Tonsillitis in Children: Causes, Symptoms, and Treatment

Acute inflammation or infection of the tonsils is a common affliction in children aged 3-5 years. The origin may be viral or bacterial, but the symptoms are distressing for the child. Your child may complain of sudden onset of severe pain in the throat, with difficulty in swallowing food and liquids. Often they will have a raised temperature with chills.

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What causes tonsillitis?

Up to 95% of acute tonsillitis or “sore throat” as it is commonly called – is caused by viruses. A recent study from Haryana concluded that only 5-15% of tonsillitis is caused by bacterial infections, which mandates antibiotics to be taken.

Tonsils are masses of lymphoid tissue, present in the throat which act as a guardian of the child’s airway by protecting it against infection. So it is common for viruses and bacteria to get lodged in these tissues, causing them to get inflamed and painfully swollen. The pain often radiates to the ear as well, due to the mass pressing on a nerve that passes through the bed of the tonsil as well as the ear. The pain makes it difficult for the child to eat or drink and often younger kids might even start drooling as even swallowing saliva becomes difficult for them. These children often develop fever as well and generally look tired and sick, made worse by loss of appetite and inability to eat. Lymph nodes in the neck may also swell up and appear as a firm mass under the jaw.

Why are children more likely to get tonsillitis than adults?

Tonsillitis is relatively more common in children rather than in adults as their natural immunity is still developing, and they are more exposed to environmental infections. Children mingle with their peers at school and during play and often spread infections to each other. The size of tonsils is larger in children than most adults as 3-5 years of age is the peak of lymphoid tissue development. So the obstruction while swallowing is more prominent.

How does a doctor diagnose tonsillitis?

Your paediatric ENT doctor will conduct an examination of the tonsils, check for enlarged lymph nodes in the neck, and take a culture swab from the tonsils to find out the virus or bacteria causing the infection. This is useful to predict what kind of antibiotic will be useful for treatment. During acute infection, tonsils appear “fire-engine red” with white spots on them denoting the pus points. If the child is looking dehydrated or sick, your doctor can prescribe IV fluids and admit the child to give medicines via IV since it may be difficult for the child to swallow medicines as well. Antibiotics should be taken as per the recommended course even if the child starts feeling better after the first 2 days. In severe cases, pus can collect over the tonsil tissue – termed as peritonsillar abscess. This can be drained by your paediatric ENT doctor.

How long will it take for my child to get better?

Antibiotics will usually show effect in 24-48 hours. Fever spikes and pain are alleviated by painkillers and anti-inflammatory medicines. Ensure a bland, soft diet to ease discomfort during feeds.

What happens if my child keeps getting tonsillitis?

The American Academy of Otolaryngology and Head and Neck Surgery has laid down guidelines termed Paradise criteria which helps in decision making related to removal of tonsils. This is often called the 7-5-3 rule. It states that if the child suffers from 7 episodes of tonsillitis in a year, 5 episodes in the previous 2 years, or 3 episodes in the past 3 years – tonsillectomy is recommended. If the culture swab shows an infection with a bacteria called Streptococcus – this is also a criterion for surgery. However, tonsillectomy is always done at least 3-6 weeks after an infection.

The surgery is done under general anaesthesia and is usually done in an hour. Post-operatively children may complain of pain – equivalent to the level of pain during an acute infection, and is managed effectively with painkillers. Post-operatively, your doctor will recommend a lot of ice creams and cold milkshakes to make up for the pain too!

Can tonsillitis be prevented?

Age-appropriate vaccinations as per the National Immunisation Schedule usually protect children from common viral infections. Some children are sensitive to cold or acidic food, so avoiding that will also reduce the frequency of these episodes.

Where can I find additional information about allergic rhinitis?


Tonsillitis or “sore throat” is common in children but can hamper their quality of life and feeding patterns. If your child is suffering from recurrent episodes, it is recommended to book an appointment with a Paediatric ENT doctor.

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