Tonsillectomy and Adenoidectomy for Children

What is a tonsillectomy and adenoidectomy for children?

Your child may have been referred to an ear, nose, and throat surgeon (ENT) to have the tonsils and adenoids removed. This surgery is called a tonsillectomy and adenoidectomy. Often the tonsils and adenoids are removed at the same time. But sometimes only one or the other is removed. Your child’s ENT will discuss this with you.

The tonsils are tissue located on either side of the back of the throat. The adenoids are located behind the nose and at the top (roof) of the mouth. Both the tonsils and adenoids are part of the immune system, the part of the body that fights infection and disease.

Why might my child need a tonsillectomy and adenoidectomy?

Healthcare providers are not in complete agreement about if and when a child should have a tonsillectomy or adenoidectomy. But here are some guidelines that are followed.

Tonsillectomy

A tonsillectomy may be recommended if your child has throat infections that keep coming back. A throat infection means your child has a sore throat with fever, swollen neck glands, drainage from the tonsils or a positive strep test. Recurrent throat infections may include the following:

7 or more throat infections in 1 year
5 or more throat infections in each of 2 years
3 or more throat infections in each of 3 years

A tonsillectomy may also be recommended if your child has recurrent throat infections and any of these:

Is unable to take antibiotics or is allergic to antibiotics
Has episodes of fever, sores in the mouth, sore throat, and swollen neck glands
Has had an infected area near the tonsils

A tonsillectomy may also be recommended if your child has:

Abnormal breathing while sleeping with enlarged tonsils. This is found by a test called a polysomnography (PSG). This test is a sleep study that may confirm brief times when your child stops breathing while sleeping (sleep apnea).
Very large tonsils that block breathing through the nose or cause trouble swallowing

Adenoidectomy

Adenoidectomy is recommended if your child has a lot of trouble breathing through the nose. It may also be recommended if your child has:

A long-term (chronic) sinus infection
Middle ear infections that keep coming back
A chronic middle ear infection with fluid and already has ear tubes

What are the risks of a tonsillectomy and adenoidectomy for a child?

All surgeries have risks including bleeding, infection, and complications from general anesthesia. The risks of tonsillectomy and adenoidectomy are:

Long-term throat pain
Excessive bleeding from the tonsils
Damage to teeth, voice box, throat, or roof of the mouth, or other nearby tissue
Breathing problems

After surgery, your child may have nausea, vomiting, pain, dehydration, bad breath, ear pain, or throat or lung problems.

How do I get my child ready for a tonsillectomy and adenoidectomy?

Your child’s healthcare provider or ENT may want to do some tests before surgery. If your child has problems while sleeping, a sleep study may be done.

The ENT will explain the surgery and answer any questions. Make sure you talk with your child’s ENT about:

Any medicines that your child should not take before surgery. This includes over-the-counter medicines.
When your child needs to stop eating and drinking. For example, it's common not to eat or drink after midnight the night before surgery.
When your child needs to arrive at the hospital or facility
What to expect and how to care for your child after surgery
When your child can get back to normal activities, including returning to daycare or school

And if your child gets sick before surgery, call their ENT. Surgery may need to be rescheduled.

What happens during a tonsillectomy and adenoidectomy for a child?

Your child will probably have the surgery as an outpatient. That means that they will go home the same day as the surgery. The surgery usually takes between 30 and 45 minutes. Your child will get medicine to sleep during the surgery (general anesthesia). Some children may need to stay overnight. This may include children who:

Are not drinking well after surgery
Have other health problems
Have complications after surgery, such as bleeding
Are younger than age 3
Have sleep apnea diagnosed by a sleep study

In general, the surgery will go as follows:

Your child will be given general anesthesia.
Medicines and fluids will be given by an IV (intravenous) line in the hand or arm.
The ENT will remove your child’s tonsils and adenoids through the mouth. There will be no cut on the skin.

What happens after a tonsillectomy and adenoidectomy for a child?

After the surgery, your child will go to the postanesthesia care unit where they can be watched closely as they wake up from anesthesia.
Your child will get medicine for pain.

Your child’s throat will be very painful for the first 2 days. Pain may last up to 2 weeks.

Directions for caring for your child at home may include:

Making sure your child drinks well. This helps to prevent dehydration and helps to lessen pain. Stay away from milk, orange, and other citrus juices.
Giving pain medicine. Your child’s ENT will tell you what to give your child. Call your child’s ENT if you are unable to control your child’s pain.
Giving your child soft, warm foods to eat. Don't give them hard or spicy foods.
Letting your child be active while at home. They should stay away from heavy or rough play. Your child's ENT will tell you when your child can go back to all normal activities.
Staying away from others with colds or other respiratory infections.

Make sure you take your child to all follow-up appointments with the ENT. And call the ENT if your child is not getting better, or if you have any questions or concerns.

Next steps

Before you agree to the test or the procedure for your child make sure you know:

The name of the test or procedure
The reason your child is having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
When and where your child is to have the test or procedure
Who will do the procedure and what that person’s qualifications are
What would happen if your child did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or your child has problems
How much you will have to pay for the test or procedure