A tonsillectomy (removal of the tonsils) is a common, safe surgery for children, leaving the child with no physical scars and little down time. Tonsillectomies are also done for adults; recovery is typically longer and more painful in adults due to more scar tissue.

This procedures may be recommended by an ears, nose and throat (ENT) physician, also called an otolaryngologist, if you or your child suffers from:

• Recurrent tonsillitis: Sore throats with infections seven or more times in a year or five or more times for two consecutive years or three or more in three consecutive years
• Obstructive sleep apnea due to tonsillar hypertrophy: Loud snoring, gasping for air or pauses in breathing while sleeping
  • Symptoms also include mouth breathing, restless sleep and daytime sleepiness due to lack of sleep during the night
• Dysphagia: Difficulty eating/swallowing due to enlarged tonsils blocking the throat which can cause pain and food getting stuck in the throat
• Peritonsillar abscess: A pus-filled infection resulting from untreated strep throat; has a high rate of recurrence
• Tonsillitis not responding to conservative management: Tonsil stones; primary symptom is bad breath, even after brushing or mouthwash
• Tonsillar lesion or mass

What should I do if my child has any of these symptoms?

If your child is experiencing any of the symptoms above, schedule an appointment with your child’s pediatrician or primary care provider (PCP). Your child’s PCP will ask you questions about the frequency and severity of sore throats and other relevant information, do a physical exam looking at the throat as well as ears and nose and partner with you to discuss next steps in treating your child. If it is time to consult with an ENT physician, your PCP will refer you to this specialist. Usually, a tonsillectomy will be scheduled when the acute infection has been resolved.

What happens if my child needs their tonsils removed?

A tonsillectomy is one of the most common surgical procedures for children. Generally, a tonsillectomy is done for children ages three and older but can be done on younger children. Overnight observation is recommended for children ages three and under or with severe sleep apnea.

The procedure takes 30-45 minutes in most cases and is considered safe. As with any surgical procedure, there are risks, with the most common being dehydration and bleeding.

Bleeding is expected in the first 24 hours and again 5-14 days after surgery when scabs from the surgery are naturally coming off. In most cases, the child is not aware of bleeding. Bleeding can irritate the child’s throat and upset their stomach, which can cause vomiting in some children. You will receive post-surgical care instructions, which will include information on when to consult your child’s ENT surgeon or, if bleeding is excessive, to get emergency assistance (e.g., call 911 or go to a hospital emergency department).

What care will my child need once they get home?

The first three days at home after surgery are the most challenging. You will need to help your child stay hydrated, manage their pain and limit activities. Most children are back to normal about 10 days after surgery. The older the child, the longer the recovery, so a young child may feel better sooner.

Hydration
Hydration is important to the healing process. Getting your child to drink water or 100% juice once they get home may be difficult due to pain. Keeping your child well-hydrated is a priority, and here’s some tips to make it easier:

• Set a timer: Your child needs to drink some sips of water or other recommended liquids at least twice an hour for the first few days.
• Provide your child options: Offer your child water, their favorite 100% juice or popsicles.
  • Thick drinks, like milkshakes, are not recommended, as they can cause more pain and irritation, are more difficult to swallow and may not provide as much hydration.
• Avoid irritating the throat: Do not use straws or sippy cups; the suction can irritate your child’s throat.

Pain management
To manage your child’s post-surgical pain at home, use over the counter (OTC) pain medicine. You can alternate children’s acetaminophen (Tylenol) and a non-steroid anti-inflammatory (ibuprofen). The after-care instructions provided to you at the hospital will include dosing instructions from your child’s ENT surgeon. For the first couple of nights, you may need to wake up during the night to provide OTC pain medicine for your child.

Limited activities
The goal during recovery is to minimize the risk of bleeding, so your child’s activities should be limited.

• Heavy physical activity, including playground activities and contact sports, should be avoided for at least two weeks post-surgery.
• Staying home from school for 10 days to two weeks should be expected to give your child time to heal.

Does my child need their tonsils for long term health?

While tonsils do have a purpose in our bodies, they are not necessary. Tonsils are the immune system’s first line of defense. Tonsils:

• Trap germs, bacteria and viruses that enter the body through the mouth or nose
• Contain immune cells that produce antibodies and white blood cells to fight germs
• Sample bacteria and viruses, helping the immune system learn to recognize and fight them

Because of the work they do, tonsils can become infected and enlarged leading to sore throats, difficulty swallowing and sleep apnea; that’s when tonsils are not able to do their job well anymore and should be removed. Once removed, the body’s immune system uses other ways to fight germs.

What are the benefits of a tonsillectomy for my child?

For children with recurrent tonsil-related issues, getting their tonsils out improves their quality of life as well as yours through:

• Fewer missed days of school due to tonsil-related illness
• Improved sleep, which can also result in better behavior and increased concentration
• Less reliance on antibiotics, which, with frequent use, can weaken the immune system
• Fewer doctor visits, resulting in lower healthcare costs for your family and less disruption of your family’s schedule