tackling tonsillitus
Health and safety

Tackling tonsillitis

Tonsillitis is synonymous with childhood. But what exactly is it and how should it be treated? Bernice Barrington reports on tackling tonsillitis.

It starts with a tickle, but within hours it’s all-out agony to swallow: tonsillitis might be one of those illnesses we frequently associate with childhood, but its symptoms are most definitely adult-like in their intensity.

So, what exactly causes it, and how best can we treat our little one if they come down with a bout of this nasty infection?

Tonsillitis is caused by an inflammation of the tonsils, the tissue that sits on both sides of the back of the throat. Though the role of the tonsils is not entirely clear, research suggests they act as a filter, protecting the body from harmful infection that may enter through the mouth. Occasionally, the tonsils will become infected (either through viral or bacterial means), causing them to enlarge and develop a white or yellow coating of pus.

Though tonsillitis can sometimes be confused with a sore throat caused by a cold, there are differences. The latter tends to be milder than tonsillitis and usually clears up after a day or two (often followed by cold-like symptoms such as a runny nose and congestion). Another difference is that while there may be inflammation around the tonsils, the tonsils themselves are not inflamed.

Symptoms of tonsillitis

If your child presents with some or all of the following symptoms, it’s highly likely they are suffering with tonsillitis.

  • Red, swollen tonsils
  • Pain and difficulty swallowing
  • High temperature (over 38°C)
  • Loss of appetite
  • Headache
  • Tiredness
  • Swollen glands in the neck
  • Pain in ears or neck
  • Voice changes because of swelling

Less common symptoms may include:

  • Vomiting
  • Constipation
  • Bad breath
  • Difficulty opening the mouth
  • A ‘furry’ tongue.

In some cases, younger children may complain of tummy pains, which may be a result of swelling of the lymph nodes in the abdomen.

If the tonsillitis has been caused by an underlying flu virus, your child may display other flu symptoms such as aches and pains and a runny nose.

In the case of a bacterial infection, they may develop a skin rash or a flushed face.

Who gets it?

Though children and adolescents aged five to fifteen are most likely to get tonsillitis, it can affect anyone. It is highly contagious and can be spread from person to person through hand contact (then touching your mouth with contaminated hands); breathing in airborne droplets after someone with the infection has sneezed; or sharing the toothbrush, cups or utensils of an infected person.

tackling tonsillitis

Treating tonsillitis

Treatment will depend on whether the tonsillitis is viral or bacterial. To find out, your GP may do a swab test on your child, a painless procedure which will take a small sample of mucous from your child’s tonsils. This will then be sent to the laboratory for analysis, and the results may take a few days to come back.

Viral tonsillitis

Viral tonsillitis is generally caused by viruses that attack the respiratory system, such as the flu virus, rhinovirus or the parainfluenza virus (which causes laryngitis and croup).

In certain rare cases, it can be caused by the Espstein-Barr virus, which causes glandular fever. If this is the case, your child will feel extremely sick and may have swollen lymph nodes throughout their body as well as an enlarged spleen. (Your GP will take a blood test if such symptoms present.)

If your child’s tonsillitis is viral, the only treatment is rest and time – antibiotics will not have any effect. Pain relief can be given in the form of paracetamol or ibuprofen although children under sixteen should not take aspirin due to its link to Reyes disease.

Other ways of easing the discomfort for your child include:

  •  Ensuring they get plenty of rest
  • Giving them lots of fluids to drink
  • Offering them plenty of soft foods  such as ice cream, milkshakes, ice pops, smoothies, and soup
  • Avoiding crunchy or spicy foods
  • There are also over-the-counter treatments such as lozenges and oral sprays that can help ease symptoms.

Bacterial tonsillitis (strep throat)

If your child is suffering from bacterial tonsillitis, the most likely cause is the group A streptococcus bacteria (which is why the illness is often referred to as ‘strep’ throat). If this is the case, your doctor will prescribe antibiotics to your child. It is important that they finish the full course of antibiotics to reduce the risk of under-treating, and to lower the risk of the bacteria developing resistance to the antibiotic.

