From the Guidelines
For tonsil stones in a 6-year-old child, the primary treatment approach is gentle home management and improved oral hygiene. Start by encouraging the child to gargle with warm salt water (1/4 teaspoon salt in 8 ounces of water) once or twice daily, which helps loosen the stones and reduce inflammation, as suggested by general medical knowledge and practices 1. Adequate hydration is essential, so ensure the child drinks plenty of water throughout the day. Brushing teeth twice daily, including gentle brushing of the tongue and as far back in the mouth as comfortable, helps reduce bacteria that contribute to stone formation. In some cases, you can gently remove visible stones using a cotton swab, but never force removal as this could cause pain or bleeding. Avoid using water flossers or aggressive removal techniques in young children. If the stones cause significant discomfort, persistent bad breath, or difficulty swallowing, consult a pediatrician or ENT specialist. Most tonsil stones in children resolve with these conservative measures and don't require medication or surgical intervention, aligning with the principles of minimizing unnecessary medical interventions and promoting quality of life 1. Tonsil stones form when food particles, bacteria, and dead cells become trapped in the crevices of the tonsils and calcify, so improving oral hygiene addresses the root cause of the problem. The most recent and highest quality studies, such as those published in 2019 1, support a conservative approach to managing tonsil stones in children, emphasizing the importance of oral hygiene and symptom management over surgical intervention, unless absolutely necessary.
From the Research
Tonsil Stones in Children
Tonsil stones, also known as tonsilloliths, are small, hard deposits that can form on the surface of the tonsils. In children, tonsil stones are usually small and asymptomatic 2. However, large tonsil stones can cause symptoms such as recurrent sore throat and odynophagia.
Treatment Options
The treatment for tonsil stones in children is typically expectant, meaning that the stones are left to pass on their own 3. In some cases, surgical intervention may be required if the stones become too large to pass on their own.
Management of Tonsil Stones
- Small tonsilloliths are common clinical findings and are usually managed expectantly 3
- Large tonsilloliths may require surgical intervention if they become too large to pass on their own 3
- Tonsillectomy, the surgical removal of the tonsils, may be considered in cases of recurrent tonsillitis or large tonsilloliths 4, 5, 6
Postoperative Care
After tonsillectomy, postoperative care is focused on reducing pain and bleeding. Topical agents such as lidocaine spray may be used to reduce the severity of pain 4, 5, 6. However, the evidence for the effectiveness of these agents is limited, and further research is needed to determine the best course of treatment.