Tonsillitis in toddlers: symptoms, treatment and when it needs a doctor
When your toddler suddenly refuses to eat, starts drooling, or has a high temperature out of nowhere, tonsillitis is one of the more common culprits. The good news is that most cases are caused by a virus and get better on their own within about a week. Here is everything you need to know to recognise it, manage it at home, and know when to call for help.
What are tonsils and what is tonsillitis?
Your child's tonsils are two small pads of tissue at the back of the throat, one on each side. They are part of the immune system and help trap germs that enter through the mouth. When those germs infect the tonsils themselves, the result is tonsillitis. The tonsils become inflamed, swollen, and sore. According to the NHS, tonsillitis is particularly common in children and toddlers because their immune systems are still maturing and they encounter many new viruses and bacteria at this age.
It is worth knowing that tonsillitis is not usually a sign that anything serious is wrong. Most children get it at some point, often more than once.
What causes tonsillitis?
The vast majority of tonsillitis cases are caused by a virus, such as the cold virus (rhinovirus), flu virus, or glandular fever virus (Epstein-Barr). Viral tonsillitis is the most common type in children under five. It cannot be treated with antibiotics and will clear up on its own as your child's immune system fights the infection.
A smaller number of cases are caused by bacteria, most commonly a type called Group A Streptococcus, which causes what is often called strep throat. Bacterial tonsillitis responds to antibiotics, which is why telling the two apart matters. Your GP can do a rapid swab test in the clinic to check.
Symptoms to look for
In an older child who can talk, tonsillitis often announces itself as a sore throat. In toddlers, you are working more from clues. The NHS lists the following signs:
- High temperature (above 38 degrees C)
- Refusal to eat or drink, or taking much longer than usual at mealtimes
- Drooling, because swallowing is painful
- Swollen, tender glands on both sides of the neck
- A muffled or changed-sounding voice
- Bad breath
- General grumpiness or tearfulness that is not typical for your child
- Pulling at or touching the throat
If you can gently look into your child's mouth with a torch, you may see red, swollen tonsils at the back. Bacterial tonsillitis often has white or yellowish patches on the tonsils (pus), though this can occasionally happen with viral infections too and is not a definitive guide on its own.
Viral versus bacterial tonsillitis: why it matters
The treatment you need depends on the cause, which is why GPs try to distinguish between the two.
Viral tonsillitis is more common, usually comes alongside cold-like symptoms (runny nose, cough), and does not respond to antibiotics. Giving antibiotics for a viral infection does not help your child get better faster and adds unnecessary antibiotic exposure, which can contribute to antibiotic resistance. The right treatment is rest, fluids, and pain relief.
Bacterial tonsillitis (strep throat) tends to come on more suddenly, often without cold symptoms. The tonsils may show white patches, the temperature can be higher, and the child is sometimes more unwell overall. A GP can swab the back of the throat and get a result within minutes using a rapid antigen test. If the test is positive, or if clinical signs strongly suggest bacterial infection, antibiotics (usually penicillin or amoxicillin) will be prescribed. According to the AAP, completing the full antibiotic course is important even when your child feels better, to prevent complications such as rheumatic fever.
Home care for viral tonsillitis
There is a lot you can do at home to make your toddler more comfortable while they recover.
- Pain relief: Children's paracetamol (such as Calpol) is your best friend here. Give it at the correct dose for your child's weight, as shown on the packaging. Ibuprofen can also be used alternately if your child is old enough and has no contraindications, as it reduces inflammation as well as pain.
- Cool drinks: Cold water, diluted fruit juice, or ice lollies can soothe a sore throat and help keep your child hydrated. Do not worry too much if eating is down for a few days; keeping fluids up is more important.
- Soft foods: Yoghurt, ice cream, mashed potato, and soup are easier to swallow. Avoid anything scratchy or hard like toast or crisps.
- Rest: Keep your toddler at home until their temperature has been normal for at least 24 hours without using fever medicine. Let them rest as much as they want.
When to see a GP
You should contact your GP or NHS 111 if your toddler:
- Has a temperature above 38 degrees C and is under 3 months old, or above 39 degrees C at any age
- Is not improving after 3 to 4 days, or is getting worse rather than better
- Is not drinking enough and you are worried about dehydration
- Has symptoms that suggest bacterial infection, such as white patches on the tonsils
- Has had tonsillitis several times this year
When to call 999 immediately
Some signs mean you should not wait. Call 999 or go to your nearest emergency department right away if your toddler:
- Is drooling and cannot swallow their own saliva at all
- Has noisy, high-pitched breathing or seems to be working hard to breathe
- Has a swollen neck that is pushing their head to one side
- Has a very muffled voice and cannot open their mouth fully
- Seems very unwell very quickly, beyond what you would expect from a sore throat
These signs can indicate quinsy (a peritonsillar abscess, where pus collects next to one tonsil) or, in rare cases, serious airway involvement. Both are medical emergencies that need hospital treatment without delay.
What is quinsy and can my toddler get it?
Quinsy is a collection of pus that forms beside one tonsil, usually as a complication of bacterial tonsillitis. It is more common in older children and teenagers than in toddlers, but it can happen at any age. The signs are one-sided throat swelling, a very muffled "hot potato" voice, an inability to open the mouth properly, severe drooling, and a child who looks quite unwell. If you suspect quinsy, this is a 999 situation. Hospital treatment involves draining the abscess and a course of intravenous antibiotics.
Frequently asked questions
How do I know if my toddler has tonsillitis?
Look for a high temperature, refusal to eat or drink, drooling, swollen glands in the neck, and a muffled or changed voice. In older toddlers who can tell you, they may say their throat hurts. You can gently look inside with a torch to check for red or swollen tonsils. Your GP can confirm it by examining your child directly.
Does tonsillitis always need antibiotics?
No. Most tonsillitis in toddlers is caused by a virus, and antibiotics do not help with viral infections. Your GP may swab for strep bacteria. Antibiotics are only prescribed when a bacterial cause is confirmed or strongly suspected based on clinical signs.
What can I give my toddler for tonsillitis pain?
Children's paracetamol at the correct dose for your child's weight is the most effective option. Ibuprofen can also help if your child is over 3 months and has no contraindications. Offer cool drinks, ice lollies, and soft foods. Always follow the dosing instructions on the packaging and do not give aspirin to children under 16.
When is tonsillitis serious?
Call 999 immediately if your toddler is drooling and cannot swallow their own saliva, has noisy or laboured breathing, has a swollen neck pushing their head to one side, or seems very unwell very quickly. These are signs of quinsy or serious airway involvement, both of which need emergency hospital care.
How long does tonsillitis last?
Viral tonsillitis usually gets better on its own within 7 to 10 days. Bacterial tonsillitis treated with antibiotics typically improves within 2 to 3 days of starting the course, though it is important to finish the full course even when your child feels well again.
What is quinsy?
Quinsy is an abscess (a pocket of pus) that forms next to one tonsil, usually as a complication of bacterial tonsillitis. Signs include one-sided swelling, a very muffled voice, inability to open the mouth fully, and severe drooling. It is rare in toddlers but does happen and needs urgent hospital treatment. Call 999 if you suspect it.
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