Enlarged tonsils occur because the immune mechanism of killing viruses and bacteria by the tonsils is exercised. Some children already have enlarged tonsils at birth, which are congenital tonsillar enlargement. Many of these are due to viral and bacterial infections that occur in the mother’s body and induce a stress response in the tonsils during fetal life. If the tonsils are not repeatedly inflamed or septic before the age of 15, they should be treated conservatively as much as possible. If recurrent inflammation leads to complications such as myocarditis and nephritis, surgical removal may be considered to prevent the recurrence of serious complications.