Common symptoms of tonsillitis include:

• Red, swollen tonsils.
• White or yellow coating or patches on the tonsils.
• Sore throat.
• Trouble swallowing or painful swallowing.
• Fever.
• Enlarged, tender glands called lymph nodes in the neck.
• A scratchy, muffled or throaty voice.
• Bad breath.
• Stomachache.
• Neck pain or stiff neck.
• Headache.

In young children who can't tell how they feel, symptoms of tonsillitis may include:

• Drooling due to trouble swallowing or painful swallowing.
• Not eating.
• Being fussier than usual.

It's important to get a diagnosis if your child has symptoms that may mean tonsillitis.

Call your healthcare professional if your child has:

• A sore throat with fever.
• A sore throat that doesn't go away within 24 to 48 hours.
• Painful swallowing or trouble swallowing.
• Extreme weakness, tiredness or fussiness.

Get care right away if your child has any of these symptoms:

• Trouble breathing.
• Extreme trouble swallowing.
• A lot of drooling.

Common viruses most often cause tonsillitis. But bacterial infections also can be the cause.

The most common bacterium causing tonsillitis is Streptococcus pyogenes, also called group A streptococcus. This bacterium causes strep throat. Other strains of strep and other bacteria also may cause tonsillitis.

Why do tonsils get infected?

The tonsils are the immune system's first line of defense against germs and viruses that enter the mouth. This work puts the tonsils at high risk of infection. But the tonsil's immune system work slows after puberty. This might explain why adults rarely have tonsilitis.

Risk factors for tonsillitis include:

• Young age. Tonsillitis most often affects children. Tonsillitis caused by bacteria is most common in children ages 5 to 15.
• Being around germs. School-age children are in close contact with other children. So they often have contact with viruses or bacteria that can cause tonsillitis.

Irritation or swelling, called inflammation, of the tonsils from getting tonsillitis often can cause complications. Complications of chronic tonsillitis include:

• Disturbed breathing during sleep, called obstructive sleep apnea.
• Infection that spreads deep into nearby tissue, called tonsillar cellulitis.
• Infection that causes a buildup of pus behind a tonsil, called peritonsillar abscess.

Strep infection

Tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria must be treated with antibiotics. If it isn't treated or if treatment isn't finished, your child has a higher risk of rare disorders such as:

• A serious condition that can affect the heart, joints, nervous system and skin, called rheumatic fever.
• Complications of scarlet fever, a streptococcal infection that has a rash as a main symptom.
• Swelling and irritation, called inflammation, of the kidney. This is called poststreptococcal glomerulonephritis.
• Swelling and irritation, called inflammation, of the joints. This is called poststreptococcal reactive arthritis.

Other people can catch the germs that cause viral and bacterial tonsillitis. So the best way to prevent tonsillitis is to teach children to:

• Wash hands often and well. This is very important after using the toilet and before eating.
• Not share food, drinking glasses, water bottles or utensils.
• Use a new toothbrush after being diagnosed with tonsillitis.

To help children not spread infection to others:

• Keep children at home when they're ill.
• Ask a healthcare professional when it's OK for a child to go back to school.
• Teach children to cough or sneeze into a tissue or into their elbows.
• Teach children to wash their hands after sneezing or coughing.

To diagnose tonsillitis, your child's healthcare professional starts with a physical exam. In the exam, they:

• Use a lighted instrument to look at your child's throat, ears and nose.
• Check for a rash known as scarlatina, which may be linked to strep throat.
• Gently feel, called palpate, your child's neck to check for swollen glands.
• Listen to your child's breathing with a device called a stethoscope.
• Check the spleen to see if it's larger than usual. They do this to check if your child has mononucleosis, which also affects the tonsils.

Throat swab

With this simple test, a healthcare professional rubs a sterile swab over the back of your child's throat. The sample is taken to check for streptococcal bacteria.

Many clinics have a lab that can get a test result in minutes. But there's a second, better test. Getting results from this throat culture can take hours. The culture often is sent to a lab. Results then can take hours to days.

If the fast in-clinic test shows strep, then your child likely has a bacterial infection. If the test comes back not showing strep, then your child likely has a viral infection. Your healthcare professional may wait for the better lab test to find the cause of the infection.

