Worried child being checked for tonsillitis

After 25 years in practice, I have begun to recognise the calls I receive from parents. When I get a call from a distressed parent whose child has a very high fever, who is refusing to eat or to take fluids, the culprit is very often tonsillitis.

Tonsils are oval-shaped glands found at the back of the throat and their job is to act as a barrier to viruses or bacteria that enter through the nose or mouth and threaten to infect the rest of the body. When the illness is such that it causes swelling and inflammation of the tonsils, then this is known as tonsillitis.

Causes of tonsillitis in children

Tonsillitis is usually caused by viruses and often accompanies the common cold with symptoms like sneezing, a runny nose and coughing. Children with viral tonsillitis will need symptomatic relief for pain and fever but their bodies will have to do the work in fighting the infection. In some cases, tonsillitis may be bacterial. The bacteria responsible is a Group A Streptococcal bacteria, which causes strep throat. If the child has a strep throat then an antibiotic will be necessary.

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What are the symptoms of tonsillitis in children?

The obvious symptom is a sore throat and this usually presents along with other cold-like symptoms. The child is likely to have a high temperature (above 38 degrees Celsius), a runny nose and cough.

Other symptoms of tonsillitis in a child may include:

  • Refusal to eat or drink
  • Difficult or painful swallowing
  • Excessive fussiness
  • Drooling or an unusual amount of saliva
  • Red, swollen tonsils
  • White or yellow coating or patches on the tonsils
  • Enlarged, tender glands (lymph nodes) in the neck
  • A gruff voice
  • Smelly breath

How is tonsillitis diagnosed in children?

Since untreated tonsillitis has the potential of leading to other more serious illnesses, it is important for the child to be examined by a doctor if the symptoms above are present. The doctor will have to examine the child fully and special attention will be given to:

  • Checking the child’s ears, nose and throat.
  • Ensuring the child is breathing normally.
  • Ensuring that the child does not have a rash. A rash may appear as a result of scarlet fever, which could be a result of a strep throat.

Signs that the child has a strep throat (bacterial tonsillitis) would include clinical signs like:

  • A sore throat that lasts longer than two days
  • A sore throat with white patches
  • Dark, red splotches or spots on the tonsils or the top of the mouth
  • A sore throat with a fine, sandpaper-like pink rash on the skin
  • Difficulty breathing
  • Difficulty swallowing

The doctor may do a swab of your child’s throat to decide if the infection is viral or bacterial before prescribing an antibiotic. The swab will be analysed in the laboratory and the results are available to the doctor within 12 to 24 hours. If your child has bacterial tonsillitis, the antibiotic treatment may be used together with these other measures.

doctor looking at a child's throat: tonsillitis in children causes symptoms and treatment

What is the treatment for tonsillitis in children?

Regardless of whether your child has a viral or bacterial infection, I would recommend that the child:

  • Is given paracetamol for pain and fever. Please ensure that it is given in the correct dose.
  • If the pain or fever is extreme, then your doctor may recommend ibuprofen. Again, it is really important to give the correct dose.
  • Has a humidifier on in the room.
  • Drinks plenty of fluids.
  • Gets plenty of rest.
  • The child may gargle with salt water. Please only allow this in older children who are not likely to swallow or choke on the saltwater.

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There is no doubt that tonsillitis makes a child feel really ill. The symptoms are likely to last seven to 10 days even with antibiotics. Hopefully, the fevers will subside in a couple of days, but the sore throat and congestion may take longer. Removing the tonsils is not something that is to be taken lightly. There are strict criteria that are followed before a doctor would recommend removing the tonsils.

If they are under the age of five years it is likely to be tonsillitis is an illness most parents can expect at least once in a year and affects children usually between the ages of two and 15 years viral but the illness is nonetheless stressful to parents because of the high fevers. Should the symptoms become severe, if your child has difficulty breathing, shows signs of dehydration or develops a stiff neck then urgent medical attention is necessary.

This article was written for BabyYumYum by our partner paediatrician, Dr Maraschin.

dr-enrico-maraschin-babyyumyum-expert
Affectionately known as “Dr Rico” by his patients, Dr Maraschin is passionate about preventative medicine and building trusted relationships with parents and patients is a priority to him. Well-known among the community, he is highly regarded with providing the best care for babies, toddlers and kids. He has played a pivotal role in creating his well-deserved prestige, with a particular interest in neonatology, allergies, immunology and vaccinology. Dr Enrico F. Maraschin, MBBCh (Wits), FCPaed (SA)