Tonsils – In or Out?

Not long ago, having a tonsillectomy was a common rite of passage for children. A night or two in the hospital with a few days of not being able to talk seemed like an excellent trade off for the promise of unlimited ice cream and no more sore throats.

Today, here at The Center For Advanced Pediatrics, we’re more cautious about removing our patients’ tonsils, as they are an important part of the overall immune system. Tonsils are two oval shaped, pink masses found on both sides of the throat towards the back of the mouth. Tonsils are filled with white blood cells which kill germs. They are one of the body’s main defenses in keeping us healthy.

The Interesting History of Tonsils
Previously, tonsils were removed when a child frequently developed sore throats or if the tonsils seemed large for a child’s mouth and throat. It was believed that tonsils did not serve a purpose necessary for health. Although people can live long, healthy lives without tonsils, we now understand why we should think twice before scheduling a surgery.

Tonsils generally grow faster than the head, so if your child is under the age of eight and their tonsils seem very large, but there are no other issues, a tonsillectomy is typically unnecessary. Your child will grow into their tonsils.

A tonsillectomy may be helpful in preventing chronic bacterial infections, but it does not prevent viral infections.

Why Would We Recommend a Tonsillectomy?
There are two reasons why a tonsillectomy is considered.

If tonsils are large and your child always seems tired, an Ear, Nose, and Throat Specialist (ENT) may recommend a sleep study. If the study finds that your child stops breathing at night due to obstructive sleep apnea, it is very likely that a tonsillectomy will be recommended.

We may recommend removing tonsils when your child is diagnosed with chronic bacterial throat infections. If your child has more than five throat infections such as strep throat in a year, we may discuss the possibility of a tonsillectomy. When tonsils become infected and the infection does not clear with antibiotics, removal may be necessary to prevent the infection from spreading.

What Happens If Tonsils Out is the Way to Go?
When it comes to our children, it’s really no comfort being told your child is having a “minor” surgery; all surgery is major surgery when it comes to your baby.

While your child and you are preparing for this surgery, know that all questions are ok to ask. The hospital and your child’s surgical team will go over all the details as much as needed to make sure you and your child understand preparing for and recovering from the tonsillectomy.

Your child will be required to fast for 8-12 hours prior to surgery to ensure that they have an empty stomach. It may be difficult to keep food and water away from your child for that long, but it is critical for their safety as a tonsillectomy will require your child to go under general anesthesia.

An IV will be inserted, most commonly in the arm or hand. Your child will go to sleep and will not experience any pain during surgery and will not have any memory of the procedure.

When the procedure is over, your child will be moved from surgery to the recovery room where you and your child will be reunited. As the general anesthesia wears off, your child may experience:

• Nausea
• Vomiting
• Itchiness
• Emergence Delirium

Emergence Delirium can last for up to 15 minutes post-surgery as your child wakes up. During this time, your child might not respond to you or even recognize you.

A tonsillectomy is considered an outpatient procedure, but depending on the general health and age of your child, an overnight stay for observation may be required. One parent is usually allowed to spend the night on the pediatric unit.

When your child is discharged, sleep might still be difficult for a few nights. Night terrors are common for children between the ages of three and six who have undergone ear, nose, and throat procedures. If low quality sleep due to obstructive sleep apnea was the reason for the tonsillectomy, parents may feel frustrated that sleep seems worse, but this issue does resolve itself within a few weeks without additional medical intervention.

One of the most common reasons young children end up back at the hospital after a tonsillectomy is due to dehydration. Make sure that your child is drinking plenty of water or broth and enjoying popsicles for several days after surgery to prevent dehydration and sooth the throat. Bland, soft foods such as applesauce, plain noodles, ice cream, and pudding can be added back to the diet as tolerated. Avoid crunchy, hard, spicy, and acidic foods for about two weeks while sounds heal, as these may cause pain or bleeding.

Your child should be fully recovered in about two weeks. During this time, it is important to get as much rest as possible, especially during the first few days of the procedure. Regular activity can resume when your child is no longer taking pain medication, they are sleeping normally through the night, and a regular diet is resumed.

While we agree that “tonsils in” is usually better than “tonsils out”, your child’s TCFAP provider will help you decide if a tonsillectomy can improve your child’s health and sleep.

Do you have questions about frequent sore throats, trouble with sleep or a tonsillectomy? We are here to help. Just call 203-229-2000 or click here to make an appointment.