What should you know about tonsillitis in infants?

An infant cannot describe a sore throat, and the tonsils may be hard for a caregiver to see. Possible clues include refusing feeds, crying during swallowing, extra drooling, a hoarse or muffled cry, fever, unsettled sleep, or swollen glands. Tonsillitis is inflammation of the tonsils, but these signs can also occur with other infections. A sore throat is a common presentation of tonsillitis; it is not proof that an infant has tonsillitis.

Strep throat is less typical in very young babies than in older children, but the cause cannot be diagnosed safely from behaviour alone. An examination is particularly useful when feeding or hydration changes.

Offer the infant's usual breast milk or formula in smaller, more frequent feeds if that is easier, unless a clinician has advised another plan. Keep the baby comfortable and watch wet nappies, alertness, and breathing. Do not give honey to a baby under twelve months, and do not give cough, cold, or pain medicines unless a healthcare professional has confirmed the product and dose for the infant. Contact a GP Consultation or paediatric service for advice about fever, feeding, or suspected throat pain.

Seek urgent medical help if the baby is struggling to breathe, cannot swallow, is drooling continuously, has blue or grey lips, is difficult to wake, or shows signs of dehydration such as markedly fewer wet nappies. Prompt advice is also needed for a young infant with fever, refusal of feeds, repeated vomiting, or a rapidly worsening condition. Infants can become unwell quickly, so do not wait for a throat examination at home.

Record when symptoms began, the baby's temperature if measured, how much the baby has fed, wet-nappy changes, breathing pattern, vomiting, and any rash. Ask whether the throat needs examination, which fluids or medicines are safe, and what exact change should prompt urgent reassessment.