Diagnosis

Your child's doctor will start with a physical exam that will include:

  • Using a lighted instrument to look at your child's throat and likely his or her ears and nose, which may also be sites of infection
  • Checking for a rash known as scarlatina, which is associated with some cases of strep throat
  • Gently feeling (palpating) your child's neck to check for swollen glands (lymph nodes)
  • Listening to his or her breathing with a stethoscope
  • Checking for enlargement of the spleen (for consideration of mononucleosis, which also inflames the tonsils)

Throat swab

With this simple test, the doctor rubs a sterile swab over the back of your child's throat to get a sample of secretions. The sample will be checked in the clinic or in a lab for streptococcal bacteria.

Many clinics are equipped with a lab that can get a test result within a few minutes. However, a second more reliable test is usually sent out to a lab that can return results within 24 to 48 hours.

If the rapid in-clinic test comes back positive, then your child almost certainly has a bacterial infection. If the test comes back negative, then your child likely has a viral infection. Your doctor will wait, however, for the more reliable out-of-clinic lab test to determine the cause of the infection.

Complete blood cell count (CBC)

Your doctor may order a CBC with a small sample of your child's blood. The result of this test, which can often be completed in a clinic, produces a count of the different types of blood cells. The profile of what's elevated, what's normal or what's below normal can indicate whether an infection is more likely caused by a bacterial or viral agent. A CBC is not often needed to diagnose strep throat. However, if the strep throat lab test is negative, the CBC may be needed to help determine the cause of tonsillitis.

Treatment

At-home care

Whether tonsillitis is caused by a viral or bacterial infection, at-home care strategies can make your child more comfortable and promote better recovery.

If a virus is the expected cause of tonsillitis, these strategies are the only treatment. Your doctor won't prescribe antibiotics. Your child will likely be better within seven to 10 days.

At-home care strategies to use during the recovery time include the following:

  • Encourage rest. Encourage your child to get plenty of sleep.
  • Provide adequate fluids. Give your child plenty of water to keep his or her throat moist and prevent dehydration.
  • Provide comforting foods and beverage. Warm liquids — broth, caffeine-free tea or warm water with honey — and cold treats like ice pops can soothe a sore throat.
  • Prepare a saltwater gargle. If your child can gargle, a saltwater gargle of 1 teaspoon (5 milliliters) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a sore throat. Have your child gargle the solution and then spit it out.
  • Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat, or sit with your child for several minutes in a steamy bathroom.
  • Offer lozenges. Children older than age 4 can suck on lozenges to relieve a sore throat.
  • Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.
  • Treat pain and fever. Talk to your doctor about using ibuprofen (Advil, Children's Motrin, others) or acetaminophen (Tylenol, others) to minimize throat pain and control a fever. Low fevers without pain do not require treatment.

    Except for certain diseases, children and teenagers should not take aspirin because when used to treat symptoms of cold or flu-like illnesses, it has been linked to Reye's syndrome, a rare but potentially life-threatening condition.

Antibiotics

If tonsillitis is caused by a bacterial infection, your doctor will prescribe a course of antibiotics. 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 doctor will prescribe an alternative antibiotic.

Your child must take the full course of antibiotics as prescribed even if the symptoms go away completely. Failure to take all of the medication as directed may result in the infection worsening or spreading to other parts of the body. Not completing the full course of antibiotics can, in particular, increase your child's risk of rheumatic fever and serious kidney inflammation.

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

Surgery

Surgery to remove tonsils (tonsillectomy) may be used to treat frequently recurring tonsillitis, chronic tonsillitis or bacterial tonsillitis that doesn't respond to antibiotic treatment. Frequent tonsillitis is generally defined as:

  • More than seven episodes in one year
  • More than four to five episodes a year in each of the preceding two years
  • More than three episodes a year in each of the preceding three years

A tonsillectomy may also be performed if tonsillitis results in difficult-to-manage complications, such as:

  • Obstructive sleep apnea
  • Breathing difficulty
  • Swallowing difficulty, especially meats and other chunky foods
  • An abscess that doesn't improve with antibiotic treatment

Tonsillectomy is usually done as an outpatient procedure, unless your child is very young, has a complex medical condition or if complications arise during surgery. That means your child should be able to go home the day of the surgery. A complete recovery usually takes seven to 14 days.

Preparing for your appointment

If your child is experiencing a sore throat, difficulty swallowing or other symptoms that may indicate tonsillitis, you'll likely start with a visit to your family doctor or your child's pediatrician. You may be referred to a specialist in ear, nose and throat (ENT) disorders (otolaryngologist).

Your doctor is likely to ask you a number of questions about your child's condition. Be prepared to answer the following questions:

  • When did the symptoms begin?
  • If your child has had a fever, what was his or her temperature?
  • Does he or she have difficulty swallowing foods, or does it hurt to swallow?
  • Does anything improve symptoms, such as an over-the-counter pain reliever or warm liquids?
  • Has your child been diagnosed with tonsillitis or strep throat before? If so, when?
  • Do symptoms seem to affect his or her sleep?
  • Has your child been exposed to anyone known to have strep throat?

Questions you may want to ask your doctor include the following:

  • How long will it take to get test results?
  • What is the best course of treatment?
  • Should I be concerned with how frequently my child is getting tonsillitis?
  • When can my child go back to school or resume other activities?
July 17, 2015
References
  1. Fact sheet: Tonsils and adenoids. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/?q=node/1432. Accessed June 2, 2015.
  2. Fact sheet: Tonsillitis. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/?q=node/1447. Accessed June 2, 2015.
  3. Tonsillopharyngitis. Merck Manual Professional Version. http://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/tonsillopharyngitis. Accessed June 2, 2015.
  4. Paradise. Tonsillectomy and/or adenoidectomy in children: Indications and contraindications. http://www.uptodate.com/ home. Accessed June 1, 2015.
  5. Papadakis MA, et al, eds. Ear, nose, & throat disorders. In: Current Medical Diagnosis & Treatment 2014. 53rd ed. New York, N.Y.: The McGraw-Hill Companies; 2014. http://accessmedicine.com. Accessed June 2, 2015.
  6. Fact sheet: Tonsils and adenoids: Postop. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/content/tonsillectomy-and-adenoids-postop. Accessed June 2, 2015.
  7. Ferri FF. Tonsillitis. In: Ferri's Clinical Advisor 2015. Philadelphia, Pa.: Mosby Elsevier; 2015. http://www.clinicalkey.com. Accessed June 2, 2015.
  8. Stopping the spread of germs at home, work and school. Centers for Disease Control and Prevention. http://www.cdc.gov/flu/protect/stopgerms.htm. Accessed June 2, 2015.
  9. NINDS Reye's syndrome information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/reyes_syndrome/reyes_syndrome.htm. Accessed June 2, 2015.
  10. What is the role of aspirin in triggering Reye's? National Reye's Syndrome Foundation. http://www.reyessyndrome.org/aspirin.html. Accessed June 2, 2015.
  11. Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. June 4, 2015.
  12. Orvidas LJ (expert opinion). Mayo Clinic, Rochester, Minn. June 16, 2015.