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
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 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
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This guidance was last reviewed 27/06/2025.
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. 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.
