Pharyngitis and Tonsillitis in Children

What are pharyngitis and tonsillitis?

Pharyngitis and tonsillitis are infections in the throat that cause inflammation.

If the tonsils are primarily affected, it is called tonsillitis. If the throat is primarily affected, it is called pharyngitis. A child might even have inflammation and infection of both the tonsils and the throat. This would be called pharyngotonsillitis. These infections are spread by close contact with other individuals. The majority of pharyngitis cases occur during the winter or colder months.

What causes pharyngitis and tonsillitis?

There are many causes of infections in the throat. Viruses are the most common cause and do not require antibiotics. Treating viral pharyngitis is a common reason for the inappropriate use of antibiotics, which should be used only for bacterial infections. Causes of throat infections include: 

  • Viruses

    • Adenovirus

    • Influenza virus

    • Rhinovirus

    • Coxsackie virus

    • Epstein-Barr virus (mononucleosis)

    • Herpes simplex virus

  • Bacteria

    • Group A beta-hemolytic streptococci (GABHS)

    • Neisseria gonorrhoeae

    • Haemophilus influenzae type b

    • Mycoplasma

    • Chlamydia pneumoniae

  • Fungal infections

  • Parasitic infections

What are the symptoms of pharyngitis and tonsillitis?

The symptoms of pharyngitis and tonsillitis depend greatly on the cause of the infection and the person affected. For some children, the onset of symptoms may be quick; for others, symptom onset is slow. The following are the most common symptoms of pharyngitis and tonsillitis. However, each child may experience symptoms differently. Symptoms may include:

  • Sore throat

  • Fever

  • Headache

  • Decrease in appetite

  • Not feeling well

  • Nausea

  • Vomiting

  • Stomach aches

  • Painful swallowing

  • Visual redness or drainage in the throat

The symptoms of pharyngitis and tonsillitis may resemble other medical conditions or problems. Always see your child's health care provider for a diagnosis. If your child's sore throat is severe and includes difficulty swallowing, drooling, stiff neck, or neck swelling, your child's provider should be seen immediately.

How are pharyngitis and tonsillitis diagnosed?

In some cases, it is hard to distinguish between a viral sore throat and a strep throat based on physical examination. It is important, though, to know if the sore throat is caused by GABHS, as this requires antibiotic treatment to help prevent the complications associated with these bacteria. Children with a runny nose or cough are very unlikely to have GABHS as a cause of their condition.

As a result, some children, when they have the above symptoms, will receive a strep test and possibly a throat culture to determine if it is an infection caused by GABHS. This usually involves a throat swab in the doctor's office.

Quick tests, called rapid strep tests, may be performed. This may immediately show as positive for GABHS and antibiotics will be started. If it is negative, part of the throat swab will usually be kept for a throat culture. This will further identify, in two to three days, if GABHS is present. Your child's health care provider will decide on the treatment plan based on the findings.

What are the treatments for pharyngitis and tonsillitis?

Specific treatment for pharyngitis and tonsillitis will be determined by your child's health care provider based on:

  • Your child's age, overall health, and medical history

  • Extent of the condition

  • Cause of the condition

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

If bacteria are not the cause of the infection, then the treatment is focused on the comfort of your child. Antibiotics will not help treat viral sore throats. Treatment may include:

  • Acetaminophen or ibuprofen (for pain)

  • Increased fluid intake

  • Throat lozenges (for children old enough to handle hard candies)

  • Antibiotics (if the cause of the infection is bacterial, not viral)