Sore Throat Season: How to Manage Their Symptoms and Avoid Needless Appointments

It’s that time of year! Kids are coming down with a variety of bugs causing sore throats, fevers and other assorted symptoms. For parents, it’s not easy to identify the cause of your child’s misery, know how to treat it or decide if or when they need to see a doctor.

Tonsillitis and adenoiditis are some of the more common illnesses this time of year — and not always easy to distinguish from each other. Here’s a breakdown of what to expect if your child has tonsillitis or adenoiditis, how to treat these illnesses at home and when to consider seeing your child’s medical provider.

What are tonsilitis and adenoiditis? And how do they differ?

First, let’s review these two similar, but distinct, illnesses.

The tonsils are small, round tissues located toward the back of the mouth and side of the throat and are visible if you look in your child’s mouth. The adenoids are made of lymph tissue and located above and behind the roof of the mouth. (They aren’t visible.) Both tonsils and adenoids play a role in helping the body fight off infection (although our body has other lymph tissue in the head and neck area to fight off infections as well). Sometimes these tissues become infected and inflamed, which results in tonsilitis and adenoiditis, respectively.

Both tonsillitis and adenoiditis are most common in young kids through teenagers. They’re also highly contagious and can easily spread to adults in the household. Both illnesses have similar symptoms, but the causes, and therefore the treatments, can differ.

For tonsillitis, the most common symptoms are:

• Sore throat
• Difficulty swallowing
• Tonsils that are red and swollen and/or have white patches/coating on the tonsils
• Pain or difficulty swallowing

Kids may also have a fever, swollen lymph nodes or complain of headaches. If your child is too young to describe their symptoms, look for signs they’re irritable or fussy, refusing to eat or even drooling (since it hurts to swallow). Some children may have stomach pain/vomiting and headaches before presenting with a sore throat.

For adenoiditis, the most common symptoms are:

• Thick mucous coming out of the nose (yellow, green, discolored)
• Thick mucous as post-nasal drip (yellow, green, discolored)
• Sore throat
• Stuffy nose

Adenoiditis symptoms may also include swollen neck glands and fever. You may also notice your child is breathing through their mouth and/or snoring. Many times, adenoiditis can be seen after a viral upper respiratory infection (aka “a cold”); if the nasal mucous does not go away after about 10 days, then the adenoids may have possibly become infected and may require antibiotic treatment.

When to see a doctor

For parents, it can be hard to determine when to treat an illness at home vs. taking your child to see the doctor.

“Especially, in this viral season, this is a hard question,” says Ryan C. Borek, MD, an attending physician in CHOP’s Division of Otolaryngology (ear, nose and throat). “Getting in to see your regular pediatrician can be difficult during the surge.” But he added that as long as your child is eating and drinking and not feeling miserable, you can probably manage their symptoms at home with a fever-reducing medication, a warm bath, a room humidifier and lots of fluids to drink. “If there’s fever, visible lymph nodes or difficulty eating or drinking, then call the pediatrician to see when you can get in.”

If your child starts to get sick after the pediatrician’s office is closed, monitoring at home is the best bet. You can watch them overnight and then address it in the morning.

“But if your child starts to look a little more unstable — maybe you see a high fever or they have trouble breathing from congestion or swelling — that’s when you should plan to go to the urgent care or emergency room,” he adds.

What to expect at the appointment

If your child does go to see their pediatrician, their doctor will look their throat for inflammation, white spots or swelling, check for a fever, and ask about any other symptoms. They’ll also examine your child’s ears, nose and the glands on the side of their neck.

If they suspect tonsilitis or adenoiditis, they may do a throat swab to see if it the cause is bacterial or viral. They may also take some blood to test for signs of infection.  

Most cases of tonsilitis and adenoiditis are caused by viruses, just like the cold and flu. But they are sometimes caused by bacteria. Your child’s treatment plan will vary based on the determined cause.

Viral or bacterial infection?

For viral cases of tonsillitis and adenoiditis, the treatment is generally a few days of rest, giving a lot of fluids and providing at-home care such as over-the-counter medications as needed to soothe their throat or provide pain relief. For adenoiditis, your child may also be prescribed steroids to help with inflammation if there are significant symptoms.

Bacterial tonsilitis, which is also referred to as strep throat for the bacteria that typically causes it, will typically be treated with a 10-day course of oral antibiotics in addition to rest and fluids.

“Sometimes parents think antibiotics should be given for tonsilitis, but those medications aren’t helpful for viral illnesses and can have other side effects,” notes Dr. Borek. He adds that if your child is prescribed antibiotics, it’s important to complete the entire course — even if your child feels fine in a few days and is complaining about the admittedly not-great-tasting medication.

“If you treat it halfway, the illness can return, and the bug may become drug-resistant and be harder to treat,” says Dr. Borek. If a kid is resisting finishing the medication, you can work with your pharmacist to add a more palatable flavor or you can try hiding it in a food like pudding or a yogurt. “Sometimes, you have to make a game of it, or reward them with a favorite TV show for getting the medicine down,” he adds. “I know from personal experience it’s not always easy, but I promise it’s harder on the parents than the kids.”

Repeated illness may point to surgery

Tonsilitis and adenoiditis are common illnesses of childhood, but some kids battle frequent, recurring bouts of either or both. If your child has frequent and/or severe infections, surgery may be an option. The American Academy of Otolaryngology recommends considering surgery if your child has:

• Seven throat infections in one year
• Five throat infections in each of two years
• Three throat infections in each of three years

An ENT can examine your child and help determine if either tonsillectomy (removal of the tonsils) or adenoidectomy (removal of the adenoids) would be beneficial.