Causes Of Tonsillitis In Children, Its Symptoms & Preventions

Tonsillitis in children is an inflammation of tonsils, small tissues located on either side of the back of the throat. They are also called palatine tonsils. The condition can occur at any age but is usually more common among school-going children from preschool to teenage.

Tonsils are lymphoid tissues that protect the body from infections (1). The common causes of tonsillitis include bacterial or viral infection. The first sign is pain while swallowing. The underlying infection of tonsillitis may potentially spread to parts of the neck and chest, increasing the risk of complications such as airway obstruction.

Read this post to learn the various signs, risk factors, complications, and treatments for tonsillitis in children.

How Does Tonsillitis Look In Children?

Tonsillitis causes the tissue on either side of the uvula to become red and swollen. Sometimes, there could be white or yellow spots on the tissue.

Tonsillitis is contagious and can spread if an infected person sneezes or coughs near your child. The incubation period can vary depending on the pathogen. It can take a day to five days for the symptoms to emerge.

Signs And Symptoms Of Tonsillitis In Children

There are three types of tonsillitis, acute, chronic, and recurrent, with the symptoms differing for each type. However, there are a few common symptoms which include (2):

• Sore throat
• Rough voice
• Difficulty in swallowing
• Fever
• Enlarged and tender lymph glands near the neck
• Bad breath
• Red and swollen tonsils
• Stiff neck
• Headache
• White or yellow patches on the tonsils
• Ear pain
• Stomachache

Types Of Tonsillitis

1. Acute tonsillitis

This type is the most common in children, with symptoms lasting up to ten days or less. It is characterized by sore throat, difficulty in swallowing, grey or white coating on the tonsils, and fever with a temperature higher than 38.3°C (100.94°F) (rectal) (3).

This can be treated with prescription antibiotics. A few home remedies might also help relieve the symptoms.

2. Chronic tonsillitis

When the symptoms last longer than ten days, then it could be chronic tonsillitis. Additional symptoms such as bad breath, swollen and tender lymph nodes near the neck might appear. The infection may also spread to the connective tissues of the neck and chest, resulting in tonsil stones. Tonsil stones are hardened dead cells, saliva, and food that gets built up in the tonsils’ crevices.

The pediatrician might recommend a tonsillectomy (a surgical procedure to remove the tonsils) in the case of chronic tonsillitis.

3. Recurrent tonsillitis

Your child is said to have recurrent tonsillitis when they have any one of the following:

• Seven or more episodes of tonsillitis in a year.

• Five or more episodes of tonsillitis in two years.

• Three or more episodes of tonsillitis in three years.

If the recurrent tonsil infection is due to bacteria, then the standard treatment option is a tonsillectomy (4). Tonsillectomy is usually done in children under the age of six when there is recurrent tonsillitis due to bacterial infection (3). Otherwise, a less risky partial tonsillectomy is the first line of therapy.

Risk Factors And Complications Of Tonsillitis

The following are the common risk factors for tonsillitis in children.

• Studies suggest that recurrent tonsillitis could be because of the microorganisms creating biofilms and repository of infections within the folds of the tonsils (5).

• A study pointed out that children with impaired development of anti-SpeA antibodies in their immune systems have lower resistance to Streptococcal bacteria, causing repeated episodes of tonsillitis (6).

• Children in close contact with those with infections, school-going children, and those who spend substantial time at daycare are usually at an increased risk (7).

Swollen and enlarged tonsils might lead to the following complications.

• Increased possibility of respiratory tract infections, such as common cold.

• Middle ear infections and glue ear as the enlarged tonsils restrict the flow of air to and from the middle ear.

• Severe enlargement of the tonsils causes breathing pauses and obstructive sleep apnea in about 2% of children with tonsillitis (8).

Causes Of Tonsillitis In Children

Tonsils are lymphoid organs that protect the airway and the lungs by trapping germs that enter the body. Sometimes, these germs enter the folds of tonsils and create a repository which leads to infection.

Viruses and bacteria are common causes of tonsillitis. Acute and mild viral tonsillitis may subside on its own in a week or two, but if your child is showing severe symptoms or if the infection is recurring, then they might need medical intervention.

