7 questions to ask when your child needs a tonsillectomy or adenoidectomy

Kids are notorious for having colds, sore throats and ear infections — it’s just part of growing up and a sign that their bodies are busy building the immunities they’ll need later in life. Although we’re born with a fairly robust system for fending off infections — the immune system — it isn’t fully developed in the beginning. It’s normal for kids to have sore throats and runny noses from time to time, but when these sorts of problems become too frequent or severe, it might be time to have a good look at what’s going on with your child’s tonsils and adenoids.

“Tonsils and adenoids are different, but they’re both glandular tissue that’s in the back of the throat,” says Dr. Jean S. Moorjani, a pediatric hospitalist at Arnold Palmer Hospital for Children in Orlando. She says these structures, which are part of the immune system, “house cells that your body produces to fight infection.” The tonsils sit at the back of the throat and are visible by looking into the mouth, especially if they’re swollen or inflamed. You can’t see the adenoids without special equipment, because they’re tucked up higher behind the nose.

[See: Top Reasons Kids End Up in the Hospital.]

Dr. Charles A. Elmaraghy, chief of otolaryngology at Nationwide Children’s Hospital in Columbus, Ohio, says these structures are “strategically located in your upper airway where you encounter a lot of viruses and pathogens,” by breathing in airborne germs or taking in a virus or bacteria by mouth. Children are especially prone to putting objects and their fingers in their mouth, but that can introduce infection-causing agents. The tonsils and adenoids are designed to protect children from these pathogens.

These glands become less important to our overall health with time, says Dr. David Chi, chief of the division of pediatric otolaryngology UPMC Children’s Hospital of Pittsburgh, noting that they tend to shrink “as we age and play less of role as we enter the teenage years. Other elements of the immune system take up the slack and the tonsils and adenoids have less of a role.” This is all part of the normal maturation of the immune system (and also why it’s generally considered safe to remove these structures when they become problematic).

But when we’re still young, because of this direct contact with a variety of pathogens, some children may develop frequent tonsillitis, sore throats, a runny nose, strep throat and other symptoms. These infections can lead to the enlargement of the tonsils and adenoids, and when they get too big, that can lead to obstruction. Surgical intervention may be the right answer for some children.

Chi says that in about 80 percent of cases where the tonsils or adenoids are removed, the reason for surgery is because they are obstructing breathing or swallowing. This obstruction is often worse at night while the child is sleeping, leading to sleep apnea, snoring, sometimes even bed-wetting. “The other 20 percent of time, tonsils and adenoids are removed because the child is getting repeated throat infections or repeat tonsillitis.” Frequent cases of strep throat that doesn’t respond to antibiotics, in particular, can signal it’s time to discuss removal of the tonsils or adenoids.

The American Academy of Otolaryngology — Head and Neck Surgery Foundation reports that more than 530,000 tonsillectomies and adenoidectomies are performed on children younger than 15 in the United States each year, making them one of the most common surgical procedures children undergo. Patients typically range in age from about 1 to 18, and while it can be a good solution to certain problems, these procedures shouldn’t be considered minor.

“The common misconception of tonsils and adenoids is that it’s a very minor surgery,” Elmaraghy says. “I would say that specifically, tonsillectomy is not a minor surgery. It’s a common surgery, but it’s not a minor surgery.” He says this designation is “based on possible complications and difficulty of recovery,” and recovery from a tonsillectomy can be challenging.

Although tonsillectomies and adenoidectomies can be performed on an outpatient basis, if your child has complications, you’ll want to have the option of an overnight stay. In addition, if your child has sleep apnea, then an overnight stay is considered the standard of care so the patient can be monitored. For that reason and because complications could arise, you want access to doctors who are skilled in treating children, Elmaraghy says. Look for “a comprehensive center that can care for a child from start to finish and that can take care of a child whether it’s an easy course or complicated postoperative course.”

If your family physician or pediatrician recommends surgery to remove your child’s tonsils or adenoids (the surgeries are often performed together but some children only need one or the other) it’s also important to seek out a doctor who has specialized experience with both the complex ear, nose and throat system and children.

“The first person I would recommend is a pediatric ear, nose and throat doctor,” Moorjani says. These specialists have advanced training in helping kids with these specific issues. However, Elmaraghy says a “general otolaryngologist who’s experienced in working with children” would also be a “reasonable option.”

[See: 10 Concerns Parents Have About Their Kids’ Health.]

There are lots of other questions you should and will ask any surgeon you’re meeting with as you consider surgery for your child, but these seven should definitely be on your list.

