Introduction

Tonsils are lymphoid tissue aggregates located near entry points to the digestive and respiratory tracts that play a significant role in our immune system. They serve as a first line of defence, initiating a primary immune response to inhaled or ingested pathogens (pathogens are microorganisms that cause disease).¹ 

Tonsillitis is one of the major concerns in the paediatric healthcare field, caused by inflammation of the tonsils mainly due to bacterial or viral infections.²

Tonsillitis has been reported recurrent in children and adults in the UK. 

Children ages 5-15 may be at risk when exposed to people with infections in enclosed spaces such as childcare centres and schools.

Figures 1 and 2 here illustrate the common signs and symptoms observed in Tonsillitis. In this article, we will look at the prevalence of tonsillitis in newborns (up to 28 days old), it is rare or common in infants (up to one year old), and what parents should be concerned about.

Signs of tonsillitis

Figure 1: The above image illustrates the normal oral cavity and signs observed in Tonsillitis. Image created in BioRender.com¹

Symptoms of tonsillitis

Figure 2: The above image illustrates the common symptoms observed in Tonsillitis. Image created in BioRender.com

Tonsillitis in newborns: How common is it?

The medical literature documents that tonsillitis is extremely rare in infants. Based on previous research, tonsil infections are rare in newborns under the age of one year, with the majority of cases occurring in children aged three to seven years of age.² 

Paediatricians rarely identify tonsillitis in infants; instead, other respiratory conditions, such as upper respiratory tract infections or bronchiolitis, are more prevalent.

In a medical setting, the majority of sore throats and accompanying symptoms in infants are caused by general viral infections rather than tonsillitis.³ Bacterial tonsillitis, such as strep throat, is almost unknown in this age bracket because newborns are less exposed to group A streptococcus, which is a major cause of tonsillitis in older children.

Tonsillitis and tiny tots: facts about newborns and their throats

• Immature Tonsils: The tonsils in infants are still developing. Their immune system is not as robust as that of older children and adults, and they are less likely to be exposed to the pathogens that cause tonsillitis. This limited exposure lowers the risk of infection
• Maternal Antibodies:  In utero, through the placenta, and after birth from the breast milk, newborns have antibodies from their mothers. These maternal antibodies provide an infant with a protective defence against most infections, but transiently⁴
• Limited exposure: This normally would reflect the limited exposure of newborns, who are usually kept in more controlled or more hygienic environments, to the pathogenic agents and the environment compared to young children, thereby reducing exposure to bacteria and viruses most commonly causing tonsillitis

Potential causes of sore throat in newborns

Conditions that cause sore throat in newborns⁴ could be:

• Immune deficiency: Infants are vulnerable to a wide range of infections when they have underlying health issues caused by a poor immune response
• Bacterial infections: In rare cases, exposure to bacterial infections through close contact with infected individuals may result in tonsillitis
• Congenital Abnormalities:  Abnormalities that are present since birth, which affect the throat or the upper respiratory tract, may present symptoms that mimic tonsillitis
• Viral infections: Examples include the common cold, which causes sore throats in infants. In most cases, the infection does not cause tonsillitis
• Gastro-oesophageal Reflux Disease (GERD): In GERD, Gastric acid may cause irritation to the throat, causing discomfort or mimicking tonsillitis and a sore throat

Are tonsillitis symptoms the same for all ages?

If tonsillitis occurs in newborns, the symptoms may be somewhat different or more generalised than in older children.³ These symptoms may include:

• Fever
• Irritation
• Difficulty in feeding
• Increased crying
• Inflammation of the tonsils
• Swollen lymph nodes (Examined by physician)

These symptoms, however, often coexist with other respiratory infections or diseases in newborns, making diagnosing tonsillitis quite challenging without clinical examination.

Diagnosis and management

A newborn's tonsillitis is diagnosed by a physical examination by a healthcare professional. The examination could involve examining the throat for redness and swelling, as well as a throat swab to identify bacterial infections such as group A strep.²

Given the rare incidence of tonsillitis in newborns, medical care often emphasises symptom management until a bacterial infection is diagnosed, in which case antibiotics may be prescribed.⁴ When managing viral tonsillitis, supportive therapy such as fluids and fever management will usually be sufficient. Antibiotics are drugs that target bacteria, and therefore will not be effective for viral tonsillitis

Newborns rarely require surgical intervention (such as a tonsillectomy) unless recurring infections are chronic and severe.

Summary

Newborn tonsillitis is a rare entity because of the smaller size of the tonsils and a poorly developed immune system. Though the newborn is prone to lots of respiratory infections, tonsillitis is rather uncommon, and most of the other causes account for sore throats in this age group. Some of the very rare instances where it may occur can relate to some underlying health condition or bacterial exposure. This condition is usually diagnosed by paediatricians during later childhood; thus, it is not a frequent concern in newborns.

FAQs

Can newborns develop tonsillitis?

Yes, although this is highly unusual.  The reason is that newborns typically have undeveloped tonsils and a distinct immune response, making them less susceptible to tonsillitis than older children.

What causes tonsillitis in newborns? 

Tonsillitis in newborns can be caused by viral infections, which are more prevalent, or, in extremely rare cases, bacterial infections. It is more likely to happen if the infant has an underlying health condition.

How can I prevent my newborn from developing tonsillitis?

Maintaining excellent hygiene, limiting exposure to infected individuals, and breastfeeding  (which can enhance immunity) can all help lower the incidence of infections, including tonsillitis.

Can tonsillitis in newborns result in complications?

While complications are rare, they may arise if tonsillitis remains untreated, particularly if it is bacterial. These might include throat abscesses or more widespread infections, but this is extremely uncommon in newborns.