Does Your Child Need Tonsil Surgery: What to Expect and How to Help

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Tonsil surgery can be done for a number of reasons, including to relieve chronic strep and sore throats. Sore throats and kids can go hand-in-hand, so when is it serious enough to warrant surgery?

According to the National Institute of Health tonsillectomy (removing the tonsils with or without the adenoids) is one of the most common surgical procedures in the United States, with more than half a million operations performed each year in children 15 and younger.

But many parents often have questions on who needs surgery, what the benefits are and what the recovery time is like. We spoke to Bruce H. Matt, M.D. and Chief, Pediatric Otolaryngology at Riley Hospital for Children at Indiana University Health to get some answers.

What is a tonsillectomy and who needs it?

First, it’s important to know the purpose of the tonsils and adenoids. They are the first line of defense in keep bacteria and infection at bay. They help your immune system by catching viruses and bacteria that enter your mouth and nose. However, they can get infected. The tonsils are found in the back of the throat and the adenoids are located on the soft palate between the nose and roof of the mouth.

Tonsil surgery can be done for a number of reasons, including to relieve chronic strep and sore throats. Sore throats and kids can go hand-in-hand, so when is it serious enough to warrant surgery?

According to the guidelines by American Academy of Otolaryngology—Head and Neck Surgery kids who are good candidates for surgery include those with a certain number of severe sore throats over time:

  • More than seven episodes in the past year
  • More than five a year for two consecutive years
  • More than three a year for three consecutive years

What constitutes a severe throat infection? Throat pain combined with:

  • a fever of 101 or higher
  • swollen or tender neck glands
  • coating on the tonsils
  • positive test for strep throat.

The other big reason for tonsil surgery?  “In 80-90 percent of cases, the main cause for surgery is sleep apnea,” says Dr. Matt.

When a child has large tonsils, it can interfere with their sleep resulting in snoring, mouth breathing, pauses in breathing and restless sleep. There are classic signs that accompany kids with sleep-disorder breathing (SDB) including bed-wetting, delayed growth, poor performance in school and behavior problems. The last two factors in particular are the reasons many parents visit an ENT (ear, nose and throat doctor). The thinking: kids who are not getting enough sleep at night may not be able to function properly during the day.  

“If your child is tired and grumpy during the day, pay attention to his sleep patterns,” advises Dr. Matt. “If you hear him snoring before you even enter his room, you may want to get this checked out.” He explains that a sleep study may also prove to be beneficial. “The only way to 100 percent prove apnea is a sleep study.”

If your child is mild or moderate you may want to hold off on surgery, whereas if they are moderate to severe your child could benefit from surgery. Often doctors remove the adenoids as well when performing a tonsillectomy. The adenoids are often the culprits for chronic ear infections, ear tubes and nasal congestion. They can also play a factor in sleep apnea.

The surgery

Tonsillectomy surgery is done as an outpatient surgery and your child will be put under general anesthesia, and go home the same day. The surgery involves cutting the tonsils (and possibly adenoids) with a scalpel or using a high-energy heat tool to destroy the tissue.  Of course, any surgery carries risk, and for tonsils, the risk is bleeding. If you see bright red blood after you bring your child home, call your doctor immediately “Less than 5 percent of patients experience bleeding post-surgery,” explains Dr. Matt. While the risk is small, he says, it’s good to be aware.  


The good news is that recovery time is easier for kids than adults. “The bigger the person, the more the surgery hurts and the longer it takes to heal,” says Dr. Matt.  That’s why it’s better to have the surgery when your child is young versus waiting until they reach adulthood.

In terms of recovery, tonsil surgery generally means a week of missed school.  Other things to consider? “Time of year doesn’t matter,” says Dr. Matt. While most people think flu season is a bad time to have the operation, he explains that it’s unrelated. If a child is going to get a cold or the flu, he’ll get it regardless of surgery and there aren’t complications involved.

What parents should focus on are things that will help their child post-surgery, including:

  • encouraging their kids to drink plenty of fluids (to avoid dehydration)
  • using acetaminophen or ibuprofen for pain control
  • giving pain medicine early and regularly
  • encouraging their child to tell them if their throat hurts

Within two weeks, Mr. Matt notes, most kids are back to normal.

-- By Judy Koutsky  

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