Pharyngitis and Tonsillitis in Children

Pharyngitis is redness, pain, and swelling of the throat (pharynx). Tonsillitis is inflammation of the tonsils. The tonsils are a pair of tissue masses on both sides at the back of the throat. They are part of the immune system, the part of the body that fights infection and other disease. Your child may have pharyngitis, tonsillitis, or both (pharyngotonsillitis).

Pharyngitis can be caused by many things. Viral infections are the most common cause. Tonsillitis is usually from viral or bacterial infections. Other causes include:

• Bacteria, such as those that cause strep throat
• Fungi, such as in those that cause a yeast infection
• Allergies, like hay fever or allergies affecting the nose
• Sinus infection
• Cancers
• Injuries
• Irritants, like cigarette smoke or air pollution
• Stomach acids in the throat

Viral and bacterial infections are spread by close contact with other people who are sick. For example, kids attending school or daycare are at risk. This is especially true during the winter months, when most viral and bacterial infections happen.

Symptoms can occur a bit differently in each child. They can include:

• Sore throat
• Trouble or painful swallowing
• Enlarged, painful neck glands
• Hoarseness or change in voice
• Fever or chills
• Headache
• Ear pain
• Upset stomach (nausea) and vomiting
• Belly pain
• Feeling achy and tired
• Red or swollen throat
• Red or enlarged tonsils
• Throat or tonsils may have a whitish discharge
• Trouble breathing or snoring

The symptoms of pharyngitis and tonsillitis can be like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

Your child's healthcare provider will ask about your child’s current symptoms. They will check your child's temperature. The provider will examine your child, paying close attention to the ears, nose, throat, and tonsils. Depending on your child’s symptoms, the provider may do a throat culture or blood tests.

Your child may have a rapid strep test. This is a fast test to see if your child has strep throat. It's important to check for strep throat to treat it and prevent complications. Your child may also have a throat culture. This also checks for strep and for the best antibiotic to treat it. It takes a few days to get the results. Blood work may be done to check for infections like mono (infectious mononucleosis).

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

If your child has a bacterial infection, then they will be treated with antibiotics. If bacteria are not the cause of the infection, then the treatment will focus on making your child comfortable. Treatment may include:

• Taking acetaminophen or ibuprofen as a liquid or pills for pain. Other medicines or treatments may be recommended for severe pain. Talk with your child's healthcare provider before giving them any medicine, especially if it is for the first time.
• Increasing how much your child drinks. Some teas have ingredients that soothe the throat.
• Eating smooth, cool foods such as gelatin, ice cream, and ice pops.
• Gargling with saltwater (for older kids). Ask your child’s healthcare provider for directions.
• Sucking on throat drops or hard candies (for older kids).

Tonsillitis may also need a hospital stay if enlarged tonsils are blocking the airways. In some children with recurrent tonsillitis, the healthcare provider may advise that your child have their tonsils removed (tonsillectomy). Your child's provider will likely want you to see an ear, nose, and throat specialist (ENT or otolaryngologist).

To help keep your child from getting ill: 

• Have them practice good hand hygiene.
• Keep them away from people who have sore throats, colds, or other upper respiratory infections.
• Don't smoke. Keep your child away from secondhand smoke.
• Keep your child up to date on their vaccines.

Complications of pharyngitis and tonsillitis are:

• Serious infections in the throat area
• Fluid loss (dehydration) in the body from trouble eating and drinking
• Breathing problems from very large tonsils with tonsillitis

Untreated strep throat may lead to heart and kidney problems, middle ear infection, lung infection, or infection of the covering of the brain and spinal cord.

Call your child's healthcare provider if either of these occur:

• A sore throat, especially if it does not go away in a few days
• A sore throat and other symptoms, such as a fever

• Pharyngitis is inflammation of the throat. Tonsillitis is inflammation of the tonsils.
• Viruses are the most common cause. They don't need antibiotics for treatment.
• If bacteria are not the cause of the infection, treatment is focused on the comfort of your child.
• If your child’s sore throat is severe and includes trouble swallowing or breathing, drooling, stiff neck, or neck swelling, call 911 or your local emergency number.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.