Tonsillitis in Children: What Parents Should Know

If your child has a sore throat, swollen tonsils and a fever, you may be wondering whether it is tonsillitis, whether they need an antibiotic, and when to worry. This article explains what to look for, how to care for your child at home, the warning signs that need urgent attention, and when taking the tonsils out (tonsillectomy) is worth discussing.

What is tonsillitis?

Tonsillitis means the tonsils, the two soft pads of tissue at the back of the throat, are inflamed, usually from an infection. Common signs are a sore throat, pain when swallowing, red or swollen tonsils (sometimes with white or yellow patches), fever, and tender, swollen glands in the neck. Most children recover fully within about a week (Bochner et al., 2017).

Is my child's tonsillitis viral or strep?

Most sore throats in children are caused by viruses, not bacteria. The most important bacterial cause is group A streptococcus, or strep throat (Shulman et al., 2012).

• More likely a virus: a runny nose, cough, hoarse voice, pink eye, mouth sores or diarrhea along with the sore throat. Antibiotics do not treat viruses (Shulman et al., 2012).
• More likely strep: a sudden sore throat with fever, swollen tonsils with patches, tender swollen glands in the front of the neck, and no cough (Linder et al., 2026). Children with strep may also have a headache, stomach ache or vomiting. Strep is most common in school-aged children and is uncommon under age 3 (Shulman et al., 2012).

Does my child need a strep test or antibiotics?

Looking at the throat alone cannot reliably tell whether strep is the cause, so a throat swab is used when strep is suspected (Linder et al., 2026). In children, a negative rapid strep test is usually confirmed with a throat culture or another more sensitive test (Shulman et al., 2012).

• Testing is usually skipped when a child clearly has cold-like symptoms such as a runny nose, cough or hoarseness, and in most children younger than 3 (Shulman et al., 2012).
• Antibiotics are only for confirmed strep. They do not help a viral sore throat or speed recovery from a virus, and they can cause side effects and add to antibiotic resistance.
• When strep is confirmed, the usual treatment is penicillin or amoxicillin by mouth for 10 days. Give every dose, even after your child feels better (Shulman et al., 2012).

How can I help my child feel better at home?

Whether the cause is a virus or strep, comfort care is the heart of treatment:

• Fluids and rest. Offer plenty to drink to prevent dehydration. Cold drinks, ice pops and soft foods are often easier to swallow.
• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Both work well for throat pain and fever in children when given at the right dose for your child's weight (Marseglia et al., 2026). Ask your pharmacist or your child's doctor for the dose. Ibuprofen is not for babies younger than 6 months or for a child who is dehydrated.
• Never give aspirin to a child or teenager. Aspirin is linked to Reye's syndrome, a rare but serious illness that affects the brain and liver (Bárzaga Arencibia and Choonara, 2012; Krauss et al., 2016).

When is tonsillitis an emergency?

Rarely, tonsillitis leads to a blocked airway or an abscess, a pocket of pus beside the tonsil (peritonsillar abscess). These can worsen quickly in children and may need a scan, antibiotics through a vein, or draining (Bochner et al., 2017).

Call 911 or go to the ER right away if your child:

• Has trouble breathing, noisy breathing or is struggling to breathe
• Is drooling or cannot swallow their own saliva

Call your child's doctor or our office right away (or go to the ER if you cannot reach us) if your child has:

• A muffled or “hot potato” voice
• Swelling on one side of the throat or neck
• Trouble opening the mouth fully
• A stiff neck, severe neck pain or neck swelling
• Signs of dehydration: little or no urine for many hours, no tears, a dry mouth, or unusual sleepiness

When should my child have their tonsils out?

Many children get several sore throats a year and outgrow them, so surgery is reserved for frequent, well-documented throat infections. Doctors use the Paradise criteria, which count episodes that a doctor examined and recorded (Mitchell et al., 2019):

• 7 or more episodes in the past year, or
• 5 or more episodes a year in each of the past 2 years, or
• 3 or more episodes a year in each of the past 3 years.

