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Pediatric Tonsillitis

  • An infection of a child's tonsils that causes difficulty swallowing
  • Symptoms include swollen tonsils, enlarged lymph nodes in neck, bad breath, and headache
  • Treatments include rest, saltwater gargle, pain relievers, and antibiotics
  • Involves General Pediatric Otolaryngology and Pediatric Sleep Medicine Program

Overview

Sometimes your child’s sore throat is just a sore throat. Other times, it may be tonsillitis, the medical name for an infection of the tonsils that causes them to swell, making it hard to swallow and leaving the lymph nodes in the neck sore.

Everyone is born with two tonsils, small, oval-shaped glands located at the back of your throat. They contain white blood cells, which help ward off infection; but sometimes, the tonsils themselves can become infected by either a virus or bacteria. The most common cause of bacterial infection in the tonsils is streptococcus pyogenes (group A strep), or strep throat.

Tonsillitis is most common among children between ages 5 and 15, and at Yale Medicine, we have a team of pediatric otolaryngologists (ear, nose and throat specialists) skilled at diagnosing and treating it. Most cases of tonsillitis do not require a tonsillectomy (removing the tonsils), but if surgery is needed, our physicians are experienced in the latest and most advanced techniques.  

What is tonsillitis?

Tonsillitis is an infection of your tonsils that can make them swell and give you a sore throat. It’s important to treat tonsillitis, especially if it is caused by the strep bacteria, because strep can lead to rare, life-threatening diseases like rheumatic fever, points out Erik Waldman, MD, director of Yale Medicine Pediatric Otolaryngology.

The tonsils trap bacteria and viruses when they enter the body, which can make them prone to infection. After puberty, the immune system function of the tonsils declines and they tend to shrink in size, which explains why tonsillitis is rare in adults. 

In addition to group A strep, other strains of strep and other bacteria can also cause tonsillitis. Children in school are particularly susceptible to tonsillitis as they are constantly exposed to germs from their peers.

Similar to the tonsils—but located higher in the throat and behind the nose—are the adenoids. The adenoids also help trap germs that enter the body through the mouth and nose and clear away infections. And like the tonsils, they can become inflamed and infected.

The symptoms of enlarged adenoids (called adenoiditis) differ from tonsillitis, Dr. Waldman points out. “Adenoiditis can cause a runny nose and blocked nasal ducts,” he says, in addition to frequent ear infections, sinusitis, hearing problems and upper respiratory infections.

Like tonsillitis, adenoiditis can also lead to problems with sleep, says Cecilia Helwig, MD, assistant director of Pediatric Otolaryngology. These problems include obstructive sleep apnea, which causes snoring and gasping for breath during sleep, and occasional hyperactivity during the day.

Many children get both tonsillitis and adenoiditis simultaneously. 

What are the signs and symptoms of tonsillitis?

Common signs and symptoms of tonsillitis include: 

  • Sore throat
  • Red, swollen tonsils
  • White or yellow patches or coating on the tonsils
  • Fever
  • Difficulty or pain with swallowing
  • Tender, enlarged lymph nodes in the neck
  • Bad breath
  • Scratchy voice
  • Stomach pain
  • Headache
  • Stiff neck

For children too young to speak, symptoms might include drooling (from difficult or painful swallowing), refusing to eat, unusual irritability. However, tonsillitis is rare in children younger than 2.

How is tonsillitis diagnosed?

If your child has a sore throat or any other symptoms associated with tonsillitis, you will likely start off with a visit to your family doctor or pediatrician, who may refer you to an ENT (ear, nose and throat specialist).

Your doctor will likely ask for a detailed history of symptoms and conduct a physical exam. The exam might include using a lighted instrument to examine the throat, ears and nose, as well as looking for a rash called scarlatina, which is linked to some cases of strep throat. Your physician would also feel your child’s neck to check for swollen lymph nodes.

A throat swab may be taken to test for strep. Your doctor may order a complete blood cell count (CBC), which can indicate if an infection is more likely bacterial or viral. If the strep throat test is negative, the CBC can help pinpoint the cause of tonsillitis.

Diagnosing swollen adenoids, however, is trickier because they are too far back in the throat to be seen without a camera. But at Yale Medicine, we have access to state-of-the-art diagnostic technology to visualize the adenoids and to perform other diagnostic procedures that can’t easily be done in other settings. One of these is an upper airway endoscopy, which takes less than 30 seconds and allows doctors to assess the adenoids.

If obstructive sleep problems are suspected, your doctor may suggest that your child have a sleep study. “This doesn’t reveal the site of the obstruction, but it can show you that there is one,” Dr. Waldman explains.

How is tonsillitis treated?

If tonsillitis is caused by a bacterial infection, your child’s doctor will prescribe antibiotics. Other steps can be taken at home to make your child comfortable, including: 

  • Rest
  • Drink adequate fluids to keep the throat moist and prevent dehydration
  • Drink warm liquids or eat ice pops
  • Gargle salt water
  • Use a cool-air humidifier
  • Soothe your throat with lozenges
  • Treat pain and fever with ibuprofen or acetaminophen 

If your child’s symptoms do not respond to antibiotics or if tonsillitis frequently recurs, your doctor may recommend a tonsillectomy. “But these days, we are more likely to do a tonsillectomy because of obstructive breathing than we are because of tonsillitis,” Dr. Helwig notes. 

What stands out about Yale Medicine’s approach to tonsillitis?

As an academic medical center, our physicians at Yale Medicine have access to highly trained and experienced pediatric specialists who are at the forefront of advanced treatment methods and clinical research.

Yale New Haven Children’s Hospital also has two pediatric-only sleep labs: one in New Haven, one in Bridgeport. These are designed to provide a comfortable experience for your child and also are equipped with technology for diagnosing obstructive sleep apnea, which is often caused by enlarged tonsils and adenoids.

We work closely with our pediatric sleep specialists, as well as with speech and swallow experts and general pediatricians. Whether your child needs simple treatment for a sore throat caused by tonsillitis—or, possibly, surgery, we are fully equipped to handle their care.