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What should parents know about tonsils, adenoids and other sore-throat sources? 

Most parents today are old enough to remember the era when tonsillectomies — and their post-op promise of endless ice cream — were a routine part of childhood. No longer. These days, pediatricians try to avoid putting their young patients under the knife unless it's essential.

What's behind sore throats? Just in time for winter, Dr. Lewis First, chief of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care, offers a tongue-depressor's view of what can go wrong back there.

KIDS VT: What causes a sore throat?

LEWIS FIRST: A sore throat represents an inflammation in the back of the throat, often in the tonsils or adenoids. What causes a sore throat is a germ setting up shop in the back of the throat.

KVT: What do the tonsils do?

LF: Basically, they help trap germs and prevent them from getting further into the system. Sometimes, when a lot of germs build up, the germs start winning and cause the tonsils to become inflamed — hence, tonsillitis. The same thing happens with the adenoids, which are tissues we don't see at the back of the nose and above the throat. When those tissues become inflamed, it's called adenoiditis.

KVT: Why are these problems more common in kids?

LF: For whatever reason, before the immune system matures, the tonsils and adenoids play a bigger role in protecting young patients than they do in adults. As we get older, our immune systems are more seasoned so we don't need that initial line of defense as much as children do. That's why we don't immediately remove the tonsils.

KVT: How do the doctors decide if surgery is necessary?

LF: Given the protection tonsils provide, the goal is to weigh the risks and benefits. So if your child has recurrent sore throats — defined as seven episodes in a year, with kids missing a lot of school — that may warrant removing them. Often we remove the adenoids and tonsils at the same time. Obviously, if the tonsils get so swollen that the child experiences difficulty breathing, swallowing or sleeping due to persistent snoring, or they stop breathing for several seconds because of an airway obstruction, those are reasons to remove them. With the adenoids, recurrent ear infections can also be the reason for removal. But we first try to treat the infection medically — not surgically.

KVT: What's the best way to treat sore-throat symptoms?

LF: Rest, acetaminophen or ibuprofen, lots of hydration and usually in a day or two the swelling will go down. The concern is when the inflammation of the throat is due to a bacterial infection. That's where strep throat may come into play.

KVT: When should parents suspect strep?

LF: A sore throat in the absence of other cold symptoms — along with fever, perhaps some belly pain — may point to a potential streptococcal — or strep — infection. It's rare for strep to come with a runny nose.

KVT: Why is strep such a concern?

LF: Strep will actually get better without an antibiotic. The concern with strep is the complications that can follow an untreated infection include problems with the heart, kidney and joints, or what we call rheumatic fever. The reason we treat strep throat is not so much to take care of the sore throat but to prevent those complications.

KVT: Can you have strep and not even know it?

LF: Yes. About 20 percent of people will carry strep, not even knowing they have it, and pass it on to others. That's why it's so important for kids to wash their hands and not share eating utensils. If parents have any question about whether a sore throat is strep, their health care provider can usually do a rapid diagnostic test in the office and can tell with about 80 to 90 percent certainty.

KVT: How long is strep contagious?

LF: The good news is that after 24 hours of taking an antibiotic, kids are no longer contagious and can return to school. But parents still need to treat this infection for about 10 days. What you're preventing are those long-term complications of the streptococcal bacteria.

KVT: Are there other throat viruses parents should know about?

LF: There's a virus that causes ulcers or blisters in the back of the throat called Coxsackie. It can also cause blisters on the hand, foot and mouth. The other one is mononucleosis. If your child has the sore throat for at least a week, despite an antibiotic, or excessive fatigue and their glands are swollen, it may be mono. That illness can be verified with a simple blood test.

KVT: Does gargling with saltwater help a sore throat?

LF: It actually does. It doesn't make the virus or bacteria go away any faster. But the tonsil or adenoid is swollen because it's full of fluid as part of the inflammation, so putting salt on it draws out that fluid and makes it less painful. Another way to deal with the pain is to have your child suck on a popsicle, which numbs the back of the throat.

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