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Tonsillitis/sore throat

Sore throat is extremely common in children, teenagers and young adults and is often associated with a high temperature. Tonsils are small glands that sit either side of the throat and are sometimes affected (tonsillitis).

Symptoms of tonsillitis

  • Sore throat and pain on swallowing
  • Fever can be present
  • Swollen, painful glands in your neck
  • Tonsils red with pus

These symptoms usually improve within 4-7 days.

Causes

Most cases of sore throat in young children (under 5 years of age) are caused by viral infections; your child may also have a runny nose, cough or earache. Tonsillitis is sometimes caused by a bacterial infection, usually due to a group A streptococcus bacteria (strep throat).

When should you worry?

If your child has any of the following:

  • Is going blue around the lips
  • Becomes pale, mottled and feels abnormally cold to touch
  • Severe breathing difficulty - too breathless to talk / eat or drink
  • Has a fit/seizure
  • Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
  • Develops a rash that does not disappear with pressure (the 'Glass Test')
  • Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features) 

You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Is having difficulty opening their mouth
  • Is having breathing problems, such as rapid breathing, shortness of breath or laboured breathing (drawing in of muscles below the lower ribs when they breath in)
  • Seems dehydrated (sunken eyes, drowsy or no urine passed for 12 hours)
  • Is unable to swallow their own saliva
  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up) - especially if they remain drowsy or irritable despite their fever coming down
  • Has extreme shivering or complains of muscle pain
  • Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations)
  • Continues to have a fever of 38.0°C or above for more than 5 days
  • Is getting worse or if you are worried

You need to contact a doctor or nurse today

Please ring your GP surgery or contact NHS 111 - dial 111 or for children aged 5 years and above visit 111.nhs.uk

If none of the above features are present.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, contact NHS 111 – dial 111 or for children aged 5 years and above visit 111.nhs.uk

Treatment

Most children with tonsillitis/sore throat do no require treatment with antibiotics. Antibiotics rarely speed up recovery and often cause side effects such as rash and diarrhoea. However with recent concerns regarding an invasive Group A Streptococcus we currently suggest a pragmatic approach where pain thresholds are considered and a value of 3 triggers antibiotic prescribing at the moment (will be reviewed Feb 2023).

Use the FeverPAIN clinical score to aid your treatment decision. Score 1 point each for presence of:

  • Fever - history of fever in last 24 hours
  • Purulent tonsillar exudate
  • Acute onset of illness – 0-3 days
  • Inflamed tonsils – must be severe inflammation to score
  • No cough

Score 0-1 - use NO antibiotic strategy

Score 2-3 and symptoms are present for 3 days or less

  • use NO antibiotic strategy.
  • advise will need review by GP if no improvement after 3 days, or symptoms worsen

Score 2-3 and symptoms are present and not improving after 3 days

  • prescribe antibiotics.

Score ≥ 4 - prescribe antibiotic

 

 

However, if your child has any features of severe infection (amber or red features above), they will need to be urgently seen by a healthcare professional who may decide that your child may benefit from antibiotic treatment.

You can help relieve symptoms by:

  • Giving your child paracetamol or ibuprofen to help relieve pain
  • Encourage your child to drink plenty of fluids
  • You can buy a throat spray from your pharmacist which may help with pain

Prevention

It is not always easy to avoid catching these infections. However, good hygiene practices can prevent infections spreading.

  • Wash your hands regularly
  • Use a tissue when coughing or sneezing and put it in the bin
  • Avoid sharing glasses or utensils with people who are unwell
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