Knowing when your child may need a tonsillectomy is a common question in my pediatric medical practice.
As a parent, you may remember a time when getting your tonsils and/or adenoids removed was a rite of passage of sorts. While this pediatric surgery is still very common, we as a medical community are more conservative about recommending tonsillectomy in children than in the past.
Consultation with a pediatric otolaryngologist (ear, nose and throat surgeon) for this common surgery may be necessary if your child is getting frequent throat infections or has been diagnosed with obstructive sleep apnea.
While these are the two most common reasons to consider tonsil removal surgery, there are other times that as a parent you may consider this type of surgery for your child.
In this article, we will look at the reasons to consider tonsillectomy and/or adenoidectomy, what purpose these tissues serve in the body, what surgery and recovery are like and what the best age for this outpatient procedure.
Criteria For Tonsillectomy and/or Adenoidectomy
- Recurrent throat infections: greater than 7 episodes in the past year or greater than 5 episodes per year in the past 2 years or greater than 3 episodes per year in the past 3 years
- Each episode of throat infection should be accompanied by a fever, swollen lymph nodes in the neck, white spots (exudate) on the tonsils or a positive test for group A Strep
- Tonsillectomy for recurrent infection with complicating factors:
- Allergy or intolerance to multiple antibiotics
- PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis)
- History of peritonsillar abscess or parapharyngeal abscess
- Severe infection with dehydration requiring IV fluids
- Frequent bacterial infections of the throat that may aggravate comorbid conditions (eg, seizure disorder)
- Children who are at risk for school problems due to multiple absences from sore throats, strep throat or chronic tonsillitis
- Sleep Disordered Breathing with or without:
- Not growing well
- Doing poorly in school / poor quality of life
- Wetting the bed
- Behavior problems
- Abnormal sleep study
- Enlarged tonsils or adenoids are causing dental or facial growth problems
- Tonsil enlargement causes trouble breathing or heart problems
- Abscess of the tonsils and/or surrounding tissues
- Persistent bad breath or bad taste in mouth due to tonsillitis that is not improved by medical treatment (antibiotics)
- Unilateral tonsil hypertrophy presumed neoplastic
- Frequent bacterial ear infections (indication for adenoidectomy +/- tonsillectomy)
- Chronic sinus infections despite appropriate medical treatment (indication for adenoidectomy +/- tonsillectomy)
Expectations of Surgery
Tonsillectomy with or without adenoidectomy is an outpatient procedure that typically takes a trained ENT surgeon less than 30 minutes to perform.
The surgery involves removing the enlarged tonsils and/or adenoids. Generally, this is done with an instrument that burns or cauterizes the tissues in order to control the bleeding.
Recovery
In the first few days after surgery, your child will complain of throat pain. Popsicles, cold liquids and soft foods are best during this time. Additionally, the surgeon will recommend scheduling doses of anti-inflammatory medication such as motrin around the clock will help control your child’s pain. While pain is one of the common symptoms in the first few days after surgery, it usually gets better pretty quickly.
Controlling this pain is also important so that your child can take in adequate amounts of fluid and stay hydrated. Dehydration will land your child back in the hospital.
Frequently, children will often once again complain of pain and experience painful swallowing about 1 week (5-10 days) after surgery. This occurs because the “scab” that has formed over the removed tonsils will fall off. This is a normal part of the healing process, but something that parents should anticipate.
Additionally, as with any surgical procedure, bleeding can be a risk. This complication is rare compared to the complication of throat pain, but it is something that you should be prepared to know how to handle. Any bleeding that does not stop pretty quickly should be brought to the attention of your child’s surgeon and/or be seen in the ER.
Consider the Age of Your Child
While recovery from a tonsillectomy and/ or adenoidectomy is normally a pretty smooth process for children, younger kids may have a harder time in the days after surgery.
Children in this age group may not be able to drink enough to stay hydrated after the surgical removal of their swollen tonsils. This is most often due to pain and can be harder to control because they are not as cooperative. As a result, your child’s surgeon may recommend that they stay overnight in the hospital for IV fluids after surgery.
The Purpose of Tonsils and Adenoids
Tonsils and adenoids are part of the immune system and play a role in filtering bacteria and viruses. In some children, these tissues remain enlarged even when the acute infection is treated.
Tonsils live in the back of the throat while adenoids live in the back of the nose.
Enlarged tonsils and adenoids in children can lead to blockage of the nose and throat. This can lead to snoring, sleep issues, recurrent infections or chronic tonsillitis. Thankfully, our bodies are amazing. We have numerous other tissues that also process bacteria and viruses.The other parts of the immune system will take over this job after the removal of tonsils and/or adenoids.
While tonsils and adenoids are part of our body’s defenses against viruses and bacteria, removing them does not negatively affect most children. If they are harming your child more than helping them, it is time to remove them.
Role of Your Pediatrician
Pediatricians play an important role in recognizing the need for tonsillectomy and/ or adenoidectomy. From ear pain to strep throat, we see sick children and know how to manage them medically.
If you are looking for a pediatrician that can provide more personalized care for your children, I am the pediatrician for you. My practice is designed to allow for time and consultation with parents.
We can talk about any cares or concerns related to childhood illnesses such as strep throat, skin irritations, and much more.
Send me an email and we will get you set up for a free meet and greet to learn if 127 Pediatrics is right for your family.
© 127 Pediatrics; August 2023
This article is for informational purposes only and should not be construed as medical advice.
Dr. Andrea Wadley is the owner, pediatrician, and breastfeeding medicine specialist for 127 Pediatrics. She has an established house-calls-only concierge pediatric practice in Colleyville, TX. She is also the owner and operator of the 127 Pediatrics Online Breastfeeding Medicine and Education Center.
