Tonsillitis in infants

Overview

Tonsillitis is when the tonsils — two small glands at the back of the throat — become swollen and sore. In infants (babies under 1 year), it can make them very uncomfortable and cause trouble feeding.

Yes, tonsillitis is common in young children, though it is less common in babies under 1 year old. When it does happen, it is usually mild.

It mainly affects children but can affect infants too. Babies who are around older siblings or in daycare may have a higher chance of getting it.

Symptoms

Common symptoms

• Fever (temperature above 38°C or 100.4°F)
• Sore throat — baby may cry when swallowing
• Red, swollen tonsils at the back of the throat
• White or yellow patches on the tonsils
• Irritability and fussiness
• Trouble sleeping or waking up often

Symptoms in children

• For older children: sore throat, pain when swallowing, hoarse voice, and sometimes a headache or stomach ache

Symptoms in older adults

• This condition is very rare in older adults. If they have a sore throat, other causes are more likely.

Causes

Main causes

• Viral infections — the same viruses that cause colds and flu
• Bacterial infections — most commonly group A streptococcus (strep throat)

Risk factors

• Being around older siblings or other children who are sick
• Attending daycare or group childcare
• Weakened immune system (rare in healthy infants)

When to see a doctor

See a doctor urgently if:

• If you see any of the emergency symptoms above, call your local emergency number right away.
• If your baby has a fever with a rash, or seems very unwell.

Book a routine appointment if:

• If symptoms last more than 2 days without improvement
• If you are worried about your baby’s feeding or hydration
• If you see white patches on the tonsils

Diagnosis

A doctor will look at your baby’s throat and tonsils with a light, and may feel the neck for swollen glands. They will ask about symptoms and how long your baby has been sick.

Tests that may be done

• A throat swab — a soft cotton bud gently rubbed on the back of the throat to test for bacteria. This is not usually done in infants unless symptoms are severe.
• A blood test or rapid strep test may be used in some cases.

What to expect at your appointment

Most of the time the doctor can diagnose by looking at the throat. A throat swab may cause a little gagging but is quick. Results for bacterial tests may take a day or two.

Treatment

Treatment depends on the cause. Viral tonsillitis cannot be cured with medicine — it just needs time and comfort. Bacterial tonsillitis may need antibiotics, but these are only prescribed if a test shows bacteria are present.

Self-care at home

• Give extra breastmilk or formula to keep your baby hydrated
• Use a cool-mist humidifier in the room to soothe dry air
• Offer soft, cool foods (like yogurt or applesauce) if your baby is eating solids
• Give infant-appropriate pain relief (always check with your doctor or pharmacist for the right dose)
• Let your baby rest as much as possible

Medical treatments

For bacterial tonsillitis, a doctor may prescribe an antibiotic (usually taken by mouth for a full course, even if symptoms improve). For viral tonsillitis, only symptom relief is needed. Doctors may recommend age-appropriate pain and fever medicine.

When is surgery considered?

Surgery to remove the tonsils (tonsillectomy) is very rarely done in infants. It may be considered only if a child has very frequent, severe infections that cause breathing problems or other complications. This decision is made by a specialist.

Living with this condition

While your baby has tonsillitis, try to keep them comfortable. Offer fluids often, keep them calm, and watch for signs of dehydration (fewer wet diapers, dry mouth). Most babies recover within a week.

Lifestyle tips

• Wash hands often to stop the infection spreading to others
• Keep your baby away from other children until they are feeling better
• Do not share cups, spoons, or pacifiers

Diet and exercise

Focus on hydration — breastmilk or formula is best. If your baby eats solids, offer cool, soft foods. Avoid any hard, scratchy foods that could hurt the throat. No special exercise — just rest.

Mental health and emotional wellbeing

Having a sick baby can be stressful for parents. It is normal to feel worried or tired. Take care of yourself too — ask for help from family or friends if you need a break.

Prevention

It is hard to prevent completely, but you can lower the risk. Wash your hands and your baby’s hands often. Keep your baby away from people who are sick. Do not share utensils or cups.

Vaccines

There is no vaccine specifically for tonsillitis. But routine childhood vaccines help prevent some infections that can lead to tonsillitis, such as influenza and some viral infections.

Screening programmes

Not applicable for tonsillitis in infants.

Complications

If left untreated

• Difficulty breathing if the tonsils are very swollen (rare in infants)
• Dehydration from not drinking enough
• In rare cases, an abscess (pus pocket) near the tonsils that may need drainage

Long-term outlook

The outlook is very good. Most infants recover fully from tonsillitis without any long-term problems. With proper care and attention to hydration, your baby should be back to normal within a week.

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