Some adults may remember a tonsillectomy (the surgical removal of the tonsils) as a rite of passage in childhood. While a tonsillectomy is still one of the most common surgical procedures for children, they are performed less frequently than in the past.
Amy Coffey, M.D., Pediatric Otolaryngologist at Children's Health℠ and Associate Professor at UT Southwestern, regularly talks to parents about if or when their child needs their tonsils removed.
Here, she answers parents' frequently asked questions including when a tonsillectomy should be performed and what they – and their child – can expect before, during and after surgery.
When should a child have their tonsils removed?
The two most common signs a child needs their tonsils removed is when the child has recurrent strep throat infections or obstructive sleep-disordered breathing.
- Recurrent strep throat infections – If your child has had seven strep throat infections in one year; five infections a year for two years in a row; or three infections a year for three or more years, your pediatrician will likely refer you to an ENT surgeon for evaluation.
- Obstructive sleep-disordered breathing (oSDB) – Also known as obstructive sleep apnea, oSDB is more than loud snoring. It can cause a child to stop and start breathing several times during the night and lead to serious health issues, including weight gain, pulmonary hypertension, behavioral problems and trouble paying attention.
Less common reasons a child may need a tonsillectomy include:
- Peritonsillar abscess – A complication from an untreated strep infection that causes a pus-filled pocket to form near one tonsil. It is more likely to recur unless tonsils are removed.
- Dysphagia – Difficulty swallowing due to large tonsil size
Reasons your child doesn't need tonsils taken out include bad breath and large or swollen tonsils.
"Large tonsils in a child by itself isn't an indication that a tonsillectomy is necessary," cautions Dr. Coffey. "Though it's a very safe procedure, tonsil removal is still surgery. The benefits must outweigh the risks of the procedure. Size doesn't necessarily impact your child's health."
At what age can a child have a tonsillectomy?
A child at any age can have a tonsillectomy if the indications are severe. However, surgeons generally wait until children are 3 years old to remove tonsils because the risk of dehydration and bleeding is greater among small children.
Is a tonsillectomy safe?
A tonsillectomy is generally considered to be a safe procedure. As with any surgical procedure, there are risks associated. The most common risks include bleeding and dehydration.
How much bleeding is normal after a tonsillectomy?
Bleeding is most common within 24 hours after the surgery and then again anywhere from 5-14 days when scabs come off after surgery. Most of the time, children and parents aren't even aware there is bleeding. It can irritate the throat and stomach and cause children to vomit, which is when parents usually become aware there is bleeding.
"Bleeding can be scary, but it doesn't last long," explains Dr. Coffey. "It does need medical attention to ensure there are no complications from the surgery, though. If your child has severe bleeding – bleeding that doesn't stop – call 911. Otherwise, call your child's surgeon to determine if your child needs to be seen."
How can I encourage my child to drink after a tonsillectomy?
Children may be hesitant to drink after surgery because of throat pain. It's important for them to drink regularly so they stay hydrated, which can help the healing process.
Dr. Coffey shares several do's and don'ts with parents to help encourage fluids after surgery:
- Do set a timer once or twice an hour the first few days after surgery so parents and kids remember to take a few sips
- Do offer popsicles
- Do offer water or 100% juice
- Do give small amounts of water by syringe like medication if refusing to drink
- Don't offer thick drinks like milkshakes unless using a spoon
- Don't use straws or sippy cups as suction can irritate the throat
How can I help relieve my child's pain after a tonsillectomy?
A sore throat and pain are the most common side effects of a tonsillectomy. Regular fluids can help ease a sore throat and pain, in addition to keeping kids hydrated after surgery.
Over-the-counter pain medicine is also effective pain relief after tonsils are removed. You can alternate children's acetaminophen (such as Tylenol) and a non-steroid anti-inflammatory (such as ibuprofen) to help control pain. Be sure to follow your surgeon or nurse's dosing instructions, including the amount and frequency.
"I often recommend parents wake children up the first night or two after surgery to stay on top of pain relief," offers Dr. Coffey.
How long does recovery take after a tonsillectomy?
Generally, most children are back to normal about 10 days after a tonsillectomy.
"The first two or three days are very intense. That's when your child needs the most attention," says Dr. Coffey. "Keep them drinking fluids and limit activities those first few days."
Your child should avoid contact sports or heavy physical activity for two weeks after surgery because of the risk of bleeding.
Children can return to school once the throat is completely healed, which can be anywhere from 10 days to two weeks. Your surgeon can help you determine the schedule that's right for your child and family.
The ear, nose and throat team at Children's Health includes fellowship-trained, board-certified physicians, advanced practice providers, nurses and support staff who have special training to diagnose and treat children with ENT issues. Learn more about our ENT program, services and support we offer children and families.