Inflamed tonsils in children: symptoms and treatment

Inflamed tonsils often occur in children: toddlers, toddlers, preschoolers and children of primary school age. Adults can also suffer from inflamed tonsils. Inflamed tonsils can be caused by viruses, but a child can also get it from bacteria, often streptococci. The symptoms and signs of inflamed tonsils are sore throat and difficulty swallowing. The lymph nodes of the neck and jaw may also be painful and swollen. The child may feel really flu-like and suffer from headaches, fatigue and little appetite. This may be accompanied by fever and general malaise. An inflammation of the tonsils is also called ‘tonsillitis’.

Inflamed tonsils

  • What are tonsils and what is tonsillitis?
  • Cause of inflamed tonsils
  • Viral causes
  • Bacterial causes
  • Symptoms of tonsillitis
  • Phenomena
  • Strep throat
  • Call in your GP
  • Examination and diagnosis
  • Tonsillitis treatment in toddlers, preschoolers and children
  • Considerations
  • Measures to alleviate complaints
  • Antibiotics
  • Tonsil surgery
  • Prognosis
  • Complications


Common tonsils and tonsillitis / Source: Solar22/

What are tonsils and what is tonsillitis?

The body has an extensive system to fight infections. This is called the ‘lymphatic system’. The lymphatic system catches invading pathogens as much as possible, after which it renders these culprits harmless. It is an ingeniously designed system. Almonds also catch bacteria and viruses and render them harmless. In this way they contribute to preventing infections in the body. If many pathogens enter the body, the tonsils or tonsils can sometimes no longer cope with the work, causing them to become inflamed themselves. When the inflammation does not really go away or keeps returning, it is called chronic tonsillitis.

Cause of inflamed tonsils

Tonsillitis is especially common in children and less common in adults. The cause is often a viral infection (such as a cold) or glandular fever. A bacterial infection (usually a streptococcal infection) or fungal infection can also be the cause.

Viral causes

Tonsillitis is usually caused by a viral infection. This often involves the following culprits:

  • Adenovirus, which is related to the common cold and sore throat.
  • Rhinovirus, which is the most common cause of the common cold.
  • Influenza virus, the cause of flu.
  • The RS virus or RSV is a virus that causes respiratory infections.
  • Coronavirus, which has two subtypes that infect humans, one of which causes SARS.

Less commonly, viral tonsillitis can be caused by:
Epstein-Barr virus, a common herpes virus and the causative agent of mononucleosis;
Herpes simplex virus;
Cytomegalovirus (CMV), a type of herpes virus.

Bacterial causes

The most common type of bacteria that infects the tonsils is Streptococcus pyogenes, the pus-forming streptococcus. Less commonly, other culprits may be at play, such as:

  • Staphylococcus aureus, a bacterium that occurs in many people, especially on the skin and in the nose;
  • Mycoplasma pneumoniae, a bacterium that often causes pneumonia in children and young adults;
  • Chlamydia pneumoniae, often occurs as a causative agent of respiratory infections, especially in adolescents, young adults and the elderly;
  • Bordetella pertussis, the bacteria that causes whooping cough;
  • Fusobacterium sp., an anaerobic, gram-negative bacterium;
  • Neisseria gonorrhoeae, which can lead to oral gonorrhea.


Symptoms of tonsillitis


How can you recognize tonsillitis in a child? The most important characteristic of tonsillitis is of course the inflamed tonsils, which you can recognize because there is a kind of white layer over the tonsils. A child with inflamed tonsils often feels sick and sometimes no longer wants to eat. His throat hurts, especially when swallowing. The child often shows a somewhat flu-like appearance. In addition to sore throat, difficulty swallowing and flu-like symptoms, the child may suffer from:

  • swollen lymph nodes in the neck
  • bad breath/smelly breath
  • frequent earache
  • persistent or recurring cold
  • headache
  • (mild) fever and chills
  • tiredness/hangover
  • bad sleeping
  • frequent breathing through the mouth
  • breathing problems when the tonsils are very large
  • vomiting (especially in young children)
  • abdominal pain (especially in young children)
  • general malaise
  • a stiff neck
  • cough
  • drooling (especially in young children due to swallowing problems)
  • nausea (especially in young children)
  • earache
  • painful blisters or sores in the throat
  • problems with eating or drinking
  • swallowing problems
  • uvulitis (swollen uvula of the tongue)
  • loss of appetite or changes in voice


Strep throat

A tonsillitis can lead to a throat infection.

