Tonsillitis in Babies & Children
Content reviewed against published AAP, AAP, Mayo Clinic guidelines
Last reviewed:
Tonsillitis is an inflammation of the tonsils, the two oval-shaped pads of tissue at the back of the throat. It is extremely common in children between ages 2 and 15. While viral infections cause most cases, bacterial tonsillitis (especially Group A Streptococcus) requires antibiotic treatment. Recurrent tonsillitis may require surgical removal of the tonsils.
Key takeaways
- Tonsillitis is an inflammation of the tonsils, the two oval-shaped pads of tissue at the back of the throat.
- Duration: Viral tonsillitis typically resolves in 7-10 days. Bacterial (strep) tonsillitis improves within 24-48 hours of starting antibiotics, with full course lasting 10 days.
- Go to ER if: Difficulty breathing or stridor
- No vaccine currently available
Symptoms
How It Presents by Age
0-12 months
Rare in infants as tonsils are very small. May present with feeding refusal, irritability, drooling, and fever. Viral causes predominate.
Risk level: Low — uncommon in this age group
1-3 years
Difficulty swallowing, drooling, food refusal, irritability, and fever. May not complain of throat pain directly. Viral causes still more common than strep.
Risk level: Low to moderate
3-7 years
Peak age for tonsillitis. Can describe throat pain. Strep becomes more common. May have stomachache and headache along with classic symptoms.
Risk level: Moderate
7-15 years
Classic presentation with severe sore throat, fever, exudates on tonsils. Strep throat becomes most common bacterial cause. May develop peritonsillar abscess.
Risk level: Moderate
Treatment
Antibiotics (bacterial)
Penicillin V or amoxicillin for 10 days is first-line for strep tonsillitis. Azithromycin or cephalosporins for penicillin-allergic patients.
Supportive care (viral)
Rest, fluids, pain management. Viral tonsillitis resolves on its own in 7-10 days without antibiotics.
Pain management
Acetaminophen or ibuprofen (6+ months) for pain and fever. Throat lozenges or sprays for older children.
Tonsillectomy
Recommended for recurrent infections (7+ episodes in 1 year, 5+ per year for 2 years, or 3+ per year for 3 years) or obstructive symptoms causing sleep apnea.
Home Care
- Offer cold fluids, ice pops, and smoothies to soothe throat
- Warm salt water gargle (for children old enough to gargle)
- Use a cool-mist humidifier in the bedroom
- Serve soft foods that are easy to swallow
- Ensure adequate rest
- Keep child well-hydrated with frequent small sips
- Honey (over 1 year old) mixed in warm water for soothing
When to Worry
Go to the ER if:
- Difficulty breathing or stridor
- Unable to swallow saliva (drooling)
- Unable to open mouth fully (trismus)
- Swelling on one side of the throat (possible abscess)
- Signs of dehydration from inability to drink
- High fever with stiff neck and lethargy
Call your doctor if:
- Sore throat lasting more than 48 hours
- Fever over 101°F with sore throat
- White patches visible on tonsils
- Difficulty swallowing liquids
- Recurrent episodes of tonsillitis
- Swollen lymph nodes lasting more than 2 weeks
Keep an eye on:
- Difficulty breathing or noisy breathing
- Unable to swallow liquids or drooling excessively
- Fever above 104°F not responding to medication
- Symptoms worsening after 48 hours of antibiotics
- Voice changes or "hot potato" muffled voice
Prevention
- Frequent handwashing with soap and water
- Avoid sharing cups, utensils, and water bottles
- Teach children to cover coughs and sneezes
- Keep sick children home from school or daycare
- Replace toothbrush after strep diagnosis
- Maintain good oral hygiene
Contagion & Incubation
Incubation
2-5 days for bacterial (strep); 1-5 days for viral causes
Contagious for
Contagious from 1-2 days before symptoms appear until 24 hours after starting antibiotics (bacterial) or until fever resolves (viral). Without treatment, strep can be contagious for 2-3 weeks.
Duration
Viral tonsillitis typically resolves in 7-10 days. Bacterial (strep) tonsillitis improves within 24-48 hours of starting antibiotics, with full course lasting 10 days.
Frequently asked questions
How long does tonsillitis last?
How does acute tonsillitis spread?
When should I take my baby to the ER?
Can acute tonsillitis 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
Related Illnesses
Bottom line
Tonsillitis is treatable with appropriate medical care. Seek emergency care if difficulty breathing or stridor.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.