Tonsil removal - what to ask your doctor
What to ask your doctor about tonsil removal; Tonsillectomy - what to ask your doctor
Your child may have throat infections and need surgery to remove the tonsils (tonsillectomy). These glands are located at the back of the throat. The tonsils and the adenoid glands can be removed at the same time. The adenoid glands are located above the tonsils, in the back of the nose.
Below are some questions you may want to ask your child's health care provider or surgeon to care for your child after surgery.
The tonsils are made up of lymphoid tissue and help fight against infections. However, some people with larger tonsils, particularly in children, may have many sore throats and ear infections, or trouble breathing. In these cases, surgical removal of the tonsils, a tonsillectomy, can be beneficial.
If your child often has a sore throat, trouble swallowing, and ear pain, she may need to have her tonsils removed. This procedure is called a Tonsillectomy. The tonsils are small, dimpled, golf ball-like nodes on either side of the back of your child's throat. They normally filter out bacteria and other germs to prevent infection in the body. If the tonsils become so overwhelmed with bacteria from strep throat or a viral infection, they can swell and become inflamed, causing tonsillitis. Although the tonsils are part of your child's immune system, and aren't removed routinely anymore, if your child has repeated infections or has trouble breathing from inflamed tonsils, she may need to have this tonsil removal surgery. Before the procedure, your child's doctor may ask your child to have blood tests or a physical examination. You should tell your doctor what drugs your child is taking, or any vitamins you have bought without a prescription. On the day of surgery, your child will usually be asked not to drink or eat anything for several hours before the surgery, and make sure you give your child any drugs your doctor told you to give your child with a small sip of water. So, what happens during a tonsillectomy? Your child will be given general anesthesia. She'll be asleep and unable to feel pain. The surgeon will insert a small tool into your child's mouth to prop it open. Then the surgeon will cut or burn away the tonsils. The doctor will control bleeding, and the cuts will heal naturally without stitches. When will my child go home? Your child will probably go home the same day as surgery. Complete recovery takes about one to two weeks. During the first week or so, your child should avoid people who are sick so she doesn't become infected easily. Have your child gently gargle often with baking soda mixed with water. Soft foods and cool drinks will make her throat feel better too. Tonsillectomy is one of the most common reasons children have surgery. But surgery doesn't have to be all bad. Your child can look forward to a steady diet of pudding, ice cream, and other soft and fun foods, until they feel better. And your child can hopefully look forward to fewer sore throats and ear infections in the future.
Questions
Questions to ask about having tonsillectomy:
- Why does my child need a tonsillectomy?
- Are there other treatments that can be tried? Is it safe not to get tonsils removed?
- Can my child still get strep throat and other throat infections after tonsillectomy?
- Can my child still have sleep problems after tonsillectomy?
Questions to ask about the surgery:
- Where is the surgery done? How long does it take?
- What type of anesthesia will my child need? Will my child feel any pain?
- What are the risks of the surgery?
- When does my child need to stop eating or drinking before the anesthesia? What if my child is breastfeeding?
- When do my child and I need to arrive on the day of the surgery?
Questions for after tonsillectomy:
- Will my child be able to go home on the same day as surgery?
- What type of symptoms will my child have while they are healing from surgery?
- Will my child be able to eat normally when we get home? Are there foods that will be easier for my child to eat or drink? Are there foods that my child should avoid?
- What should I give my child to help with pain after the surgery?
- What should I do if my child has any bleeding?
- Will my child be able to do normal activities? How long will it be before my child is back to full strength?
