Tonsils & Tonsil Infections

The tonsils are two little bumps or nodes found in the back of the throat at the end of the tongue. Tonsils are thought to be related to the development of the immune system and are part of the lymphatic tissue. Although older children and adults can live without them, tonsils are probably more important for the development of our immune system during pregnancy, before we are born.

The tonsils are small at birth and during infancy. Between the ages of five and ten, they start to get bigger on their own. Eventually, after the age of twelve, they start to shrink on their own. In the meantime, they can get infected and enlarge enough to cause problems. Some children’s tonsils get so big that they are unable to breathe properly, especially at night. In addition, enlarged tonsils can also prevent a child from eating or swallowing well. Most tonsil-related problems occur in children over the age of two years, but can, less commonly, be seen in younger children too.


Tonsillitis is an infection of the tonsils caused either by viruses or bacteria. The usual bacteria causing tonsil infections are Streptococcus also known as Strep throat. The symptoms of a tonsil infection include

  • Sore throat;
  • Difficulty swallowing;
  • Drooling;
  • Not being able to fully open his or her mouth;
  • Pain in the lymph nodes in the neck;
  • Neck pain.Sometimes there can be associated nonspecific symptoms of a throat or tonsil infection in young children including fever, headache, and even abdominal pain.

    Tonsillitis Treatment

    Most throat or tonsil infections are caused by viruses and do not need any treatment. Usually, with viral infections of the tonsils, there are other associated symptoms of a cold such as a runny nose and cough. Strep throat, on the other hand, usually causes very sharp pain, in the throat without any other symptoms.
    By examining the throat, a healthcare provider cannot tell whether it is a viral infection or Strep throat. It is important to know the cause because, unlike viral infections, streptococcal throat infections can cause complications such as local spread to the back of the throat and longer-term kidney and heart problems.

    Antibiotics given promptly will prevent most of these complications. To test for the presence of Streptococcus, a swab is taken from the back of the throat. If the test shows it is a Streptococcal infection, then antibiotics, usually taken by mouth, are prescribed. You should give the medicine on time and for as many days as directed. It usually takes about twenty-four to forty-eight hours for the fever to fall and for the child to start feeling better. In the meantime, make sure the child is drinking well and enough. Also during this time, acetaminophen can be given for fever.

    If your child worsens or the fever persists despite forty-eight hours of antibiotics contact your healthcare provider. Note that very rarely the infection spreads into the throat to cause an abscess full of pus. This complication requires hospitalization for surgery to drain the pus as well as antibiotics are given intravenously.

    Removing Tonsils

    In most children, the tonsils will not cause any significant problems and therefore do not need to be surgically removed. However, in some situations, they need to be removed surgically under general anesthesia. This operation is known as a tonsillectomy. Currently, the indications for removing tonsils are:

    -Recurrent (Strep) infections; more than six in a year.
    -The tonsils are so enlarged that they block breathing and or prevent eating.
    -The development of an abscess around the tonsils.

    Note that children and adults can still get throat infections even if they have had their tonsils removed in the past. The throat infection in this circumstance is known as pharyngitis.

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Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.