Does your child have tonsillitis?

By Matthew W. Good, MD

By Matthew W. Good, MD

“It hurts when I swallow.”
If your child says something like this, it could be tonsillitis—an inflammation of the tonsils that usually occurs during an infection. Although you can get tonsillitis year-round, most episodes occur during the winter months of the cold and flu season. A virus usually causes the infection, but bacteria also can be the source. A viral tonsillitis will improve by itself, but bacterial infections need treatment with antibiotics.

How do I know if my child has tonsillitis?
An infection of the tonsils usually begins suddenly, with fever and throat pain. Younger children will drool excessively, and older children will refuse to eat and drink. Swollen and tender nodes in the neck are also common. Headache, stomachache, nausea, vomiting and decreased activity usually accompany the infection. The child’s breath may be unpleasant, as well.
Almost all cases of tonsillitis are contagious. Daycares and schools report outbreaks every year. The infection spreads from person to person through close contact, coughing and sneezing, sharing toys and shared food. Frequent and thorough hand-washing is a family’s best defense against the spread of infection.

What can I do to treat tonsillitis?
Focus your efforts on providing plenty of fluids for your child. Don’t be alarmed if your child refuses to eat for several days, but try to keep the child drinking. Cool liquids, such as water and sports drinks, go down easier than hot drinks like tea with honey, which can irritate an already inflamed throat. Popsicles are a great choice too. If your child wants popsicles for breakfast, lunch and dinner, go for it!
One of the best ways to encourage your child to drink is by controlling pain. Many over-the-counter remedies promise instant relief, but most fail to provide lasting results. These medications can also be dangerous. Throat lozenges, for example, are clearly a choking hazard for young children. You may be told to try gargling with salt-water, but the salt commonly burns inflamed tonsils. Younger children may even swallow this concoction, which can be toxic if they consume too much. The most effective way to control the child’s pain is by using acetaminophen (Tylenol) regularly every four to six hours. Not only will it keep your child’s fever down, but, more importantly, it will help alleviate discomfort. Avoid ibuprofen (Motrin or Advil), which has dangerous side-effects in a dehydrated child.

Should I call my pediatrician?
Most causes of tonsillitis are viruses, which get better on their own and are not treated with antibiotics. Strep throat, however, is also a common type of tonsillitis that needs treatment with antibiotics. Your pediatrician can diagnose strep throat with a simple swab in the back of your child’s throat. This quick test can be performed in the office.
After being diagnosed with tonsillitis, your child may need to return to the pediatrician’s office if he or she shows signs of dehydration. If your child refuses to drink and becomes dehydrated, your pediatrician may prescribe stronger pain medicine or even recommend intravenous fluids to re-hydrate your child. Signs of dehydration include a decrease in wet diapers, a dry mouth or no tears when crying. Any of these symptoms should prompt a return visit to the pediatrician.

Is surgery an option?
If your child has multiple episodes of tonsillitis, it may be time to have the tonsils removed. Your pediatrician and an ear, nose and throat specialist will determine if your child is a good candidate for surgery. General guidelines for surgery include:

∑ seven or more episodes of tonsillitis in one year
∑ five or more episodes per year over a two-year period
∑ enlarged tonsils that interfere with breathing
∑ an abscess in the tonsils
∑ different-sized tonsils

Usually your child will come to the hospital the day of the surgery and return home later that afternoon. General anesthesia keeps your child safe and comfortable during the procedure. Full recovery can be expected in 10 to 14 days.
Complications from surgery and anesthesia are rare, but it is best to have a medical team competent and comfortable providing safe care for children. The entire staff at T.C. Thompson Children’s Hospital at Erlanger specializes in pediatric care, with recovery room nurses, child-life specialists, anesthesia experts and surgeons who work exclusively with children.

Matthew W. Good, MD, FAAP, is a pediatrician at T.C. Thompson Children’s Hospital. For more information, call Erlanger’s physician referral line at 423-778-LINK (5465).