The pharynx or throat is made up of three parts – the nasopharynx behind the nose, the oropharynx, which you can see when someone opens their mouth, and the hypopharynx near the vocal cords. The adenoids in the nasopharynx and the tonsils in the oropharynx are lymph nodes that help trap bacteria and other germs or pathogens before they can cause a serious infection of the throat and beyond. These lymphatic structures can themselves become infected. When this occurs, it is known as pharyngitis (inflammation of the pharynx) or tonsillitis (inflammation of the tonsils).
What is Pediatric Pharyngitis and Tonsillitis?
The tonsils and surrounding structures of the pharynx help your child’s immune system protect the body from infections. But at times, they too can become primarily infected by a viral or bacterial infection. Pharyngitis and tonsillitis are very common childhood illnesses, typically affecting school-aged children, from around four to sixteen years of age. Most of these are self limited or resolve with antibiotic treatment. If the immune system is unable to stop the infection at the tonsils, it may spread to surrounding tissues resulting in peritonsillar cellulitis or peritonsillar abscess.
Peritonsillar abscess is a serious complication of tonsilitis. Early treatment in a case like this is critical as the swollen tissue in the neck and chest can block your child’s airway, and make breathing difficult.
Different Types of Pediatric Tonsillitis
While pharyngitis is an infection of the tissue of the throat, tonsillitis also involves the tonsillar tissue. There are three different types of tonsillitis. The type affecting your child will influence the treatment plan and the potential need for surgery.
- Acute tonsillitis occurs suddenly and often with severe symptoms.
- Recurrent tonsillitis is when several episodes of acute tonsillitis occur in one year.
- Chronic tonsillitis is constantly present, even after being treated by a physician.
Common Symptoms of Pediatric Tonsillitis?
Pediatric tonsillitis affects children typically between the ages of four and sixteen. Common symptoms include:
- A scratchy voice
- Sore throat that lasts for more than 48 hours
- Snoring problems or sleep apnea (usually with chronic sinusitis)
- Trouble swallowing
- Complaining that it feels like something is stuck in the back of their throat
- White or yellow coating in the back of the mouth
- Patches on the tonsils
- Recurring bad breath
- Ear pain not related to an ear infection
- Enlarged lymph nodes in the neck
What Are Common Causes of Pediatric Tonsillitis?
Pediatric pharyngitis and tonsillitis can be caused by number of factors including:
- Viral infections (many causes)
- Ebstein Barr virus (the etiology of mononucleosis, which causes nasal congestion, sore throat, enlarged tonsils, enlarged anterior neck lymph nodes, and fatigue)
- Fungal infections (uncommon)
- Irritants (such as air pollution, cigarette smoke and other annoyances)
- Post nasal drip
- Mouth breathing (from enlarged adenoids)
- Bacterial infection (most are self limited and do not require antibiotics)
- Streptococcal sore throat (requires antibiotics because untreated strep throat may lead to a severe post infectious process known as Rheumatic Fever)
How Is Pediatric Tonsillitis Diagnosed?
As in diagnosing most pediatric problems, the first step is knowing the child’s history. How long has a sore throat been present? Is there difficulty swallowing? Is there fever, headache, nausea, or abdominal pain? Are there other symptoms such as runny nose, congestion, cough or swollen lymph nodes?
Next, is the physical exam. Is the throat red? Are the tonsils (round structures on the sides in the back of the oropharynx) red or enlarged or have pus on them? Are the glands of the neck enlarged or tender?
Once the diagnosis of pharyngitis or tonsillitis is made, your pediatrician will search for a cause. It is most important to rule out strep throat, as this infection requires antibiotic treatment. This is usually done by performing a throat swab and testing for the presence of streptococcus.
Antibiotics not only make the patient feel better, but prevent the serious consequence of Rheumatic fever from untreated strep infection.
While other causes are often self limited and require no specific treatments, allergies can be relieved with antihistamines or inhaled corticosteroids. More chronic conditions, such as enlarged adenoids, mouth breathing, and chronic tonsillitis or tonsillar enlargement may improve following surgical intervention.
How To Prevent Tonsillitis
Preventing tonsillitis starts with a lot of the same measures you and your child would practice to avoid other infections. Good hand washing and avoiding sick people are the best ways for your child to avoid getting pharyngitis or tonsillitis.
How Is Pediatric Tonsillitis Treated?
The underlying cause and severity of symptoms will determine the treatment plan your child’s pediatrician advocates. In a case of viral tonsillitis, the infection will usually go away on its own in a few days. Other treatment options might include:
- Prescription medication
- Managing discomfort
- Considering surgery
In a case of pediatric tonsillitis associated with strep throat, your pediatrician will prescribe antibiotics. Children on antibiotics tend to feel better in two or three days. Your child must take the exact dosage of antibiotics over the full amount of time. They should continue to take antibiotics even if their symptoms improve.
Children on antibiotics should stay out of school or childcare facilities for at least 24 hours and until they feel better and are fever free to prevent the spread of strep to other children.
Managing Discomfort from Tonsilitis
There are several homeopathic things you can do at home to help manage your child’s tonsillitis symptoms:
- Encouraging them to stay hydrated
- Drinking cold liquids or warm, bland fluids
- Avoiding hot fluids
- Gargling with warm saltwater
- Sucking on lozenges containing benzocaine
- Taking OTC pain medications such as ibuprofen or acetaminophen
- Sucking on a popsicle
Tonsillectomy Surgery for Pediatric Tonsillitis
A child that has recurrent pharyngitis or tonsillitis infections defined as more than four infections in six months might need a tonsillectomy. This is an outpatient surgery to completely remove the tonsils. Tonsillectomy may also be used to relieve symptoms of chronic tonsillitis causing snoring and sleep apnea. Speak with your pediatrician for referral to a pediatric otolaryngologist (Ear, Nose and Throat surgeon) if you think this may apply to your child.