There is no specific treatment for tonsillitis.
Whether your child’s tonsillitis is caused by a virus or bacteria, it is likely that their immune system will clear the infection within a few days. In the meantime, there are some things that you can do to help.
Make sure your child has plenty to eat and drink, even if they find it painful to swallow. Being hungry and dehydrated can make other symptoms, such as headaches and tiredness, worse.
If your child has recurring bouts of tonsillitis, surgery may be considered.
Self-help
Over-the-counter (OTC) painkillers such as paracetamol and ibuprofen can help relieve symptoms such as a sore throat.
When treating children with painkillers it is important to check you have bought the correct type and dosage as younger children only need small dosages. Your pharmacist will be able to advise you.
Children under 16 years of age should not take aspirin.
There are also over-the-counter treatments that can soothe a sore throat, such as lozenges and oral sprays.
Some people find that gargling with a mild antiseptic solution can help relieve a sore throat.
An alternative method is to gargle with warm salty water. Mix half a teaspoon of salt (2.5g) with a quarter of a litre (eight ounces) of water. It is important never to swallow the water so this method may not be suitable for younger children.
Antibiotics
Even if tests confirm that your child’s tonsillitis is due to a bacterial infection they still may not be prescribed antibiotics. There are two main reasons for this:
- in most cases of tonsillitis the use of antibiotics will not speed up the recovery time but can still cause unpleasant side effects such as stomach pain and feeling sick
- the more an antibiotic is used to treat a non-serious infection, the greater the chance that it will not be effective in treating a more serious infection (this is known as antibiotic resistance)
Exceptions are made if:
- your child’s symptoms are severe
- your child’s symptoms show no sign of easing
- your child has a weakened immune system
In these circumstances a 10-day course of penicillin is usually recommended. If your child has a known allergy to penicillin then alternative antibiotics, such as erythromycin, can be used.
Antibiotics sometimes cause mild side effects, such as an upset stomach, diarrhoea or a rash.
Surgery
Surgery for tonsillitis is now usually only recommended if:
- your child has five or more episodes of sore throat due to tonsillitis in one year
- the episodes of tonsillitis are disabling and are disrupting normal activities, such as school work
Surgery involves removing the tonsils. This is done in an operation known as a tonsillectomy.
A tonsillectomy is done under a general anaesthetic, which means that your child will be asleep during the procedure. Your child’s mouth will be held open to allow the surgeon to see their tonsils, and no cuts will be made in their skin.
The operation can be carried out in a number of ways:
- Cold steel surgery. This is the most common method, where a surgical blade is used to cut the tonsils out. Bleeding is controlled by applying pressure or, occasionally, the blood vessels are sealed using heat generated by diathermy.
- Diathermy. A diathermy probe is used to destroy tissue surrounding the tonsils and to remove the tonsils. At the same time, the heat seals the blood vessels to stop any bleeding.
- Coblation (or cold ablation). This method works in a similar way to diathermy but uses a lower temperature (60°C). It is considered less painful than diathermy.
- Lasers. High energy laser beams are used to cut away the tonsils and then seal the underlying blood vessels shut.
- Ultrasound. High energy ultrasound waves are used in a similar way to lasers.
Each of these techniques is relatively similar in terms of safety, results and recovery so the type of surgery that is used will depend on the expertise and training of the surgeon.
Your child will usually be able to leave hospital the same day or the day after surgery is performed.
After surgery
After surgery it is likely that your child will experience some pain at the site of the surgery. This can last for up to a week. Painkillers can help relieve the pain.
Children who have had a tonsillectomy should be kept off school for two weeks. This is to reduce the chance of them picking up an infection from another child that will make them feel more uncomfortable.
They will probably find swallowing difficult after a tonsillectomy, but it is important that they eat solid foods as this will help the throat to heal more quickly.
They should drink plenty of fluids but avoid acidic drinks, such as orange juice, as they will sting.
It is important to make sure they keep their teeth clean as this helps prevent infection in the mouth.
The pain usually gets worse during the first week after the operation and gradually improves during the second week. Earache is common with tonsillectomies and is no cause for concern.
Post-operative bleeding
A relatively common complication of tonsillectomy is bleeding at the site where the tonsils were removed. This can occur in the first 24 hours after surgery or up to 10 days after surgery.
It is estimated that around 1 in 100 children and 1 in 30 adults will experience post-operative bleeding.
Minor bleeding is not usually a cause for concern as, in most cases, it resolves by itself. Gargling cold water can often help stem the bleeding as the cold water can contract the blood vessels.
However, in some cases the bleeding can be extensive, causing people to vomit up or cough up blood.
In this case you should seek immediate medical advice. You should be given a contact number in case of emergency before you’re discharged from hospital. If you're not given an emergency number call NHS Direct on 0845 46 47.
Extensive bleeding may need treatment with surgery or a blood transfusion.
