Understanding Tonsillitis -- Diagnosis and Treatment

How Do I Know If My Child Has Tonsillitis?

To check your child's tonsils, gently place the handle of a spoon, if possible, on their tongue and ask the child to say "aaahhh" while you shine a light on the back of the throat. If the tonsils look bright red and swollen, see your pediatrician or family doctor. Do not insist on doing this exam if you or the child is reluctant.

Often tonsillitis due to a virus looks no different than one caused by bacteria. Your pediatrician will examine your child's tonsils and take a throat swab to check for strep throat. The test can be done with results available during the office visit. This is the rapid strep test. If this is negative a culture is done for confirmation which takes 24-48 hours. To check for a tonsillar abscess, the doctor will examine the tonsils and soft palate.

What Are the Treatments for Tonsillitis?

Since most of the time infection is due to a virus and not a bacteria, antibiotics are not routinely needed. For a bacterial infection such as strep, the doctor will prescribe an antibiotic, usually for 10 days. Be sure to give your child the full course; if unchecked, strep bacteria can cause serious conditions such as an abscess or rheumatic fever (a heart condition). If the infection is due to strep, the contagious period is over after the first 24 hours of using antibiotics.

If the throat culture is negative for bacteria, the infection is probably caused by a virus and requires only treatment for relief of symptoms. To ease pain, the doctor may also recommend acetaminophen (Tylenol) or ibuprofen (Advil). Do not give your child aspirin, which has been linked to Reye's syndrome, a life-threatening condition. Gargling three times a day with warm salt water (1 teaspoon of salt in 8 ounces of warm water) may relieve some of the pain.

If your doctor discovers or suspects an abscess, you may need to be seen by an ear, nose, and throat doctor (called an ENT or otolaryngologist) to be evaluated for possible drainage of pus.

Frequent cases of tonsillitis that affect your child's general health, interfere with school attendance, cause breathing problems (snoring), snoring, or difficulty swallowing may warrant surgical removal of the tonsils (tonsillectomy). This procedure is usually performed as outpatient surgery and your child can go home after a few hours of observation.

Recovery is usually helped by rest and avoiding vigorous activity. Try to get your child to drink plenty of fluids, but don't force them to eat or drink. Older children should be given at least a pint of extra liquids per day. Although ice cream is usually the favorite food to cool the throat, it's okay to offer your child any foods they desire if it will make your child more comfortable and help them eat. Do only what your doctor advises to lower your child's fever.

How Can I Prevent Tonsillitis?

Hand washing remains crucial in preventing the spread of viruses and bacteria that cause tonsillitis. Avoid prolonged contact with anyone who has strep throat and has not been taking antibiotics for at least 24 hours. To be certain, avoid people who have been ill until such time as you are sure they no longer are.

Tonsillectomy, the surgical removal of the tonsils, is one of the most commonly performed operations in children. Newer surgical techniques and advances in anesthesia have made this 20-minute operation much more tolerable and safer than ever before. The reasons for tonsillectomy have also changed. Until the 1980s, the most common reason for tonsillectomy was because of recurrent infection. In the last 30 years, although tonsillectomy is frequently performed for recurrent infections, the most common reason for removing tonsils is tonsil-enlargement (hypertrophy) causing obstructive symptoms such as snoring, sleep apnea, and difficulty swallowing.

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