Kids Health Info

Tonsillitis

  • An infection of the tonsils is called tonsillitis. Tonsils are glands at the back of the throat. Tonsils are part of the immune system and help to fight germs in the mouth.

    It is common for tonsils to get infected by viruses or bacteria (bacterial tonsillitis is sometimes called strep throat). Tonsillitis is common in children of all ages and often occurs when children have a cold, with a runny nose and a cough. In teenagers, glandular fever can cause severe tonsillitis.

    Signs and symptoms of tonsillitis

    If your child has tonsillitis, they may have some of the following symptoms:

    • a sore throat
    • difficulty swallowing
    • tender lymph nodes (glands under the jaw)
    • pain in their ears (usually referred pain, but the ears should be checked by your GP as there may also be a middle ear infection)
    • a fever
    • bad breath
    • loss of appetite
    • lethargy and generally being unwell.

    Older children may also complain of headache or abdominal pain.

    When to see a doctor

    If you think your child has tonsillitis for the first time, take them to the GP. If your child has had tonsillitis before and they usually improve with care at home, you don't always need to see a doctor.

    As tonsillitis is often caused by a virus, your doctor may not prescribe antibiotics as these will not help your child. 

    Some children are likely to need antibiotics, including:

    • Aboriginal and Torres Strait Islander children and those from the Pacific Islands
    • those who have previously had rheumatic heart disease (which is rare in Australia)
    • children with severe forms of tonsillitis, especially if there is a rash (this is known as scarlet fever)
    • children who have a complication, such as an abscess behind the tonsil or in the glands in the neck.

    If there is difficulty with swallowing, some children are prescribed prednisolone (an anti-inflammatory corticosteroid medication) as well as or instead of antibiotics. Prednisolone reduces the swelling of the tonsils.

    If your child is extremely unwell, drooling and having difficulty breathing, call an ambulance immediately. This may represent a dangerous inflammation of the epiglottis (a flap in the throat).

    Care at home

    Most children with tonsillitis can be cared for at home after seeing a doctor (if necessary).

    You can care for your child in the following ways:

    • Make sure they have plenty of rest.
    • Give them pain relief such as paracetamol or ibuprofen. See our fact sheet Pain relief for children.
    • Give them extra fluids to drink. This will prevent your child from becoming dehydrated and will help their throat feel less dry and painful. Icy poles are a good option as they provide extra fluids as well as soothing and numbing the sore throat.
    • There are no restrictions on what your child can have to eat or drink; however, they may prefer softer foods if they have a sore throat.

    Your child should stay at home until their fever is gone and they are able to swallow again. This will usually be three to four days.

    If antibiotics are prescribed, give these to your child as directed, and make sure you complete the full course of antibiotics.

    You should go back to see your GP if your child has tonsillitis and:

    • difficulty breathing with an increase in snoring when asleep
    • difficulty swallowing and shows signs of dehydration (see our fact sheet Dehydration)
    • difficulty opening their mouth
    • you are worried for any reason.

    Key points to remember

    • Tonsillitis an infection of the tonsils, which can be caused by viruses or bacteria.
    • Most children recover with rest at home, pain relief and plenty of fluids.
    • Many children do not require treatment with antibiotics. Antibiotics don't treat viruses.
    • If antibiotics are prescribed, make sure you complete the course of antibiotics.

    For more information

    Common questions our doctors are asked

    Why isn't my child being treated with antibiotics?

    Even when tonsillitis is caused by bacteria (strep throat), this is usually an infection that the child can recover from without the need for antibiotics. Antibiotics do not improve the symptoms of tonsillitis, and most children have a sore throat for three to four days even if they do have treatment with antibiotics.

    Waiting to see if children will get better without antibiotics is helpful as it builds up immunity to the infection and makes it less likely that your child will get tonsillitis from that type of infection again. If your child is having recurrent infections it may be helpful to change the toothbrush after each infection, so that the tonsils will not be reinfected.

    How can I prevent tonsillitis spreading to the other children in the family?

    Good hygiene reduces the chance of passing infections onto others. Good hygiene includes: regularly washing hands thoroughly, not sharing cups or cutlery, not letting toothbrushes touch, encouraging children to cough or sneeze into their elbow and using tissues instead of hankies. Teach your child to throw tissues into the bin as soon as they have used them and to wash their hands afterwards.


    Developed by The Royal Children's Hospital. We acknowledge the input of RCH consumers and carers.

    Developed July 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au

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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.