Medical Conditions

Signs of a Peritonsillar Abscess in My Child

Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist

Content reviewed against published AAP, Mayo Clinic, NIH guidelines

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If your baby has been diagnosed with or you suspect signs of a peritonsillar abscess in my child, here is what the evidence says.

The short answer

A peritonsillar abscess is a pocket of pus that forms behind or near one tonsil, usually as a complication of untreated tonsillitis. It is uncommon in young children but can occur. Signs include severe sore throat (typically one-sided), difficulty swallowing and opening the mouth, drooling, muffled or "hot potato" voice, fever, and swelling on one side of the throat. This is a medical emergency that requires prompt drainage and antibiotics.

Key takeaways

  • A peritonsillar abscess is a pocket of pus that forms behind or near one tonsil, usually as a complication of untreated tonsillitis. It is uncommon in young children but can occur. Signs include severe sore throat (typically one-sided), difficulty swallowing and opening the mouth, drooling, muffled or "hot potato" voice, fever, and swelling on one side of the throat. This is a medical emergency that requires prompt drainage and antibiotics.
  • Usually normal when: A sore throat with mild tonsil swelling that improves over 3-5 days with treatment
  • Call your doctor if: Your child has severe one-sided throat swelling, cannot open their mouth fully, is drooling and unable to swallow, has a muffled voice, or is leaning forward to breathe
  • Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
— Fever and Your Child, American Academy of Pediatrics (AAP)

Parents everywhere have the same worry. You are doing the right thing by looking into it.

What Parents Should Know

According to AAP, Mayo Clinic, NIH guidelines, a peritonsillar abscess is a pocket of pus that forms behind or near one tonsil, usually as a complication of untreated tonsillitis. It is uncommon in young children but can occur. Signs include severe sore throat (typically one-sided), difficulty swallowing and opening the mouth, drooling, muffled or "hot potato" voice, fever, and swelling on one side of the throat. This is a medical emergency that requires prompt drainage and antibiotics. At 0-3 months, peritonsillar abscess is extremely rare in newborns and very young babies. Any significant throat swelling in this age group needs emergency evaluation. Deep neck space infections in young babies can be life-threatening and require immediate treatment. It is generally considered normal when a sore throat with mild tonsil swelling that improves over 3-5 days with treatment. However, you should contact your pediatrician promptly if your child has severe one-sided throat swelling, cannot open their mouth fully, is drooling and unable to swallow, has a muffled voice, or is leaning forward to breathe.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
A sore throat with mild tonsil swelling that improves over 3-5 days with treatment
Your child has severe one-sided throat swelling, cannot open their mouth fully, is drooling and unable to swallow, has a muffled voice, or is leaning forward to breathe
Both tonsils are equally swollen during a viral illness
Your child has a very high fever with throat pain and any signs of difficulty breathing or airway compromise
Your child can swallow and open their mouth normally despite a sore throat
Your child's sore throat is notably worse on one side

By Age

What to expect by age

0-3 months

Peritonsillar abscess is extremely rare in newborns and very young babies. Any significant throat swelling in this age group needs emergency evaluation. Deep neck space infections in young babies can be life-threatening and require immediate treatment.

3-12 months

Still very rare at this age. If your baby has a very high fever with drooling, refusal to swallow, and seems to be in severe pain, seek emergency care. An abscess may present differently in young children than in older children, making clinical evaluation essential.

12-24 months

While uncommon, peritonsillar abscess can occur in toddlers, especially following a bout of tonsillitis or strep throat that was not adequately treated. Watch for sudden worsening of a sore throat, drooling (inability or unwillingness to swallow), high fever, and preference for tilting the head to one side.

2-3 years

Peritonsillar abscess becomes slightly more common in older children and adolescents. If your child has been treated for tonsillitis or strep but symptoms worsen rather than improve (especially on one side), or new symptoms develop such as difficulty opening the mouth (trismus), seek medical evaluation promptly. Treatment typically involves drainage (needle aspiration or incision) and IV antibiotics.

3-5 years

Children with recurrent tonsillitis are at higher risk. If treated strep throat worsens after initial improvement, with one-sided throat pain, difficulty opening the mouth, and drooling, this may indicate abscess formation. Emergency evaluation is needed as the abscess can compromise the airway if it grows large enough.