Viral tonsillitis

The viruses that usually cause tonsillitis are rhinovirus, coronavirus, and adenovirus, and in rare cases, influenza virus, parainfluenza virus, enteroviruses, and herpes viruses.

The Epstein-Barr virus is said to cause both mononucleosis and tonsillitis. So, if your child has mononucleosis, then there is a chance of them developing tonsillitis as a secondary infection.

Bacterial tonsillitis

Bacteria are said to be the cause of about 15-30% of tonsillitis cases (9). Streptococcus pneumoniae and Streptococcus aureus are the two types of bacteria that cause tonsillitis. The Streptococcus pneumoniae can stay inside the body without causing infection and might get transmitted from adults to children (10).

How To Know If It Is A Viral Or Bacterial Tonsillitis?

The symptoms of both forms of tonsillitis are similar, and the exact cause can only be determined through medical testing. If tonsillitis is caused by common cold and flu viruses, the symptoms tend to be mild (11). Bacterial tonsillitis due to streptococcus bacteria tends to display severe symptoms, along with a bad breath.

When To Take Your Child To The Doctor?

If your child has the following symptoms, then it is best to take them to a doctor.

• Has a sore throat for more than two days
• Has trouble swallowing
• Feeling sick and weak
• Shows trouble breathing
• Starts to drool

Diagnosis Of Tonsillitis

The healthcare provider examines your child’s throat and neck, and ask questions about the child’s medical history and symptoms. They examine your child’s tonsils for swelling, redness, or white spots. In some cases, a throat culture or rapid strep throat test or both may be recommended.

Infection can also be confirmed through a blood test that shows a high amount of white blood cells.

Treatment For Tonsillitis

Acute and mild tonsillitis caused by viruses are benign, and the symptoms usually subside in a week or two. But if it is a bacterial infection or if the symptoms are severe and do not subside on their own, your child’s doctor might prescribe beta lactam antibiotics, such as penicillin or cefuroxime. Studies suggest that antibiotic treatment might prevent the spread of infection beyond the tonsils, thus reducing the risk of inflammation of the ear and sinusitis (3).

It is important to complete the entire course of the prescribed antibiotics, even if the symptoms disappear, as the infection might return. In recurrent bacterial and viral infections, your doctor may recommend tonsillectomy after considering the child’s age and other health factors.

Home Remedies For Tonsillitis

Along with the treatment prescribed by your child’s doctor, you can try some home remedies to relieve the symptoms of tonsillitis. Do note that most of these remedies lack scientific evidence, and it is best to take the pediatrician’s opinion before trying any of them.

1. Make sure your child gets lots of rest.

2. Ask them to drink fluids frequently.

3. Serve them soft foods that do not hurt the throat.

4. Some children might find warm foods, such as soups, soothing, while cold food items, such as popsicles, might soothe the throat in some children.

5. You can use a cool-mist humidifier in your child’s room. The humidifier can make breathing easier and relieve throat irritation.

6. You may give over-the-counter medicines, such as acetaminophen or ibuprofen, for pain relief after consulting the doctor. Never give aspirin to children (12).

Prevention Of Tonsillitis In Children

The best way to prevent tonsillitis is to keep the child away from those with tonsillitis or other upper respiratory system infections. You may also take the following preventive measures.

• Train your children to practice basic hygienic habits like washing hands and to close their mouth while coughing or sneezing.

• Maintain good hand hygiene outdoors by using a hand sanitizer.

• If there is an outbreak of infection, then encourage your child to wear a mask at school or daycare.

• Discourage sharing of utensils with others since pathogens can transmit through saliva.

• Immunization against pathogens, such as the flu virus, can reduce the risk of infections, including tonsillitis.

References

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Reviewer

Dr. Richard Mario LurshayMBBS, DNB

 

Dr. Richard Mario Lurshay has around 11 years of experience in the care of children and their well-being. After completing his post-graduation in Pediatrics, he completed his training in Pediatric Nutrition from Boston University School of Medicine (USA).

Read full bio of Dr. Richard Mario Lurshay