Tonsillectomy

What are tonsils and adenoids?  

The tonsils are pieces of soft fleshy tissue on each side of the back of the throat. The adenoids are made of similar tissue but they are at the back of the nose and you can’t see them when you look in the mouth.  Both the tonsils and adenoids help to protect the body from germs which you may breathe in.  There are a lot of organs and tissues in the body that protect us from germs, so your child will still be well protected without their tonsils and adenoids.

Why should they be removed?

Tonsillectomy (removal of the tonsils) and adenoidectomy (removal of the adenoids) are two different operations which are often needed at the same time. This is because the tonsils and adenoids are often affected by the same conditions.

There are a number of reasons why your child may need to have their tonsils (and possibly adenoids) removed. They include:

• Difficulty in breathing & sleeping - swollen tonsils or adenoids can keep a child from breathing normally through the mouth or nose. If someone stops breathing for short periods during sleep, doctors call it ‘sleep apnoea’.

• Many throat or ear infections - if other treatments do not help, your child might need surgery.

• A growth in or on the tonsils.

See Fact Sheet ‘Adenoidectomy’ for information on removing adenoids: www.schn.health.nsw.gov.au/parents-and-carers/fact-sheets/adenoidectomy

What happens during the operation?

Most often, your child will come into hospital the day they are having their surgery.  It is important that they don’t have anything to eat or drink for some time before the operation.  You will be advised from what time they need to be fasted (‘nil by mouth’).

Before surgery your child’s doctor will give you instructions about medications. Some medications may increase the chance of bleeding and this is why it is important to talk to your doctor about any medicines your child is taking or may take.

Before the operation starts, your child will be given an anaesthetic to put them into a deep sleep. It will keep them from feeling pain during the operation.

The doctor will then remove the tonsils, adenoids, or both.

What to expect in the ward after the operation?

Some children go home on the same day of the operation and some children stay in hospital overnight. If your child is going home the same day, you will stay in the day surgery ward after your child’s operation. If your child is staying in hospital overnight, you will be taken to a ward after recovery, so please come prepared if you would like to stay with them.

Your child may be a little sleepy when they first wake up because of the anaesthetic they were given during the operation to keep them asleep.

They may have an upset stomach and may have a vomit straight after the procedure, but that settles very quickly.

They may also have a sore throat for up to two weeks. When they wake up they will be given a drink. They can eat and drink whatever they can tolerate. Your child may not feel like drinking, but it is important that they get enough liquids.  Avoid citrus juices like orange or grapefruit, as they can irritate your child’s throat and cause discomfort.

Your child needs to drink fluids before they can go home.

The nurses will check your child often during your stay. They will check their temperature, pulse and breathing.

It is very important that your child takes their pain medicine while in hospital to help reduce the pain in their throat. If you stay in hospital overnight, your child may be woken during the night for pain medicine so they don’t wake with a sore throat in the morning. It will be easier for them to eat and drink if they don’t have a sore throat.

Your child may have ear pain after the surgery. This is common and may stay for a few days.  It doesn’t mean they have an ear infection; it is called referred pain and is associated with the sore throat. The pain medicine will help this pain as well.

How long will my child stay in hospital?

If your child needs to stay in hospital overnight, you should expect to go home the next day. For Day Surgery patients, you will need to stay for 4-6 hours after the surgery. The doctors or nurses will let you know when you can be discharged from hospital and they will talk to you about what you need to know when you are home. You will also be given information about follow up appointments for your child.

What do I need to know when my child goes home?

Encourage your child to drink fluids, this ensures that they do not dehydrate. It also helps to decrease the pain and wash away any bugs that can build up in the throat.  Please give your child their recommended dose of pain medicine regularly for the first few days, if they are sore.

Don’t wait until your child says they have pain or they may not want to take their medicine and then won’t want to eat or drink.

Your doctor will send your child home with a choice of a number of different pain relief medications, depending on their age and their clinical history. Correct doses depend on your child’s weight - ask your doctor how much pain medication to give.

Remember: Do not give aspirin medicines or medications containing aspirin to your child.

In children, aspirin can cause serious medical problems. It can also increase the risk of bleeding after surgery.

Encourage fluids (that are not acidic) - e.g. water, milk, cordials, apple juice, broth and offer foods that are easy to swallow; e.g. soft bread, mashed potato, pudding (not hard or scratchy foods). Ice blocks are very useful during the first couple of days.

Children need to stay home from school /preschool for some days after surgery. For tonsillectomy, which is a painful procedure, children are normally home for one to two weeks.  Please check with your doctor regarding when your child can return to schooling.

Your child should avoid sports and very active play for at least 2 weeks.

Prevent your child coming in contact with people who have colds, coughs, flu symptoms for the 2 weeks after the surgery 

When should I call the Doctor or Hospital?

You should call/ bring your child to the hospital if your child:

• has any bright red bleeding coming from the nose or throat or in their vomit or if your child starts suddenly swallowing more frequently (this could be blood that they are swallowing. The doctor may advise you to bring your child back to hospital.

• cannot drink enough.

• vomits more than four times after surgery.

• gets a fever (higher than 38 degrees Celsius).

• has a severe sore throat that doesn’t get better or gets worse.

• if you see a lot of bright red blood. Take your child straight to the Hospital Emergency Department or to the nearest hospital emergency department, if you live further away.

This bleeding can happen any time, mainly in the first 2 weeks after the surgery.

Remember:

• Your child will have a sore throat so they need to continue to take their pain medicine when they go home.
• Children’s need for pain relief can be reduced by distracting them with a DVD, ipad games, a story or a favourite toy… and a cuddle.
• Is important that your child eats and drinks enough when they are at home.
• Call the hospital if your child has any bleeding.