Tonsillitis/sore throat

Advice for professionals to be used with parents and carers

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 the neck
  • Tonsils red with pus.

These symptoms usually improve within 4-7 days.


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
  • Is unable to swallow their own saliva
  • 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 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 your GP surgery today

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

If none of the above features are present.


Pharmacists can advise and treat a range of common symptoms. No appointment is needed and most pharmacies have a private consulting area. Click on this link to find a pharmacy near to you

If you are still concerned about your child, contact NHS 111 – dial 111 or for children aged 5 years and above visit

This guidance has been reviewed and adapted by healthcare professionals across the Black Country Integrated Care System.


Most children with tonsillitis/sore throat do not require treatment with antibiotics. Antibiotics rarely speed up recovery and often cause side-effects such as rash and diarrhoea. They will also promote the development of antibiotic resistant bacteria in your child.


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.


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.
Feedback Question: Has the advice on this page helped you with a healthcare decision?