Each episode should also have had a fever over 101°F (38.3°C), swollen neck glands, patches on the tonsils, or a positive strep test. That is why it helps to have each sore throat seen and written down by your child's doctor when it happens (Mitchell et al., 2019).

Some children may benefit from surgery with fewer episodes, for example a child who is allergic to several antibiotics, has had more than one peritonsillar abscess, or has PFAPA, a condition that causes repeated fevers with sore throat, mouth sores and swollen neck glands (Mitchell et al., 2019).

Loud snoring, pauses in breathing during sleep, or restless sleep are a separate and common reason to consider removing the tonsils. See pediatric ENT care.

If tonsillectomy is recommended, the surgery itself usually takes 15 to 30 minutes. Recovery usually takes 10 to 14 days and varies from child to child; our tonsillectomy recovery guide walks through it day by day.

Is watchful waiting a good option?

Often, yes. Even for children who meet the Paradise criteria, the benefit of tonsillectomy is modest and mainly seen in the first year, after which children who did not have surgery tend to improve on their own (Morad et al., 2017). For children with fewer episodes, the guideline recommends watchful waiting rather than surgery (Mitchell et al., 2019).

Watchful waiting does not mean doing nothing. It means having each sore throat checked and recorded, and checking in regularly so the picture stays accurate. The decision is best made together by you, your child's doctor and an ENT, weighing how often and how badly the infections disrupt your child's life against the risks of surgery and anesthesia.

Schedule a Visit for Your Child

See an ENT if your child has frequent, documented throat infections, has had a peritonsillar abscess, or snores loudly or stops breathing during sleep. Our board-certified ENTs can examine your child, review the infection history with you, and talk through watchful waiting and surgery. For any of the emergency warning signs above, seek care right away rather than waiting for an appointment.

Sources

• Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngology–Head and Neck Surgery. 2019;160(1 Suppl):S1-S42. doi:10.1177/0194599818801757. PMID: 30798778
• Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2012;55(10):e86-e102. doi:10.1093/cid/cis629. PMID: 22965026
• Linder JA, Watson ME, Wessels MR, et al. 2025 clinical practice guideline update by the Infectious Diseases Society of America on group A streptococcal pharyngitis: risk assessment using clinical scoring systems in children and adults. Clinical Infectious Diseases. 2026;82(Suppl 3):i97-i104. doi:10.1093/cid/ciaf668. PMID: 41343363
• Bochner RE, Gangar M, Belamarich PF. A clinical approach to tonsillitis, tonsillar hypertrophy, and peritonsillar and retropharyngeal abscesses. Pediatrics in Review. 2017;38(2):81-92. doi:10.1542/pir.2016-0072. PMID: 28148705
• Morad A, Sathe NA, Francis DO, McPheeters ML, Chinnadurai S. Tonsillectomy versus watchful waiting for recurrent throat infection: a systematic review. Pediatrics. 2017;139(2):e20163490. doi:10.1542/peds.2016-3490. PMID: 28096515
• Marseglia GL, Marchisio PG, Milani GP, et al. Ibuprofen versus acetaminophen for acute mild-to-moderate pain management in pediatric populations: a systematic review and meta-analysis of their efficacy. European Journal of Pediatrics. 2026;185(9):723. doi:10.1007/s00431-026-07383-7. PMID: 42704487
• Bárzaga Arencibia Z, Choonara I. Balancing the risks and benefits of the use of over-the-counter pain medications in children. Drug Safety. 2012;35(12):1119-1125. doi:10.2165/11633620-000000000-00000. PMID: 23078168
• Krauss BS, Calligaris L, Green SM, Barbi E. Current concepts in management of pain in children in the emergency department. Lancet. 2016;387(10013):83-92. doi:10.1016/S0140-6736(14)61686-X. PMID: 26095580