All of the previously mentioned methods of aiding discomfort (above) can also be used.

Around the house

If your child has come down with tonsillitis, remember to keep their drinking glasses and eating utensils separate, and wash them in hot, soapy water. Remind family members to wash their hands frequently to prevent cross-infection. If your child starts antibiotic therapy for strep throat, throw out his or her toothbrush and replace it with a new one a day or two after starting medication. Most importantly, do not panic.

According to Dr Darach O’Ciardha, Chair of Communications at the Irish College of General Practitioners, “The vast majority of sore throats will improve with just symptomatic relief, but it’s important to note that the expected duration is anything up to a week.”

Preventing tonsillitis

Try to keep kids away from anyone who already has tonsillitis or a sore throat, and make sure everyone in your family is encouraged to wash their hands frequently.


If a child gets tonsillitis more than five to seven times in one year, or has frequent bouts over several years, their doctor may suggest a tonsillectomy to remove the tonsils. It is one of the most common major operations carried out on children in Ireland and is done under a general anaesthetic.

Directly after surgery, your child may feel quite uncomfortable and should be kept off school for two weeks. (This is not just to recover, but to reduce the risk of picking up an infection from another child.)

They should also be encouraged to eat solid foods, as this will help the throat heal more quickly, and to drink plenty of fluids.

Although most tonsillectomies are performed without any problems, occasionally the child may have some bleeding around the operation site. Serious bleeding is uncommon, however. It should be borne in mind that while tonsillectomy can be beneficial to children suffering from recurrent tonsillitis, it does not necessarily rule out throat infections in the future. Make sure to discuss all the risks and benefits fully with your GP or surgeon before proceeding.

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Ask Sarah

Q I’ve heard a lot about the Paleo diet and as I am very interested in reducing the amount of processed foods and grain based meals my family eats, we are considering following this diet. From what I read it seems to be a back-to-basics type of eating. Is a Paleo diet safe for children? My kids are aged seven and nine.

A The Paleo diet is one of the most fashionable diets around at the moment. It is also known as the ‘caveman diet’ and is based on cutting out processed foods, starchy foods like bread and potatoes and eating more meat, vegetables and fruit.
As fad diets go, it is not the worst but there are some good and bad sides to it. Reducing the amount of processed foods we eat is always a good idea and by doing that you will usually reduce the amount of fat, salt and sugar you eat, which is a good thing! The problem with the Paleo diet is that it also cuts out dairy (on the basis that cavemen didn’t drink milk) and this means that the diet is very low in calcium. For this reason it is really not suitable for children who do need a lot of calcium for growing bones. How did cavemen manage without dairy? They ate a lot more food than we do (up to 10,000 calories per day compared to the 2,000 most of us eat). By eating that amount of food they were able to pick up just enough calcium from green vegetables and seeds. To put it in perspective, you would need to eat 16 servings of broccoli a day to get all the calcium you need. This is easier to do if you eat 10,000 calories per day rather than 2,000.
The other problem with the paleo diet is that it is not entirely based in science. Many of the Paleo diets out there say you should not eat wheat, even though we know that cavemen did in fact eat wheat and other grains. These diets also don’t recommend that you eat blubber and the big lumps of fat that were also a large part of the caveman diet!
A final problem is that many Paleo diets encourage people to cut out beans and lentils and to get their protein from meat and fish instead. Many studies over the last few years are clear that eating too much animal protein is linked with more cancer and heart disease. Eating some vegetarian meals based on beans and lentils is a great way to get your protein without always going for meat.
Is this a diet we should follow? I think there is a lot we can learn from the Paleo diets. We could all do with eating less salt, sugar and processed foods and adding in more nuts and seeds as well as more vegetables. However, I think following a strict Paleo diet could lead to low levels of calcium and vitamin D and so it is not suitable for children or teens and adults would need to think about a calcium supplement.


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Midwife Tracey Donegan answers your questions about pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.