When your child is having surgery it feels like a big deal. I know that as a Dad. But I'm also a pediatrician. I'm Dr. Alan Greene and I want to talk to you about how to prepare for tonsillectomy and adenoidectomy. Perhaps the first thing is preparing yourself because if you're feeling confident and good about the surgery, then everything will go much easier for you and for your child. And that means getting your questions answered beforehand. And in particular, the question I hear the most from parents is concern about the anesthesia. And that comes often from anesthesia risks that happened back when we were children. Anesthesia was much more dangerous than it is today. The problem was there weren't ways to monitor whether kids were getting enough oxygen to the brain or not. But since those monitors were developed about 20 years or so ago now, anesthesia has become incredibly safe - in fact, often safer than driving to the hospital. Now there other things that are important to do to prepare. First is to remember to take notice if your doctor has ordered any lab tests before the surgery. Perhaps blood tests, perhaps urine tests, maybe nothing was needed. But if it was, you want to make sure you've gotten it done before you end up going to the hospital. The second thing are instructions should've been given to you about when is the last time your child could eat or drink before heading to the hospital. Often it'll be midnight the night before, but whatever you were told be sure to take note of that and really don't cheat on this one. Nothing after what they say. And that leads to point number 3. Whatever medications that your child is taking, prescribed medicines, over-the-counter medicines, need to be taken into account. So, make sure you discuss with your physician, your anesthesiologist or the surgeon beforehand whatever medicines your child is taking and whether they should be taken or skipped after that deadline for food and drink. Next thing that's important, number 4, is to help your child select a favorite toy or stuffed animal, action figure to bring with them to the hospital. This little dog here or something that's comforting for them to have with them along the way. And it's a great idea before the whole thing depending on the age and temperament of your child to act out the whole scenario using their favorite toy. So, for instance, this little dog is not feeling well, hasn't been feeling well for awhile, has to take lots of medications, but the doctors are going to be able to fix it. Can't eat or drink anything after midnight - every step of it you go through. They're a little bit scared and they find out everything is fine and it worked out great and they get some ice cream afterwards and the problem is all gone. But to work it through with them so they get the story and it also helps you feel more prepared. I also suggest giving children something specific and fun to look forward to shortly after the surgery. It might be something as simple as a trip to the movies together or a trip to get ice cream but something that they can focus on. Take the focus a little bit off the surgery itself. Not a bad thing for you too. Then a couple of practical things. I do suggest that before going in you take off any jewelry that the child has, you bathe them, you get rid of even earrings that may stay in all the time or hair clips that may, you don't really want those at the hospital. And it's good to choose comfortable clothes when you go to the hospital, things that are easy on, easy off. It's not a fashion show. Although you may want some pictures of this cause it is a kind of historic moment. And lastly, if your child does develop any kind of fever or rash or cold beforehand, make sure to give them a call and let the folks know what's going on cause it may mean the surgery should be postponed. But the good news is that this kind of minor surgery today in children is extraordinarily safe and when it's done for the right child at the right time really helps move them ahead, move the family ahead. Most parents are really glad afterwards that the surgery has been done.
Now that your child's had a tonsillectomy or adenoidectomy what do you do when you go home? I'm Dr. Alan Greene and I want to give you some tips for going home with a child who's just had surgery. First thing to expect is your child's not going to be feeling great for a week or two, especially that first week they may still have pretty significant throat pain and may feel lower energy. So plan a pretty easy week or maybe 2 weeks after the surgery. When it comes to diet one of the most important things is getting plenty to drink. So you want lots of popsicles, fluids, juices, but avoid real citrusy or acidic juices. This isn't the time for lemonade. You also want foods that are soft going down and not crunchy or spicy. So things like jello can be good, ice cream. I still remember sherbet after my tonsillectomy when I was 4-years-old, it was wonderful. Pasta can be good, mashed potatoes, you want to avoid though toast. Toast is great after a tummy ache perhaps, but it can be really scratchy on the raw throat after a tonsillectomy. Also want to avoid really spicy foods. Now your doctor may have prescribed some medication, perhaps some for pain and perhaps some antibiotics and those should be taken regularly as prescribed. And you want to make sure and call your physician if the pain is severe and is not relieved by the pain medications that were given to you. Or if there is bright red bleeding. A little oozing afterwards is normal, but if there's a lot of bleeding it should be looked into. Or if there's real difficulty swallowing even those mashed foods or any difficulty breathing would be reasons to get back in touch with the doctor.
References
Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillectomy in children (Update). Otolaryngol Head Neck Surg. 2019;160(1_suppl):S1-S42. PMID: 30798778
Nixon IJ. Ear, nose and throat surgery. In: Garden OJ, Parks RW, Wigmore SJ, eds. Principles and Practice of Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 27.
Told TN. Tonsillectomy and adenoidectomy. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 66.
Wetmore RF. Tonsils and adenoids. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 411.
Version Info
Last reviewed on: 6/4/2023
Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
