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Tonsillectomy in children

Published by Bupa's health information team, January 2008.

This factsheet is for parents of children who are having tonsils removed. The tonsils are small lumps of tissue at the back of your child's throat, one at each side. The operation for removing them is called a tonsillectomy.

Your child's care will be adapted to meet their individual needs and may differ from what is described here. So it's important that you follow the surgeon's advice.

• About tonsils
• Diagnosis
• What are the alternatives?
• Preparing for your child's operation
• About the operation
• What to expect afterwards
• Recovering from tonsillectomy
• What are the risks?
• Further information
• Questions and answers
• Related topics
• Sources

About tonsils

The tonsils help fight ear, nose and throat infections in younger children. They usually reach their maximum size when your child is between three to five years old. They begin to shrink by age seven and can hardly be seen by the late teens.

The position of the tonsils

When children have a cold or a throat infection the tonsils can become infected and swell up, causing symptoms such as a sore throat, headache and fever. This is called tonsillitis. They can also block the airways, making it difficult for your child to breathe, especially when asleep. This can cause sleep problems such as snoring. In severe cases they can stop your child from breathing for a short time (known as sleep apnoea).

Diagnosis

Your doctor will examine the tonsils by looking in the back of your child's mouth using a light and mirror or a flexible telescope.

Your doctor may recommend a tonsillectomy if your child suffers from frequent bouts of tonsillitis or ear infections, or has breathing problems caused by swollen tonsils.

Most tonsillectomy operations are done in children under 15.

What are the alternatives?

The only effective treatment for recurrent and persistent tonsillitis is to have the tonsils removed. The tonsils will shrink in size as your child grows older, so an operation may not be necessary. Painkillers and antibiotics only provide temporary relief and are not used for long-term treatment. A viral infection won't respond to antibiotics.

Preparing for your child's operation

A tonsillectomy usually requires an overnight stay in hospital. If your child has a cold or infection in the week before the operation, please let your hospital know. The operation may need to be postponed until your child has fully recovered.

The operation is done under general anaesthesia. This means your child will be asleep during the procedure. Typically, your child must not eat or drink for about six hours before a general anaesthetic. Often the operation will be planned for the morning, so that your child will only have to miss breakfast.

At the hospital a nurse will ask you questions about your child's general health, and check that your child has not had anything to eat or drink. He or she will also measure your child's heart rate and blood pressure.

The surgeon and anaesthetist will usually visit your child before the operation. Please tell them if your child has any allergies, loose teeth or any history of bleeding problems in the family.

If you have parental responsibility for the child, you may be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your child may wish to sign this form too. In some circumstances a child can sign their own consent form independently, providing he or she understands what they are being asked to do.

About the operation

The operation usually takes about 30 minutes. There are several methods available for removing tonsils.

• Traditional method - a special surgical blade is used to cut out the tonsils. Pressure is applied to stop the bleeding, and dissolvable stitches or heat is used to seal the wound.
• Lasers or ultrasound waves - high-energy waves are used to cut out the tonsils and seal the blood vessels to stop bleeding.
• Diathermy - heat from an electric current is used to cut out the tonsils and seal the blood vessels.

What to expect afterwards

Your child will be monitored and will need to rest on their side until the effects of the anaesthetic have passed. Your child will be groggy, and may feel or be sick.

Your child may complain of a sore throat, earache and a stiff jaw. Pain relief and antibiotics are usually prescribed for a week to 10 days.

You should encourage your child to drink and eat as soon as they feel ready, starting with clear fluids such as water or apple juice.

After about 12 hours, a white or yellowish membrane (thin "skin") will appear where the tonsils were. This is nothing to worry about and is not a sign of infection. It's just new "skin" growing over the wound.

Your child will usually be ready to go home the morning after the operation. Before you go home a nurse will give you a date for a follow-up appointment.

Recovering from tonsillectomy

Once home, follow the surgeon's advice about pain relief. You can give your child over-the-counter painkillers such as paracetamol or ibuprofen syrup (for example Calpol or Calprofen). Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. Do not give aspirin to children under 16.

If your child is prescribed antibiotics it's important to finish the course.

Get your child to drink plenty of fluids and eat. It's best to start with soft or liquid foods which are easier to swallow. Giving your child a dose of pain relief half an hour before meals may help make eating more comfortable. Encourage your child to brush their teeth thoroughly, at least twice a day.

Your child should rest for a few days and stay at home to avoid contact with possible infections at school. Also keep your child away from crowded and smoky places, and from people with coughs and colds.

If your child develops any of the following symptoms, please contact your GP or the hospital immediately:

• bleeding in the nose or throat
• an inability to drink normally, as this can lead to dehydration
• a high temperature
• increasing pain

You can expect your child to make a full and quick recovery once the initial pain has resolved. Complete recovery can take two weeks.

What are the risks?

Tonsillectomy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic. Common side-effects include:

• sore throat, earache and a stiff jaw - these side-effects may last for up to two weeks
• bad breath - this usually improves after two to three weeks

Complications

This is when problems occur during or after the operation. Most children are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection. Antibiotics are usually prescribed to help prevent infection.

Specific complications of tonsillectomy are rare but include:

• bleeding within 24 hours - your child may need to go back into theatre to have it stopped
• bleeding four to seven days after the operation (secondary haemorrhage) - this can be the result of an infection
• damage to the teeth or jaw - this can be caused by the instruments used to keep the mouth open during surgery
• chest infection and breathing problems - there's a risk blood and tissue from the operation may get into the throat and down into the lungs

The exact risks are specific to your child and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to your child.

Further information

• ENT UK
  020 7404 8373
  www.entuk.org
• Action for Sick Children
  0800 0744519
  www.actionforsickchildren.org

 

Related topics

• Adenoidectomy
• General anaesthesia

Sources

• Tonsil surgery. ENT UK
  www.entuk.org
  accessed 16 August 2007
• Tonsillectomy for sore throats. Bandolier
  www.jr2.ox.ac.uk
  accessed 15 August 2007
• Tonsillectomy using ultrasonic scalpel. NICE guidance 178 - June 2006
  www.nice.org.uk
  accessed 16 August 2007
• Tonsillectomy using laser. NICE guidance 186 - July 2006.
  www.nice.org.uk
  accessed 16 August 2007
• Electrosurgery (diathermy and coblation) for tonsillectomy. NICE guidance 150 - December 2005
  www.nice.org.uk
  accessed 17 August 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by ENT specialist Mr Paul Tierney, MA, FRCS, FRCS (ORL-HNS) of Bristol ENT Partnership, and The Charity for Sick Children and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: January 2008.