Springdale Mason Pediatrics

Tonsil Infection - Strep

Definition

  • A bacterial infection of the tonsils caused by Strep
  • Also called Strep tonsillitis

Call or Return If

  • Trouble breathing or drooling occurs
  • Fever lasts more than 3 days
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic

Symptoms

  • The tonsils are lymph glands in the back of the throat. They stand guard on each side of the throat. Usually they are the size of a small cherry.
  • Pain, discomfort or raw feeling of the throat
  • Pain is made worse when swallows
  • Other symptoms include sore throat, fever, and swollen lymph nodes in the neck. General symptoms include headache, stomach pain, nausea and vomiting.
  • Cough, hoarseness, red eyes, and runny nose are not seen with Strep throat. These symptoms point more to a viral cause.
  • Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat.
  • If you look at the throat with a light, it will be bright red. The tonsil will be red and swollen, often covered with pus.
  • Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep.

Tonsil Size

  • Grade 1 - Can barely see the tonsil
  • Grade 2 - Small tonsil
  • Grade 3 - Tonsil half way to the midline
  • Grade 4 - Tonsils are touching (called kissing tonsils)

Cause

  • Group A Strep is the only common bacterial cause of a throat infection. (called Strep pharyngitis).
  • Any infection of the throat usually also involves the tonsils. (called Strep tonsillitis)
  • Strep accounts for 20% of sore throats with fever.

Diagnosis

  • Diagnosis can be confirmed by a Strep test on a sample of throat secretions.
  • There is no risk to wait until a Strep test can be done.
  • If your child has cold symptoms too, a Strep test is not needed.

Prevention of Spread to Others

  • Good hand washing can prevent spread of infection.

After Care Advice

Overview:
  • Strep causes 20% of throat and tonsil infections in school age children.
  • Viral infections cause the rest.
  • Strep tonsillitis is easy to treat with an antibiotic.
  • Complications are rare.
  • Here is some care advice that should help.
Antibiotic by Mouth:
  • Strep infections need a prescription for an antibiotic.
  • The antibiotic will kill the bacteria that are causing the Strep tonsil infection.
  • Give the antibiotic as directed.
  • Try not to forget any of the doses.
  • Give the antibiotic until it is gone. Reason: To stop the Strep infection from flaring up again.
Sore Throat Pain Relief:
  • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
  • Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
  • Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
  • Medicated throat sprays or lozenges are generally not helpful.
Pain Medicine:
  • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
Fever:
  • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. Note: Lower fevers are important for fighting infections.
  • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
Fluids and Soft Diet:
  • Try to get your child to drink adequate fluids.
  • Goal: Keep your child well hydrated.
  • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
  • Solids. Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solids.
  • Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces.
What to Expect:
  • Strep throat responds quickly to antibiotics.
  • The fever is usually gone by 24 hours.
  • The sore throat starts to feel better by 48 hours.
Return to School:
  • Your child can return to school after the fever is gone.
  • Your child should feel well enough to join in normal activities.
  • Children with Strep throat need to be taking an antibiotic for at least 12 hours.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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