Test Your Knowledge

Most cases of tonsillitis are caused by viruses. Thus, symptoms do not require treatment and usually resolve within a week. Managing a child’s symptoms is often the only treatment necessary. This allows parents to comfort their child while they monitor the condition and wait for their child to get better.

Home care remedies that may comfort a child with viral tonsillitis include:

• Rest. Sleep and relaxation can help the body fight infection and begin to heal. Restful activities such as reading to a child from a favorite book can help calm and relax a sick child.
  
  
• Proper nourishment. Ensuring adequate nourishment is important to help children with tonsillitis recover from their infection. If swallowing is difficult, soft foods (e.g., soup, broth, popsicles, applesauce, flavored gelatin, fruit smoothies) may be easier to consume than solid foods. Parents may wish to avoid dairy products (e.g., ice cream, yogurt) that can thicken saliva and make swallowing more difficult.
  
  
• Plenty of fluids. This can help prevent dehydration in children with tonsillitis. Parents should avoid providing their child with caffeinated products (e.g., sodas, teas), which can increase the risk of dehydration. Adequate fluid intake can also help thin mucus and make it easy to expel.
  
  
• Soothe a sore throat. Various methods may be used to help relieve a sore throat. In general, anything that may irritate the throat should be avoided (e.g., cigarette smoke, citrus drinks). Methods to soothe a sore throat include:
  
  
• Gargle with warm salt water. Mix 1 teaspoon of table salt in 8 ounces of warm water. This remedy should only be attempted with children old enough to gargle (without swallowing).
  
  
• Drink warm (not hot) liquids.
  
  
• Add honey and lemon. Honey coats and soothes a sore throat while lemon thins mucus, aiding its elimination from the body. Both of these can be easily dissolved into a warm drink.
  
  
• Drink very cold beverages.
  
  
• Throat lozenges. These may stimulate the production of saliva, which can help cleanse the throat. Lozenges are not advised for young children since they may pose a choking hazard.
  
  
• Use a cool-mist humidifier. This may help soothe a sore throat. However, it is important to clean this device often since it may breed bacteria and mold, which can worsen a child’s symptoms.
  
  
• Over-the-counter pain and fever relief. Use of acetaminophen or ibuprofen may help relieve pain and fever in children with tonsillitis. Parents should not provide aspirin to any child or adolescent under 20 years old, since it may increase the risk of Reye syndrome, a life-threatening condition.

Tonsillitis caused by bacteria will require antibiotic treatment. This may be provided as a single injection or a 10-day course of pills. Parents should ensure their child takes all the pills prescribed. Symptoms may improve within a day or two of starting antibiotic treatment, but the infection is not cured until the full course of pills has been taken. Antibiotics do not speed recovery time, reduce symptoms or prevent tonsillitis from recurring. 

In the past, physicians may have prescribed antibiotics for all cases of tonsillitis (even viral infections, for which antibiotics are ineffective). However, nowadays physicians often advise against the unnecessary use of antibiotics. Overuse of antibiotics has led to the development of antibiotic-resistant strains of disease that are very difficult to treat. The Centers for Disease Control and Prevention (CDC) advises against using antibiotics for sore throats unless a patient tests positive for strep throat or other bacterial infection.

Surgery is no longer routinely recommended for children with tonsillitis. Tonsils serve an important immune system function and their removal does not necessarily prevent future throat or respiratory infections.

The surgical removal of the tonsils is called a tonsillectomy. This procedure may be recommended under the following conditions:

• Tonsillitis recurs often despite the patient receiving antibiotic treatment:
  
  
• Three to five episodes in one year
  
  
• At least five episodes per year for two years
  
  
• At least three episodes per year for three years
  

In addition, if the tonsils impair breathing or seriously impair swallowing, a tonsillectomy may be performed. Tonsillectomies also may help prevent recurrent strep throat infection (a common bacterial cause of tonsillitis) in children, according to a new study. However, more research is needed to establish this link.

Tonsillectomies generally take less than an hour and can be performed on an outpatient basis (no overnight stay in a hospital is necessary). Tonsil removal does not eliminate the body’s infection-fighting capabilities, since tissues in other areas of the body perform a similar task. Children undergoing a tonsillectomy may experience a sore throat and ear pain after the surgery. Complete recovery may take a couple of weeks.