Peritonsillar Abscess in Children
Content reviewed against published AAP, NIH, Mayo Clinic guidelines
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A peritonsillar abscess (PTA) is a collection of pus that forms in the tissue beside the tonsil, usually as a complication of untreated or inadequately treated tonsillitis or strep throat. It is the most common deep neck infection in children and adolescents, with peak incidence in teens and young adults. It requires urgent medical treatment and often drainage.
Key takeaways
- A peritonsillar abscess (PTA) is a collection of pus that forms in the tissue beside the tonsil, usually as a complication of untreated or inadequately treated tonsillitis or strep throat.
- Duration: Significant improvement within 24-48 hours after drainage and antibiotics. Complete resolution in 1-2 weeks with appropriate treatment. Oral antibiotics continue for 10-14 days total.
- Go to ER if: Unable to swallow saliva or drooling
- No vaccine currently available
Symptoms
How It Presents by Age
0-3 years
Rare in this age group. May present with drooling, feeding refusal, irritability, and fever. Diagnosis is challenging due to difficulty examining the throat.
Risk level: Low incidence but high risk if present
3-7 years
Uncommon but possible. Drooling, food refusal, muffled speech, and unilateral throat swelling. May not be able to describe unilateral pain clearly.
Risk level: Moderate
7-12 years
Can describe unilateral throat pain, difficulty swallowing, and voice changes. Trismus is a key finding. Often follows a recent strep or tonsillitis diagnosis.
Risk level: Moderate
12-18 years
Most common age group for PTA. Classic presentation with severe unilateral throat pain, trismus, "hot potato" voice, and deviation of the uvula.
Risk level: Moderate — most common age group
Treatment
Needle aspiration
First-line treatment for confirmed abscess. A needle is used to aspirate pus from the abscess cavity. Effective in 90-95% of cases and can be performed in the emergency department.
Incision and drainage
Performed if needle aspiration fails or abscess recurs. Makes a small incision in the abscess to drain pus. Usually done under sedation in children.
IV antibiotics
Broad-spectrum antibiotics covering strep, staph, and anaerobes. Common regimens include ampicillin-sulbactam or clindamycin. Transitioned to oral antibiotics for 10-14 day total course.
Pain management
IV fluids for dehydration, IV analgesics, and corticosteroids (dexamethasone) to reduce swelling and pain.
Home Care
- This condition requires medical treatment — do not attempt to manage at home
- After drainage, offer soft cold foods and plenty of fluids
- Use prescribed pain medications on schedule
- Complete the full antibiotic course
- Gargle gently with warm salt water if tolerated (after drainage)
- Watch for signs of recurrence or worsening
When to Worry
Go to the ER if:
- Unable to swallow saliva or drooling
- Difficulty breathing or stridor
- Unable to open mouth (severe trismus)
- Signs of dehydration from inability to drink
- High fever with severe neck swelling
- Torticollis (neck tilted to one side) with throat pain
Call your doctor if:
- Severe sore throat with difficulty swallowing
- Voice changes or muffled speech
- Unable to open mouth fully
- Throat pain that is much worse on one side
- Not improving on antibiotics for tonsillitis
- History of recent strep with worsening symptoms
Keep an eye on:
- Inability to swallow any liquids
- Difficulty breathing or noisy breathing
- Rapidly worsening swelling
- Fever not responding to treatment
- Neck swelling spreading below the jaw
Prevention
- Prompt treatment of strep throat with full antibiotic course
- Complete all prescribed antibiotics — do not stop early
- Seek care if throat symptoms worsen despite antibiotics
- Consider tonsillectomy for recurrent tonsillitis or prior PTA
- Do not ignore persistent unilateral throat pain
Contagion & Incubation
Incubation
Typically develops 2-8 days after onset of tonsillitis or pharyngitis, or can develop despite antibiotic treatment
Contagious for
The abscess itself is not contagious. The underlying strep or bacterial pharyngitis may be contagious until treated with 24 hours of antibiotics.
Duration
Significant improvement within 24-48 hours after drainage and antibiotics. Complete resolution in 1-2 weeks with appropriate treatment. Oral antibiotics continue for 10-14 days total.
Frequently asked questions
How long does peritonsillar abscess in children last?
How does peritonsillar abscess (quinsy) spread?
When should I take my baby to the ER?
Can peritonsillar abscess (quinsy) be prevented?
When can my child return to daycare?
Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
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Bottom line
Peritonsillar Abscess in Children is treatable with appropriate medical care. Seek emergency care if unable to swallow saliva or drooling.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.