Call in your GP

Although not common, tonsillitis can sometimes cause breathing problems. If this happens, immediate medical attention is needed. If you experience any of the following symptoms, it is advisable to consult a doctor:

  • fever, more than 39.5°C
  • muscle weakness
  • sore throat that lasts more than 2 days


Examination and diagnosis

For inflamed tonsils, a doctor will start with a general examination, during which he inspects the mouth and throat. The tonsils are red and swollen and white spots may be visible. The lymph nodes in the neck are swollen and tender to the touch. A throat swab can be taken, after which the culprit will be examined in a laboratory; which bacteria or virus is involved? Sometimes a blood test is necessary to rule out glandular fever.

Tonsillitis treatment in toddlers, preschoolers and children


In 2023, the almonds will no longer be removed as quickly as before. Especially in very young children such as toddlers and preschoolers, people will not easily proceed with removing the tonsils. As children get older, they should build up more resistance and the complaints will normally diminish automatically. Only in case of serious (persistent) complaints will surgery be considered. This may be the case if, for example, the child suffers from breathing problems or has a throat infection more than three times a year.

Measures to alleviate complaints

In the case of tonsillitis, attempts can be made to alleviate the symptoms, for example by taking the following measures:

  • drink plenty of cold, non-acidic drinks
  • eat ice cream
  • gargle with warm water and salt
  • take a painkiller for a sore throat

In addition, throat rinses, cough lozenges, and sprays can be used to soothe a sore throat.


Even if a bacteria is the cause of a tonsil or throat infection, it is often not prescribed because it makes no difference. In practice, you will be ill for about the same amount of time with antibiotics as without antibiotics, although you will have to deal with the side effects of an antibiotic. An antibiotic may be advised in certain situations:

  • in case of a serious infection that does not diminish after a few days;
  • at an increased risk of complications;
  • if your immune system is not working properly (for example if you have had your spleen removed or if you are undergoing chemotherapy).


General practitioner examines the throat / Source: BravissimoS/

Tonsil surgery

In case of severe or persistent throat complaints, if the fever lasts for more than three days or if the child is very ill, the doctor should be consulted. If the tonsils are removed, this will be done during a short anesthesia. The child’s parent(s) and/or caregiver(s) may be present when the doctor anesthetizes the child. This is reassuring for the child. In small children, the doctor can cut the tonsils loose in one go with special pliers. However, in older children the tonsils are more firmly attached and the doctor will cut the tonsils loose step by step.
After tonsil surgery, the child can go home the same day. It is best for children to stay at home for the first few days after the operation. A week after the procedure, most children can play outside again, go to daycare or go to school. It is recommended not to swim for the first two to three weeks after the operation. As for food and drinks, it is pleasant for the child to give him or her cold or lukewarm soft food in the first days after tonsil surgery. It is good to drink cold water, especially just after the operation. Ice pops are also recommended. Most children will have no problem with that! Do not give the child acidic or carbonated drinks. These types of drinks hurt the throat. Dairy products often do not feel pleasant during the first few days.


Acute tonsillitis is an acute, ‘self-limiting’ condition that normally resolves completely within 1 week without further complications. However, some people may develop recurrent tonsillitis; Removal of the tonsils (tonsillectomy) may be considered in these cases. In vulnerable people (for example, infants, the very old, or immunocompromised patients), inflamed tonsils may have a more serious course. Antibiotics and/or a short stay in hospital may then be necessary.


Very rarely (and usually in developing countries), acute tonsillitis may be associated with significant suppurative (purulent) complications, such as a peritonsillar abscess (throat abscess), and non-suppurative complications, such as rheumatic fever or acute glomerulonephritis.

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