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Q: I have a two-year-old son. For the last three months, he has had tonsil infections. My family doctor said next time they would have to come out. (Every two weeks he has had to be on medicine.) I took him to a specialist and he said his tonsils look okay, but chronic tonsil problems may not be seen on the outside with the white dots on the tonsils. He is on an antibiotic for 20 days; if he can be off antibiotics then he is cleared up -- if he still has problems after 20 days he will need them out. What does all this mean? Can they be sure it's tonsils from just trying an antibiotic for 20 days?
A: Tonsil infections are very common in children, and most children do not need to have their tonsils removed. The tonsils are generally at their largest (relative to body size), between two and five years of age. The two major indications for removing the tonsils are: (1) enlarged tonsils that are so big that they interfere with breathing and sleeping (also called sleep apnea), and (2) persistent or recurrent infections of the tonsils--this usually means five or six separate, documented episodes per year caused by strep. It is unusual to have this second problem happen in children under age four.
Sometimes an infection in the tonsils may be difficult to treat because the tonsils have lots of little nooks and crannies, and they can get mini-infections deep inside. You should ask your doctor specifically, but it is likely that your son is being given the antibiotic for a long time (20 days instead of the usual 10 days that we treat most infections) to attempt to reach deep into the tonsils and get rid of any bacteria that may be present. Since he's had the problem over a few months, it may be that its never fully cleared up, rather than that he's been getting new infections each time.
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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.