Tonsillitis (recurrent) – Paediatric

This RAC is applicable to referrals for patients aged <16 years only. Please refer to the Adult ENT RAC for referrals for patients aged 16 years or more.

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

  • Abscess or haematoma (e.g. peritonsillar, parapharyngeal (quinsy), salivary, neck or retropharyngeal abscess)
  • Acutely enlarging neck mass with any associated airway symptoms e.g. stridor, drooling, dysphagia etc
  • Airway compromise: severe stridor/drooling/ breathing difficulty/acute, sudden voice change/ severe odynophagia
  • Foreign body (button batteries – inhaled or ingested) if suspicion of button battery immediate emergency review
  • Hoarseness associated with neck trauma or surgery
  • New onset hoarse voice and any airway obstructive symptoms 
  • Post-tonsillectomy haemorrhage
  • Trauma

Immediately contact on-call registrar or service to arrange an immediate ENT assessment (seen within 7 days) for:

  • Acute episode with non-resolution despite optimal medical management
  • Noisy breathing, voice change or severe odynophagia/obstructive sleep apnoea
  • Suspected neoplasm – ulceration, or recurrent unilateral enlargement, particularly with associated cervical lymphadenopathy

To contact the relevant service, please see HealthPathways: Acute Paediatric ENT Assessment

Presenting issues
  • Recurrent sore throat due to acute tonsillitis where the episodes of sore throat are disabling and prevent normal functioning (i.e. tonsillitis indicated for tonsillectomy), and:
  • Episodes must be well documented, clinically significant and adequately treated:
    • ≥7 episodes in the last 12 months, or
    • ≥5 episodes per year for 2 consecutive years, or
    • ≥3 episodes per year for 3 consecutive years, or
    • >4 weeks missed for school or parents' attendance at work
Mandatory referral information (referral will be returned if this information is not included)


  • Relevant history, frequency, and severity of episodes, including details of:
    • Sleep apnoea symptoms or sleep disordered breathing symptoms
  • Details of previous treatment and outcome
  • Relevant past medical history (including any syndromes, cardiac conditions, haematological conditions, and metabolic conditions)


  • Size of tonsils
  • Height and weight

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Highly desirable referral information
  • EBV serology/monospot
  • FBC
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • No category 1 criteria
Category 2
Appointment within 90 days
  • Ulceration and/or recurrent unilateral enlargement, with/without lymphadenopathy
Category 3
Appointment within 365 days
  • Recurrent sore throat due to acute tonsillitis and any of the following:
    • 7 or more episodes in the last 12 months
    • 5 episodes per year for 2 consecutive years
    • 3 episodes per year for 3 consecutive years
    • more than 4 weeks missed for school or parents’ attendance at work
    • history of quinsy 
Last reviewed: 26-05-2023

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