What causes tonsillitis in children?

It can be caused by

• viruses, such as coxsackie virus, adenovirus, or the infectious mononucleosis virus called Epstein-Barr virus (EBV)
• bacteria - most commonly Group A Streptococcus, which is commonly called Group A Strep

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How is tonsillitis in children diagnosed?

Children will have a sore throat and general symptoms like slight fever and grumpiness. When the doctor looks in their throat, they will have a red pharynx (lining of the palate) and red, enlarged tonsils. Sometimes, there will be pus on the tonsils.

Throat swabs can be taken to see if there is evidence of Strep.

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How do you know if the infection is caused by a virus or bacteria?

The only way to really know whether a bacteria is causing the tonsillitis is to take a throat swab and test for the bacteria.

If your child has a runny nose and other symptoms like diarrhea, the infection is more likely to be due to a virus. Pre-school children will more often have a viral infection causing a sore throat than a bacterial infection.

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What is the treatment of tonsillitis in children?

Keep your child drinking lots of fluids and give Paracetamol (Acetaminophen) if she is miserable - read more.

Try soft foods - ice cream is a popular choice!

If the infection is caused by Group A Strep (a bacteria), children need treatment for 10 days with an antibiotic (usually Penicillin).

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Will my child need surgery (tonsillectomy)?

Reasons for tonsillectomy include:

• recurrent infections that mean your child is missing school (usually at least 3 per year)
• quinsey, which is an abscess of the tonsils
• PFAPA syndrome - which is a syndrome with periodic fever, aphthous stomatitis (mouth ulcers), pharyngitis (sore throat) and large glands (adenitis)
• sleep apnoea - when children have episodes when they stop breathing when asleep

As you can see, an occasional episode of tonsillitis is not a reason for tonsillectomy.

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What is Strep Throat?

Strep throat is infection caused by Group A Streptococcus. As mentioned above, treatment is 10 days of Penicillin (an antibiotic).

This treatment is given to prevent Rheumatic fever, which can be a complication of Group A Strep throat infection.

Rheumatic fever usually occurs in children aged 5 - 15 years and is uncommon in most developed countries but is not uncommon in Maori and Pacific children in New Zealand. It is especially important for Maori and Pacific children to have a throat swab when they have a sore throat.

Children who get rheumatic fever will need long term antibiotic prevention of streptococcal infections as repeated infection can affect the heart valves.

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What should I do if my toddler has a sore throat?

If she has a runny nose and is not too unwell, just keep her drinking and keep her comfortable. Give soft food. If she is miserable or distressed with a fever, you can give Paracetamol (Pamol or Calpol) or Acetominophen (Tylenol).

If the symptoms do not improve after 3 days or if there are no signs of a virus, (she doesn't have a runny nose), see your doctor who can organise a throat swab, looking for signs of Strep throat.

If you live in New Zealand, particularly the North Island, and you are Maori or Pacific, then get a throat swab for your child as early as possible.