Mother hand holding sick daughter hand who have IV solution bandaged with love and care while she is sleeping on bed in the hospital
1. Does my child really need this surgery? Elmaraghy says that surgeons should be careful to conduct a risk-versus-benefit analysis of each patient before proceeding because “some of these conditions can resolve on their own without intervention. We try to give every child the possibility of not having surgery.” Therefore, careful consideration of the individual child’s situation is critical. Chi adds that there are specific criteria that should be met before you schedule surgery. “There should be at least seven cases of strep throat per year or at least five infections per year over the past two years or three infections per year for the past three years. If these numbers are not exceeded, then watchful waiting is recommended.”
Pediatrician Visiting Father And Child In Hospital Bed
2. How involved is the surgery, and what are the potential complications? Bleeding, pain and difficulty breathing in the first 24 to 48 hours after surgery are the most likely complications of tonsillectomy and adenoidectomy, Elmaraghy says. “You should expect your child to have a sore throat for 7 to 10 days, depending on your child’s pain tolerance.” (Getty Images/iStockphoto/monkeybusinessimages)
A child is laying on a hospital bed with his arm and hand raised above his head with an I.V. and bandage on it.
3. How will you address pain after the procedure? Chi says the “family should ask about pain management and what the surgeon expects to do to manage pain,” including which medications they’ll use and “who to contact if their child encounters difficulty with pain.” As Elmaraghy notes, “we have a national opioid crisis,” which means that “for us at Nationwide Children’s, we’ve tried to go away from opioids postoperatively and use other alternatives to escalate pain management for a child if they have that issue.” These strategies can vary from doctor to doctor, so it’s important to ask how your surgeon will manage postoperative pain if it arises.
Sick asian little child girl who have IV solution bandaged hugging her mother with love in the hospital
4. What should I do if my child is having problems such as bleeding, fever or nausea? In addition to pain, one of the more common complications of this surgery is bleeding, and Chi says it “can occur up to 5 or 6 percent of the time.” Therefore, it’s very important to ask what you should do if your child experiences bleeding. Where should you go? If you’re far from a children’s hospital or it’s after hours, will a local ER be able to help you? Some children also may develop a fever and nausea. Moorjani recommends talking to your doctor about how to manage these side effects and when you should seek additional help. “High fevers, nausea and vomiting are all reasons to contact the doctor after the procedure.”
Nurse Talking To Child Patient In Hospital Bed
5. How long should it take my child to recover? The surgery generally takes about 30 minutes to complete, but Moorjani says “the recovery time for the anesthesia is longer than the procedure itself” and takes about two to three hours. That said, “every kid is a little bit different in the way they respond. Some kids wake up a little sleepy, but they’re feeling OK. Some kids may have other side effects like vomiting.” Your child might be fussy or confused, but “these are all normal reactions to anesthesia and will eventually wear off.” After the surgery, it’s best if your child takes it easy for one to two weeks, depending on how he or she is responding. Elmaraghy says he tells patients not to participate in sports activities for two weeks after surgery because of the risk of bleeding. If your child is active in sports and other events, you should schedule the surgery carefully. Your child will “need two full weeks to recover, and within that window, there shouldn’t be any travel, sports or major exams planned.” Ask your doctor if your child’s case might necessitate any other specific restrictions. [See: 9 Ways to Boost Your Immune System.]
A boy in hospital drinking water while watching tv.
6. Is ice cream the best food for my child after the procedure? Moorjani says that although there’s a strong cultural association with tonsillectomies and kids getting to eat all the ice cream they want afterward, “I wouldn’t say ice cream is the best choice. The most important thing parents should know is hydration, hydration, hydration.” Your child’s throat will be sore and swallowing may be difficult, but it’s very important that they avoid getting dehydrated. “Parents need to really encourage liquids,” Moorjani says. Plain water is usually best, but products like Pedialyte and Gatorade can also work. Slushie drinks and Popsicles may also be comforting, as the cold will help numb the affected area. “If your child is not able to take in enough fluids, there’s a chance he or she might need to be admitted to the hospital for IV fluids,” Moorjani says. So keep track of how frequently your child is urinating and its color — light yellow urine means your child is well hydrated. It may be challenging for your child to eat solid food in the initial days after surgery. Moorjani recommends giving “soft, boring food and no food that’s hard, crunchy, spicy or has a lot of flavor.”
Pediatrician Visiting Parents And Child In Hospital Bed
7. How comfortable am I with you? Lastly, Elmaraghy says you should consider whether the surgeon puts you at ease and observe how your child interacts with this doctor. He says it’s important that you all “feel comfortable with that doctor and feel like they’re meeting the specific needs of your child.” If the doctor is able to build a rapport with your child, that can be a good sign that you’ve got a good one. “Ultimately when you’re in the waiting room, you’re trusting your child to someone who’s going to take care of them. Being able to establish rapport with pediatric patients is a really important aspect of taking care of them.” Chi agrees, adding that being comfortable with the surgeon means you’ll be able to ask anything and share in the decision-making process. “It’s important that families feel comfortable asking a lot of questions about the surgery, what to expect and potential complications before proceeding. You should be very comfortable with inquiring about the different issues and share in that decision-making with the surgeon about moving forward with the surgery.”
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Mother hand holding sick daughter hand who have IV solution bandaged with love and care while she is sleeping on bed in the hospital
Pediatrician Visiting Father And Child In Hospital Bed
A child is laying on a hospital bed with his arm and hand raised above his head with an I.V. and bandage on it.
Sick asian little child girl who have IV solution bandaged hugging her mother with love in the hospital
Nurse Talking To Child Patient In Hospital Bed
A boy in hospital drinking water while watching tv.
Pediatrician Visiting Parents And Child In Hospital Bed

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7 Questions to Ask When Your Child Needs a Tonsillectomy or Adenoidectomy originally appeared on usnews.com

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