Introduction

Tonsillitis is the infection and inflammation of the tonsils at the back of the throat.¹ The tonsils are small, soft masses of tissue that are part of the immune system and help defend against harmful microorganisms in the mouth. Tonsillitis is most common in children, but teenagers and adults can be affected too. Tonsillitis can be caused by a number of different types of bacteria and viruses. Bacterial tonsillitis can usually be treated with antibiotics, but antibiotics will not work if the tonsillitis is caused by a virus. Normally, tonsillitis will get better on its own, or with antibiotics- however, some children get recurrent tonsillitis, which means that the infection keeps coming back. These recurrent infections can stop children from doing normal activities, like sleeping, going to school and playing with friends. This article will discuss the causes and symptoms of tonsillitis in children, as well as how to manage and treat the condition.

What causes tonsillitis in children?

Tonsillitis in children is generally caused by an infection, though other factors, such as pollutants, irritants, allergens and having a weakened immune system, can contribute too.

Infections

Most cases of tonsillitis are caused by a virus, particularly adenovirus and rhinovirus. These viruses are also responsible for causing many cases of the common cold. Other viruses that can cause tonsillitis include Influenza virus C, which also causes mild cases of the flu, and Epstein-Barr virus, which can also cause mononucleosis, also known as glandular fever.²

Sometimes, tonsillitis can be caused by infection with bacteria, usually Streptococcus pyogenes. Streptococcus pyogenes is a group A Streptococcus, a group of bacteria that cause a number of different infections, ranging from mild to very severe. Streptococcus pyogenes is also the bacteria that causes strep throat. There are other bacteria that can cause tonsillitis too, such as Staphylococcus aureus, but group A Streptococcus bacteria are the most common cause. 

Environmental and social factors

There are certain environmental and social factors that can increase a child’s susceptibility to tonsillitis and infection, including:

• Exposure to pollutants and irritants
  • Being exposed to cigarette smoke and certain allergens, such as pollen and dust, can irritate and damage the tonsils, increasing the risk of tonsillitis. Living in a highly polluted, urban area can also increase this risk
• Crowded living conditions
  • Living in crowded conditions can increase a child’s susceptibility to tonsillitis, as they are more exposed to viruses and bacteria, such as rhinoviruses, adenoviruses and group A streptococci, that can cause infection in the tonsils
• Poor hygiene practices
  • Not washing hands often or thoroughly enough, and sharing cutlery and utensils can increase the risk of infection and tonsillitis

Weakened immune system

Children can have a weakened immune system for a number of reasons, such as poor nutrition, lack of sleep, or a chronic illness, and this can increase the risk of infection and tonsillitis.

Signs and symptoms of tonsillitis

Symptoms of tonsillitis can include: sore throat; red, inflamed, swollen tonsils; difficulty swallowing; and a fever (high temperature)

In severe cases, some children may also experience:

• Swollen, painful lymph nodes (glands) in the neck¹
• Bad breath¹
• Pus-filled spots on the tonsils¹
  • These spots will appear white on the tonsils, which will usually be swollen and enlarged. If the collection of pus forms between one of the tonsils and the wall of the throat, this is called quinsy. Quinsy is very rare, but it can be a serious complication of tonsillitis

How is tonsillitis diagnosed?

If your doctor is concerned that your child may have tonsillitis, they will carry out a thorough physical examination, including looking down your child’s throat to check for redness, swelling and pus on the tonsils. The doctor will usually be able to diagnose tonsillitis from your child’s symptoms and from examining the throat.¹

In some cases, further tests may be needed to diagnose tonsillitis. Your child may need a throat swab test to help determine whether the infection is caused by bacteria or a virus. In a throat swab, a small cotton bud is rubbed gently over the tonsils at the back of the throat. The cotton bud can then be sent to a laboratory, where the sample is tested and it can be determined whether the infection is caused by group A streptococcus (bacteria) or a virus. If the infection is severe and does not go away, your child may need a blood test for glandular fever.¹

Treatment and management

Managing tonsillitis at home

Tonsillitis can be treated and managed at home in milder cases, and it will usually get better within a few days.¹ Getting lots of sleep and rest, and staying hydrated helps the body recover from infection. 

Taking over-the-counter medications, such as paracetamol and ibuprofen, can help relieve a sore throat, and older children can also try gargling with warm salt water to help ease the pain.¹ Soft, soothing foods and cold drinks can also help to relieve a sore throat, as well as help to stay hydrated. Other methods of alleviating a sore throat include using humidifiers to moisturise air, and using throat sprays, although there is not much evidence to suggest that these methods provide much benefit.¹

Pharmacists can also help and give advice in mild cases of tonsillitis. They can recommend throat lozenges, throat sprays, and other treatments that can help relieve sore throats in children.¹ If they think the infection is more severe, they will also recommend that your child visit the GP. 

Medical treatment

If the infection is caused by bacteria, your child will be prescribed antibiotics to kill the bacteria and stop them from spreading. It is important to finish the full prescription of antibiotics, even if your child begins to feel better before the end of the course- this ensures that the infection has fully cleared. 

If your child has severe, recurrent tonsillitis, they may need to have their tonsils removed. This is called a tonsillectomy. Your child may have their tonsils removed if they have quinsy, or if they have very severe tonsillitis that keeps coming back over a long period of time. A tonsillectomy is carried out under general anaesthesia, and the tonsils are then cut out. This should reduce the number of infections your child gets in the future. 

How can tonsillitis in children be prevented?

Tonsillitis in children can be prevented through good hygiene practices, ensuring the immune system is healthy and strong, and keeping up-to-date with vaccinations. 

Encouraging your child to wash their hands regularly, especially before eating and after using the toilet, can help prevent infections and stop the spread of bacteria and viruses. Avoiding close contact with individuals who are sick will also help stop bacteria and viruses from spreading. Other good hygiene practices, such as coughing and sneezing into tissues, will help to protect your child, and other children, from infection. 

A strong immune system can help protect children from infections and tonsillitis. Eating a balanced diet, getting enough sleep and keeping active all help the immune system stay strong and healthy, ensuring your child can fight off infections.

Ensuring your child is up-to-date on all vaccinations will help protect them from a wide range of infections. The flu vaccine has been shown to protect against group A streptococcal infections, which is the main group of bacteria that cause tonsillitis. Making sure that your child has had the flu vaccine is one of the best ways to keep them healthy and protect them from tonsillitis.

Summary

Tonsillitis is the infection and inflammation of the tonsils. It is usually caused by viruses, such as adenoviruses and rhinoviruses, but it can be caused by bacteria too. Other factors, such as exposure to pollutants and irritants, living in crowded conditions, poor hygiene practices and having a weakened immune system can also increase the risk of a child developing tonsillitis. Tonsillitis is usually mild and can be treated at home, with rest, over-the-counter medication, salt water gargles and throat lozenges. If the tonsillitis doesn’t get better or parents/guardians are concerned, they should take their children to the pharmacist or GP for further advice, treatment and support. If the infection is more severe or caused by bacteria, children may need antibiotics and further tests to rule out other conditions, such as glandular fever. If the tonsillitis recurs and is very severe, the tonsils may need to be taken out. Tonsillitis can be prevented through good hygiene practices, eating and sleeping well, exercising regularly and staying up-to-date with vaccinations.