Sore Throat and Tonsillitis in Children: Viral or Bacterial, Rapid Test and Care

He refuses his snack, swallows with a grimace and has a burning forehead. Looking to the back of his throat with your phone torch, you see red tonsils, perhaps covered in white spots. It is tonsillitis, and the first question that comes to mind is whether he needs an antibiotic.

The answer is more nuanced than people think. In children, most cases of tonsillitis are caused by viruses and get better on their own. A minority, caused by a bacterium, streptococcus (strep), must be treated, and for a reason that concerns Morocco directly: preventing acute rheumatic fever. A simple test, done at the surgery, tells you which case you are in.

What is tonsillitis, and how do you recognise it?

Tonsillitis is an inflammation of the tonsils, caused by an infection. It brings a sore throat that gets worse when the child swallows, and a fever, often between 38 and 39 °C, according to French national health insurance.

Other signs can come with it:

• in children, tummy aches and vomiting, common and sometimes the main complaint;
• headaches, tiredness;
• a cold, a cough or a hoarse voice, which point more towards a virus;
• tender glands in the neck;
• a rough, sandpaper-like rash, if scarlet fever is also present.

A small child does not always say "my throat hurts". They drool more, refuse to eat or drink, or complain of their tummy. Before age 3, this picture is most often viral.

Viral or bacterial: why the look of the throat is not enough

In children, 60 to 75% of cases of tonsillitis are viral and 25 to 40% are due to group A streptococcus, according to French national health insurance. Before age 3, bacterial tonsillitis is very rare.

People often talk about "red" and "white" tonsillitis, as if the colour said everything. It does not: in children, neither the symptoms nor the look of the tonsils can tell a viral tonsillitis from strep throat. White spots can come with a virus, and a simply red throat can hide strep.

The rapid diagnostic test: what happens?

It is this test that decides on the antibiotic, from age 3. The doctor swabs the tonsils with a long cotton bud, dips the swab in a liquid, then dips a test strip in it. The colour shows whether strep is present. The test is painless and the result comes in a few minutes, specifies French national health insurance.

If your doctor does not do the test and prescribes an antibiotic straight away for a sore throat, you can ask whether they do this test.

When is an antibiotic needed, and why take it to the end?

Only strep throat is treated with an antibiotic; against a virus, it is useless. The medicine, dose and length are set by the doctor: in France, the HAS recommends a course of just a few days for first-line treatment.

The child often feels better in a day or two. That is precisely the trap: you must go to the last prescribed day, even if they seem cured. The WHO explains that acute rheumatic fever (ARF) is an inflammatory reaction triggered by strep throat, and that it can leave scars on the heart valves. Appropriate treatment of the tonsillitis can prevent it.

In Morocco, this risk is not theoretical. The Ministry of Health states that ARF remains endemic there, with 2,873 new cases reported in 2020, and reminds us to avoid self-medication and herbal remedies for sore throats of this kind.

How to soothe a child with tonsillitis

Pain and fever are treated whether the tonsillitis is viral or bacterial. Paracetamol is the first-choice medicine according to the HAS; ask the doctor or pharmacist for the dose suited to your child's weight. Never aspirin in children, reminds the NHS. Our article on baby fever details how to react.

• Offer drinks often, in small sips: the NHS advises cool drinks. A sore throat makes children drink less, and dehydration is what you need to avoid.
• Offer foods that are easy to swallow, lukewarm or cool: blended vegetable soup, yoghurt, stewed fruit, purée. Appetite will come back.
• Let your child rest and adapt their activities.
• No gargling in young children, warns the NHS: they risk swallowing the wrong way.
• Rinse the nose if it is blocked, so they breathe better while eating.

Nursery, school: when can your child go back?

For strep throat, the NHS advises keeping your child at home until 24 hours after starting the antibiotic. For viral tonsillitis, they can go back when they no longer have a fever and feel well enough to get through the day. The viruses responsible pass easily from child to child, which explains the runs of sore throats in group settings (see our article on nursery illnesses).

The habits that limit spread are simple: wash hands, cough into the elbow, do not share cups or spoons. A sore throat with a cough and a cold is often caused by a winter virus, sometimes flu. If an ear infection follows the sore throat, our guide to ear infections will help you recognise it.