A pain in the neck

One of the most common ailments among pre-school children, and its symptoms and treatment, are examined by doctors at London's Great Ormond Street Hospital

What is tonsillitis?

Tonsillitis is a viral or bacterial infection in the throat that causes inflammation of the tonsils, which are small glands on either side of the throat. In the first six months of life they provide a useful defence against infections.

Tonsillitis is one of the most common ailments in pre-school children, but can occur at any age. Children are most often affected from around the age of three or four, when they start nursery or school and come into contact with many new infections. A child may have tonsillitis if they have a sore throat and a fever and are off food. Only children whose tonsillitis is recurrent and severe are referred to an Ear, Nose and Throat surgeon to be considered for a tonsillectomy.

What causes tonsillitis?

Tonsillitis is caused by a variety of contagious viral and bacterial infections. It is spread by close contact with other individuals and occurs more during winter periods.

The most common bacterium causing tonsillitis is streptococcus, so you may hear tonsillitis being called 'strep throat'.

If a child has tonsillitis they may also get some swelling in the glands in the neck, especially the ones just beneath the angle of the jaw. That is because these glands in the neck are part of the body's defences, fighting off the infection.

Signs and symptoms

Tonsillitis can be mild and just cause a sore throat. But it can also come on suddenly making the child feel unwell. The symptoms can vary depending largely on the cause of the infection and the person affected. If a child is very young you may not immediately suspect tonsillitis. Children up to the age of five will rarely complain of a sore or inflamed throat because they have difficulties detecting where the pain is coming from. Instead they might complain of a stomach ache.

A child with tonsillitis will always have:

• sore throat or some evidence the throat is causing pain on swallowing
• red, swollen tonsils. These may also have some white or yellow discharge on them
• fever
• loss of appetite.

A child with tonsillitis may sometimes also have:

• headache
• abdominal pain
• enlarged, tender glands in the neck
• vomiting.

If a child gets many episodes of tonsillitis they may appear thin, pale and lacking in energy.

Complications of tonsillitis are rare. There is no evidence that tonsillitis leads to ear infections, as is often suggested.

Advice and treatment

If the child in your care is simply refusing to eat, or having trouble swallowing, and has a fever, you should consider seeing a doctor for advice.

They will diagnose tonsillitis based on your description of the attacks and on examination of the mouth and neck.

Paracetamol. Generally, episodes of tonsillitis settle without antibiotics. All that is required is to keep the child cool. Also use paracetamol to lower the fever and relieve the pain. Since most episodes of tonsillitis are caused by viruses, antibiotics (which only kill bacteria) will not be helpful for most children. If tonsillitis is not settling, or the child is particularly unwell, a doctor may prescribe antibiotics.

Throat swabs. Nowadays throat swabs are rarely done on children. This is not always an accurate method of identifying the cause of the problem as the infection is buried within the tonsil.

When should tonsils be removed?

If a child has severe tonsillitis that is recurrent, persistent and troublesome, it is advisable to talk to a doctor about tonsillectomy. For example, in cases where the child is subjected to around four attacks a year for two years or more, surgery should be considered as an option. Surgery might also be considered if the tonsils are so large they are causing breathing problems at night.

What is involved in tonsillectomy?

The operation is fairly quick, and takes about 20 minutes under general anaesthetic. The child is usually admitted to hospital a day before the operation and will be able go home the following day if eating and drinking and generally feeling well. A child's throat will feel sore for a few days after a tonsillectomy. Complications such as bleeding are rare.