What to Tell Your Pediatrician

  • Describe when you first noticed signs of a peritonsillar abscess in my child and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your child's sore throat is notably worse on one side.
  • Mention if symptoms of tonsillitis worsen after initially improving.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • A sore throat with mild tonsil swelling that improves over 3-5 days with treatment
  • Both tonsils are equally swollen during a viral illness
  • Your child can swallow and open their mouth normally despite a sore throat
Mention at your next visit when...
  • Your child's sore throat is notably worse on one side
  • Symptoms of tonsillitis worsen after initially improving
  • Your child has difficulty swallowing saliva and is drooling more than expected for their age
Act now when...
  • Your child has severe one-sided throat swelling, cannot open their mouth fully, is drooling and unable to swallow, has a muffled voice, or is leaning forward to breathe
  • Your child has a very high fever with throat pain and any signs of difficulty breathing or airway compromise

What You Can Do at Home

  • Keep track of when you notice signs of a peritonsillar abscess in my child — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that a sore throat with mild tonsil swelling that improves over 3-5 days with treatment — this is generally within the range of normal.
  • At 0-3 months, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
  • While monitoring at home, seek immediate care if your child has severe one-sided throat swelling, cannot open their mouth fully, is drooling and unable to swallow, has a muffled voice, or is leaning forward to breathe.

Could My Baby Have Tonsillitis?

Tonsillitis (inflammation of the tonsils) is usually caused by viral infections in babies and toddlers. It causes sore throat, difficulty swallowing, fever, and visibly red or swollen tonsils sometimes with white patches. Viral tonsillitis resolves on its own in 5-7 days. Bacterial tonsillitis (strep) is uncommon before age 2-3 but needs antibiotic treatment. See your pediatrician if your baby has a severe sore throat with high fever.

Strep Throat in Baby or Toddler

Strep throat (Group A Streptococcus infection) is uncommon in babies under 2 years but can occur in toddlers. It is most common in children ages 5-15. In toddlers, strep may present differently than in older children - instead of the classic sore throat, toddlers may have low-grade fever, irritability, decreased appetite, runny nose, and swollen lymph nodes. A rapid strep test or throat culture is needed for diagnosis. Strep throat requires antibiotic treatment (usually amoxicillin for 10 days) to prevent complications including rheumatic fever.

When Should My Baby See a Pediatric ENT?

A pediatric ENT (otolaryngologist) specializes in ear, nose, and throat conditions in children. Common reasons for referral include recurrent ear infections (3+ in 6 months or 4+ in a year), hearing loss, chronic ear fluid, enlarged tonsils or adenoids causing sleep or breathing problems, stridor, chronic sinusitis, airway abnormalities, and neck masses. These specialists can perform ear tube surgery, tonsillectomy, adenoidectomy, and airway evaluations.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is signs of a peritonsillar abscess in my child normal?
A peritonsillar abscess is a pocket of pus that forms behind or near one tonsil, usually as a complication of untreated tonsillitis. It is uncommon in young children but can occur. Signs include severe sore throat (typically one-sided), difficulty swallowing and opening the mouth, drooling, muffled or "hot potato" voice, fever, and swelling on one side of the throat. This is a medical emergency that requires prompt drainage and antibiotics.
When should I call the doctor about signs of a peritonsillar abscess in my child?
Your child has severe one-sided throat swelling, cannot open their mouth fully, is drooling and unable to swallow, has a muffled voice, or is leaning forward to breathe Your child has a very high fever with throat pain and any signs of difficulty breathing or airway compromise
When is signs of a peritonsillar abscess in my child normal?
A sore throat with mild tonsil swelling that improves over 3-5 days with treatment Both tonsils are equally swollen during a viral illness Your child can swallow and open their mouth normally despite a sore throat
What causes signs of a peritonsillar abscess in my child?
A peritonsillar abscess is a pocket of pus that forms behind or near one tonsil, usually as a complication of untreated tonsillitis. It is uncommon in young children but can occur. Signs include severe sore throat (typically one-sided), difficulty swallowing and opening the mouth, drooling, muffled or "hot potato" voice, fever, and swelling on one side of the throat. This is a medical emergency that requires prompt drainage and antibiotics. Common explanations include: A sore throat with mild tonsil swelling that improves over 3-5 days with treatment. Both tonsils are equally swollen during a viral illness.
What should I mention to my pediatrician about signs of a peritonsillar abscess in my child?
You should mention signs of a peritonsillar abscess in my child at your next visit if: Your child's sore throat is notably worse on one side. Symptoms of tonsillitis worsen after initially improving. Your child has difficulty swallowing saliva and is drooling more than expected for their age.
Is signs of a peritonsillar abscess in my child normal at 0-3 months?
Peritonsillar abscess is extremely rare in newborns and very young babies. Any significant throat swelling in this age group needs emergency evaluation. Deep neck space infections in young babies can be life-threatening and require immediate treatment.
Is signs of a peritonsillar abscess in my child normal at 3-12 months?
Still very rare at this age. If your baby has a very high fever with drooling, refusal to swallow, and seems to be in severe pain, seek emergency care. An abscess may present differently in young children than in older children, making clinical evaluation essential.
Should I go to the ER for signs of a peritonsillar abscess in my child?
Seek emergency care if your child has severe one-sided throat swelling, cannot open their mouth fully, is drooling and unable to swallow, has a muffled voice, or is leaning forward to breathe, or if your child has a very high fever with throat pain and any signs of difficulty breathing or airway compromise. When in doubt, call your pediatrician's after-hours line for guidance.
Does signs of a peritonsillar abscess in my child go away on its own?
In many cases, signs of a peritonsillar abscess in my child resolves on its own, especially when a sore throat with mild tonsil swelling that improves over 3-5 days with treatment. By 3-5 years, children with recurrent tonsillitis are at higher risk. If treated strep throat worsens after initial improvement, with one-sided throat pain, difficulty opening the mouth, and drooling, this may indicate abscess formation. Emergency evaluation is needed as the abscess can compromise the airway if it grows large enough.
AAPMAYO CLINICNIH

