Definition

• A viral infection of the tonsils
• Also called viral tonsillitis

Health Information

Symptoms

• The tonsils are lymph glands in the back of the throat. They stand guard on each side of the throat. Usually they are the size of a small cherry.
• Any infection of the throat usually also involves the tonsils. Red and swollen tonsils don’t have any special meaning.
• Pain, discomfort or raw feeling of the throat
• Pain is made worse when swallows
• Children less than 2 years of age usually can’t complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings.
• If you look at the throat with a light, it will be bright red. The tonsil will be red and swollen.

Tonsil Size

• Grade 1 - Can barely see the tonsil
• Grade 2 - Small tonsil
• Grade 3 - Tonsil half way to the midline
• Grade 4 - Tonsils are touching (called kissing tonsils)

Cause

• Usually caused by an infection of the throat (pharyngitis). Since the tonsils are in that area, they are usually also infected (tonsillitis).
• Colds (URIs). Most sore throats are part of a cold. In fact, a sore throat may be the only symptom for the first 24 hours.
• Influenza. A sore throat can be the first symptom in flu infections.
• Viral tonsillitis. Some viruses cause a sore throat without any nasal symptoms.

Prevention of Spread to Others

• Good hand washing can prevent spread of infection.

Care Advice

1. Overview:
   • Most tonsil infections are just part of a cold and caused by a virus.
   • A cough, hoarse voice or nasal discharge points to a cold as the cause.
   • If a sore throat is the only symptom, it’s still usually viral. A fever may also be present.
   • Viral tonsil infections can be treated at home.
   • Here is some care advice that should help.
2. Sore Throat Pain Relief:
   • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
   • Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
   • Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
   • Medicated throat sprays or lozenges are generally not helpful.
3. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
4. Fever:
   • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. Note: Lower fevers are important for fighting infections.
   • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
5. Antibiotics Not Needed:
   • Antibiotics are not helpful for viral infections.
   • They can only kill bacteria.
6. Fluids and Soft Diet:
   • Try to get your child to drink adequate fluids.
   • Goal: Keep your child well hydrated.
   • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
   • Solids: Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solids.
   • Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces.
7. What to Expect:
   • Most often, sore throats with a viral illness last 4 or 5 days.
   • Other cold symptoms may last longer.
8. Return to School:
   • Your child can return to school after the fever is gone.
   • Your child should feel well enough to join in normal activities.

Call Your Doctor If

• Trouble breathing or drooling occurs
• Sore throat with a cold lasts more than 5 days
• Fever lasts more than 3 days
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

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