Tonsillectomy and Adenoidectomy in Children

Tonsillectomy and adenoidectomy are surgeries to remove tissues in the mouth and throat called the tonsils and adenoids. These surgeries may be done separately. Often, they are done at the same time in a surgery called adenotonsillectomy.

Tonsils and adenoids normally work to protect the body from infection. This procedure may be done if these tissues repeatedly become enlarged or infected and if other treatments are not effective.

Tell a health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines, especially those that contain aspirin, ibuprofen, or valproic acid.
• Any problems your child or family members have had with anesthetic medicines.
• Any blood disorders your child has.
• Any surgeries your child has had.
• Any medical conditions your child has.
• Whether your child has recently had a cough or a fever.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Bleeding.
• Infection.
• Scarring.
• Changes in your child’s sense of taste.
• Changes in your child’s voice.
• Changes in the way your child swallows.
• Persistent ear pain.
• Persistent pressure in your child’s ears.
• Nausea and vomiting.
• Dehydration.

What happens before the procedure?

Tests and exams

• Your child may have a physical exam.
• Your child may have tests. A blood or urine sample may be taken for testing.

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

• Up to 2 hours before the procedure – your child may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your child’s health care provider about eating and drinking, which may include:

• 8 hours before the procedure – have your child stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – have your child stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – have your child stop drinking milk, formula, or drinks that contain milk.
• 4 hours before the procedure – stop giving your child breast milk.
• 2 hours before the procedure – have your child stop drinking clear liquids.

Medicines

• Ask your child’s health care provider about:
  • Changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your child’s blood. Do not give these medicines before your child’s procedure if his or her health care provider instructs you not to.
• Your child may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To lower your child’s risk of infection, your child’s health care team will wash or sanitize their hands.
• An IV tube will be inserted into one of your child’s veins. If IV insertion is difficult for your child to manage, your child may be given a medicine to breathe in (inhale) to help him or her relax (sedative).
• Your child will be given a medicine to make him or her fall sleep (general anesthetic).
• A device will be placed inside your child’s mouth to press down his or her tongue.
• A device that uses heat energy (electrocautery device) may be used to cut your child’s tonsils and adenoids out.
• The blood vessels in the area where the tissues were removed will be closed off with heat (cauterized) or closed with stitches (sutured) to keep them from bleeding.
• Your child may be given a steroid medicine in the IV tube to help reduce the swelling and pain that occurs with surgery.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines your child was given have worn off.

Summary

• A tonsillectomy and adenoidectomy are surgeries that are usually done together to remove your child’s tonsils and adenoids.
• This procedure may be done if these tissues repeatedly become enlarged or infected and if other treatments are not effective.
• Generally, this is a safe procedure. However, problems may occur, including bleeding, infection, scarring, ear pain, nausea and vomiting, and changes in your child’s voice or sense of taste.

Care After Tonsillectomy and Adenoidectomy in Children

This information about how to care for your child after her or his procedure. Your child’s doctor may also give you more specific instructions. If your child has problems or if you have questions, contact your child’s doctor.

Follow these instructions at home:

Eating and drinking

• Have your child drink and eat as soon as possible after surgery. This is important.
• Have your child drink enough to keep her or his pee (urine) clear or light yellow. Water and apple juice are good choices.
• Avoid giving your child:
  • Hot drinks.
  • Sour drinks, like orange or grapefruit juice.
• For many days after surgery, give your child foods that are soft and cold, like:
  • Gelatin.
  • Sherbet.
  • Ice cream.
  • Frozen fruit pops.
  • Fruit smoothies.
• When the surgery has been many days ago, you may give your child foods that are soft and solid. Give your child new foods slowly over time.
• Do these things to make swallowing hurt less when your child eats:
  • Give your child a small amount of food. The food should be soft, like eggs, oatmeal, sandwiches, mashed potatoes, and pasta. The food should also be cool.
  • Do not make your child eat more at one time than what is comfortable for your child.
  • Offer small meals and snacks during the day.
  • Give your child pain medicine as told by your child’s doctor.

Managing pain and discomfort

• Talk with your child’s doctor about ways to help with your child’s pain. Talk about ways to check how much pain your child is in.
• To make your child more comfortable when lying down, try keeping your child’s head raised (elevated).
• To help a dry throat and to make swallowing easier, try using a humidifier close to your child’s bed or chair.
• Give medicines only as told by your child’s doctor. These include over-the-counter medicines and prescription medicines.

Driving

• If your child is of driving age:
  • Do not let your child drive for 24 hours if he or she was given a medicine to help him or her relax (sedative).
  • Do not let your child drive while taking prescription pain medicine or until your child’s doctor approves.

General instructions

• Have your child rest.
• Until the doctor says it is safe:
  • Avoid letting your child move liquid around in the throat.
  • Avoid letting your child use mouthwash.
• Keep your child away from people who are sick.
• Before going back to school, your child:
  • Should be able to eat and drink as usual.
  • Should be able to sleep all night.
  • Should not need pain medicine.
• Avoid taking your child on an airplane during the 2 weeks after surgery. Wait longer if told by your child’s doctor.

Contact a doctor if:

• Your child’s pain gets worse and does not get better after he or she takes pain medicine.
• Your child has a fever.
• Your child has a rash.
• Your child feels light-headed or passes out (faints).
• Your child shows signs of not getting enough fluids (dehydration), such as:
  • Peeing (urinating) only one time a day, or not peeing at all in a day.
  • Crying without tears.
• Your child cannot swallow even small amounts of liquid or saliva.

Get help right away if:

• Your child has trouble breathing.
• Bright red blood comes from your child’s throat.
• Your child throws up (vomits) bright red blood.

Summary

• After this surgery, it is common to have pain and trouble swallowing. To help healing, have your child eat and drink as soon as possible after surgery.
• It is important to talk with your child’s doctor about ways to help with your child’s pain. It is also important to check how much pain your child is in.
• Bleeding after the surgery is a serious problem. Get help right away if bright red blood comes from your child’s throat or if your child throws up (vomits) blood.