References

  1. [1]American Academy of Pediatrics. Peritonsillar Abscess. Pediatrics in Review. AAP
  2. [2]Mayo Clinic. Peritonsillar abscess. Mayo Clinic
  3. [3]National Library of Medicine. Peritonsillar Abscess. StatPearls. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Signs of a Peritonsillar Abscess in My Child.

Things to mention

  • Describe when you first noticed signs of a peritonsillar abscess in my child and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your child's sore throat is notably worse on one side.
  • Mention if symptoms of tonsillitis worsen after initially improving.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Your child's sore throat is notably worse on one side
  • Symptoms of tonsillitis worsen after initially improving
  • Your child has difficulty swallowing saliva and is drooling more than expected for their age

Urgent signs to report immediately

  • Your child has severe one-sided throat swelling, cannot open their mouth fully, is drooling and unable to swallow, has a muffled voice, or is leaning forward to breathe
  • Your child has a very high fever with throat pain and any signs of difficulty breathing or airway compromise

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

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Bottom line

Most cases of signs of a peritonsillar abscess in my child are normal. Talk to your pediatrician if your child has severe one-sided throat swelling, cannot open their mouth fully, is drooling and unable to swallow, has a muffled voice, or is leaning forward to breathe.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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Could My Baby Have Tonsillitis?

Tonsillitis (inflammation of the tonsils) is usually caused by viral infections in babies and toddlers. It causes sore throat, difficulty swallowing, fever, and visibly red or swollen tonsils sometimes with white patches. Viral tonsillitis resolves on its own in 5-7 days. Bacterial tonsillitis (strep) is uncommon before age 2-3 but needs antibiotic treatment. See your pediatrician if your baby has a severe sore throat with high fever.

Strep Throat in Baby or Toddler

Strep throat (Group A Streptococcus infection) is uncommon in babies under 2 years but can occur in toddlers. It is most common in children ages 5-15. In toddlers, strep may present differently than in older children - instead of the classic sore throat, toddlers may have low-grade fever, irritability, decreased appetite, runny nose, and swollen lymph nodes. A rapid strep test or throat culture is needed for diagnosis. Strep throat requires antibiotic treatment (usually amoxicillin for 10 days) to prevent complications including rheumatic fever.

When Should My Baby See a Pediatric ENT?

A pediatric ENT (otolaryngologist) specializes in ear, nose, and throat conditions in children. Common reasons for referral include recurrent ear infections (3+ in 6 months or 4+ in a year), hearing loss, chronic ear fluid, enlarged tonsils or adenoids causing sleep or breathing problems, stridor, chronic sinusitis, airway abnormalities, and neck masses. These specialists can perform ear tube surgery, tonsillectomy, adenoidectomy, and airway evaluations.

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