Complete blood cell count (CBC)

Your healthcare professional may order a complete blood count (CBC) that uses a small sample of your child's blood. The test measures the types of cells in the blood, such as red cells and white cells. The results can show whether an infection is more likely caused by bacteria or viruses.

A CBC is not often needed to diagnose strep throat. But if the strep throat lab test shows no strep, the CBC can help healthcare professionals find the cause of tonsillitis.

Treatment for tonsillitis can include at-home care; antibiotics, if the cause is a bacterial infection; and in some cases, surgery.

At-home care

If a virus is causing the tonsillitis, at-home care is the only treatment. Antibiotics won't help to treat a virus. Children with viral tonsillitis likely will be better within 7 to 10 days.

You can help children with tonsillitis feel better and recover at home in many ways, including the following:

• Have them rest. They need plenty of sleep.
• Give fluids. Plenty of water keeps throats moist and prevents dehydration.
• Offer food and drink that gives comfort. Warm liquids, such as broth, caffeine-free tea or warm water with honey can soothe a sore throat. So can cold treats like ice pops.
• Make a warm saltwater gargle. For children who can gargle, a saltwater gargle of 1/2 teaspoon (2.5 milliliters) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a sore throat. After gargling, have them spit out the saltwater.
• Keep the air moist. Use a cool-air humidifier. This gets rid of dry air that can make a sore throat feel worse. Or sit with your child for a few minutes in a steamy bathroom.
• Offer drops to suck on. Children older than age 4 can suck on lozenges to ease a sore throat.
• Keep out things that can irritate the throat. Keep your home free from cigarette smoke and cleaning products that can bother the throat.

• Treat pain and fever. Talk with your healthcare professional about using ibuprofen (Advil, Children's Motrin, others) or acetaminophen (Tylenol, others) to ease throat pain and control a fever. Low fevers without pain don’t need treatment.

  Do not give children or teenagers aspirin. Aspirin has been linked to Reye's syndrome, a rare life-threatening condition, in children or teenagers who have the flu or chickenpox.

Antibiotics

If a bacterial infection is the cause of tonsillitis, your healthcare professional prescribes an antibiotic. Penicillin taken by mouth for 10 days is the most common antibiotic treatment prescribed for tonsillitis caused by group A streptococcus. If your child is allergic to penicillin, your healthcare professional can prescribe another antibiotic.

Your child must take the full course of antibiotics as prescribed. This is true even if the symptoms go away. Not taking all the medicine may cause the infection to get worse or spread to other parts of the body. Not taking the full course of antibiotics also can raise your child's risk of rheumatic fever and serious kidney inflammation.

Talk with your healthcare professional or pharmacist about what to do if you forget to give your child a dose.

Surgery

Surgery to remove tonsils, called a tonsillectomy, can treat tonsillitis that comes back often, ongoing tonsillitis or bacterial tonsillitis that doesn't respond to antibiotic treatment. Tonsillitis that comes back often is defined as:

• At least seven times in the year before.
• At least five times a year in the past two years.
• At least three times a year in the past three years.

A tonsillectomy also may be done if tonsillitis causes complications, such as:

• Breathing troubles during sleep, called obstructive sleep apnea.
• Trouble breathing.
• Trouble swallowing.
• Pus buildup, called an abscess, that doesn't get better with antibiotic treatment.

A tonsillectomy most often is done as an outpatient procedure. That means your child should be able to go home the day of the surgery. But if your child is very young or has other medical conditions, or if complications happen during surgery, your child might stay overnight in the hospital. A complete recovery most often takes 7 to 14 days.

If your child has a sore throat, trouble swallowing or other symptoms that may mean tonsillitis, you'll likely visit your family healthcare professional or your child's healthcare professional. You may be referred to a specialist in ear, nose and throat disorders.

Your healthcare professional is likely to ask you questions about your child's condition. Be ready to answer the following questions:

• When did the symptoms begin?
• If your child has had a fever, what was the temperature?
• Does anything ease symptoms, such as pain relievers you can get without a prescription or warm liquids?
• Has your child been diagnosed with tonsillitis or strep throat before? If so, when?
• Do symptoms seem to affect your child's sleep?
• Has your child been with anyone who had strep throat?

Questions you may want to ask include the following:

• How long will it take to get test results?
• What is the best course of treatment?
• When can my child go back to school or resume other activities?