Tonsillitis: Symptoms and Treatment

By Howard Jeffries, MD
Medically reviewed checkmarkMedically reviewed
January 23, 2020

At least once in their lives, most people will come down with tonsillitis, a painful infection of the tonsils caused by a bacteria or virus. Infected tonsils—typically characterized by swelling, redness, and a sore throat—are much more common in children than adults, but anyone exposed to the associated virus or bacteria can experience a tonsil infection. That’s why it’s so important to practice thorough, routine hand washing, especially if your child was around someone with a bacterial or viral illness or a sore throat. If your child does get tonsillitis, try not to worry—rest, plenty of fluids, and proper medical attention, should get them back to health within a week.

What Is Tonsillitis?

Tonsillitis is an infection of the tonsils, which are two small, round lumps of tissue in the back of the throat that help the immune system fight infections in the body. Inflamed tonsils are most common in children and adolescents older than age two. Most people will get tonsillitis at least once in their lifetime.

Signs and Symptoms of Tonsillitis

A child with tonsillitis typically complains of a sore throat and may also have visibly red, swollen tonsils. Children may also experience the following with tonsillitis:

If you have a baby or toddler who can’t verbalize their symptoms, you might notice the following signs of inflamed tonsils:

  • Refusal to eat
  • Drooling due to painful swallowing
  • Unusual crabbiness or fussiness

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Causes of Tonsillitis

A tonsil infection can have a number of causes. Up to 70% of tonsillitis cases in children are viral, which means the infection is caused by a virus. Common childhood illnesses such as the common cold, adenovirus, influenza, or the Epstein-Barr virus (also known as mononucleosis, or mono) may cause tonsillitis. Viral causes of tonsillitis are usually more common in younger children.

Some cases of tonsillitis can be caused by bacteria, like group A streptococcus (more commonly known as strep throat). This is generally more common in kids ages 5-15.

Diagnosing Tonsillitis

To diagnose tonsillitis, your child’s doctor will ask you a series of questions about your child’s symptoms and examine him or her for white spots on the throat along with checking for signs of swelling and redness.

Your doctor may also conduct a strep throat test, because strep can cause tonsillitis, and it requires treatment with antibiotics. Usually, this test involves collecting fluids from your child’s throat with a cotton swab. If the strep test is positive, your child’s tonsillitis likely has a bacterial cause.

If the strep test is negative, the doctor may order blood work to help determine the cause of tonsillitis, which will assist in deciding the course of treatment.

Tonsillitis Treatment Options

Tonsillitis treatment depends on what’s causing the infection. If a virus is to blame, tonsillitis usually goes away on its own in about a week. For bacterial tonsillitis, your child’s doctor will likely prescribe antibiotics.

In rare cases—for example, if your child’s tonsils get infected frequently or they’re so swollen your child has difficulty breathing—a doctor might recommend a surgery called a tonsillectomy to remove your child’s tonsils. Doctors have guidelines for deciding whether a tonsillectomy is necessary. Typically, the surgery occurs if a child has seven sore throat episodes in a year, five episodes for two consecutive years, or three episodes for three consecutive years. However, given the usual decrease in tonsillitis with age, watching and waiting may be an appropriate strategy and the decision to have surgery typically occurs in collaboration between your family and a surgeon.

At-Home Remedies for Tonsillitis

The sore throat and swelling that come with tonsillitis can be very uncomfortable for kids. You can try a variety of at-home remedies for tonsils that are infected and inflamed, whether your child has bacterial or viral tonsillitis, including:

  • Drink plenty of fluids: Encourage your child to rest and stay hydrated to ease throat irritation and help the body kick the infection.
  • Consume soothing foods and beverages: Popsicles, smoothies, yogurt, or ice cream may provide temporary pain relief. Others may find warm foods and drinks like non-caffeinated tea or soup more comforting. Regardless of temperature, serve liquids and easy-to-swallow foods to comfort a child’s sore throat.
  • Gargle salt water: Try making your own saltwater gargle with one teaspoon (five milliliters) of table salt per eight ounces (240 milliliters) of warm water. If your child is older than four and you’re not concerned about choking, a throat lozenge will help to ease the pain.
  • Take a pain reliever: Pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) reduce pain and fever when your child is sick. Ibuprofen has an additional advantage of reducing inflammation, though one needs to make sure that your child is taking plenty of fluids to avoid any kidney complications. You can chat with your child’s pediatrician or a K doctor about appropriate dosages.

Preventing Tonsillitis

Tonsillitis is contagious and can be spread by coming into contact with an infected person. The best way to prevent tonsillitis is to avoid contact with anyone who has tonsillitis or a sore throat. Practice thorough, routine hand washing to prevent the spread of germs that could make your child or other family members sick.

If someone in your family has tonsillitis, focus on hygiene—keep drinking glasses and food utensils separate and wash them thoroughly before another person uses them.

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Exposure to viral or bacterial illness is the biggest risk factor for a sore throat and infected tonsils. Usually, tonsillitis isn’t serious with proper medical care.

Antibiotic treatment of streptococcal tonsillitis is important to quicken recovery and prevent early complications of ear infections and peritonsillar abscesses, in addition to late complications that include acute rheumatic fever and kidney disease.

If your child has bacterial tonsillitis, he or she may be at an increased risk for a peritonsillar abscess, which occurs when bacteria spread from the tonsil to the surrounding area and fill it with pus. Signs to look out for include:

  • A worsening sore throat on one side
  • Fever
  • Headache
  • Earache
  • Drooling
  • A muffled voice

Make sure to bring your concerns to a physician if you suspect your child has an abscess, which could require a procedure to drain the infection.

When to See a Doctor

It’s important to prioritize medical care if you suspect your child has tonsillitis because treatment depends on the infection’s cause. In general, it’s a good idea to contact your child’s pediatrician if your child has any of the following signs or symptoms:

  • A sore throat that lasts more than two days
  • Difficulty swallowing or painful swallowing
  • Weakness, fatigue, or fussiness that concerns you

Seek immediate medical care if your child has any of these signs or symptoms:

Difficulty breathing

Extreme difficulty swallowing

Abnormal drooling

How K Health Can Help

Wondering if you may have tonsillitis or concerned about your symptoms? Use K Health’s virtual diagnosis tool to determine if your symptoms may be tonsillitis. You can also chat with a medical provider to identify tonsillitis symptoms, prescribe antibiotics if needed, recommend home treatment options, or recommend that you visit a doctor in person when needed.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Howard Jeffries, MD

A pediatric cardiac intensivist at Seattle Children's Hospital, Dr. Jeffries is also Senior Medical Director, Regional Network. He completed a residency in pediatrics and a fellowship in pediatric intensive care. He has published chapters and peer-reviewed articles, with an emphasis on cardiac intensive care, informatics, outcomes assessment and quality improvement.