signs your child's tonsils need to be removed

If your child has chronic throat infections, it may seem like the tonsils do nothing but cause trouble. In actuality, they do have a role to play as a part of the body’s natural defense against germs. 

However, when your child has recurrent tonsillitis, removing the tonsils can make a dramatic improvement in his or her life.

We’ve provided this guide for parents to help determine whether or not this procedure is right for your child.

What do the Tonsils do?

The tonsils are located at the back of the throat and the soft palate. They are responsible for trapping germs when they enter your body through your mouth or nose. When the tonsils come in contact with these bacteria or viruses, they activate your immune system. 

Signs Your Child's Tonsils Need to be Removed

If your child has experienced any of the following, we encourage you to speak with us about whether or not a tonsillectomy would be appropriate:

Frequent throat infections

This is the most common reason for a tonsillectomy. Recurring infections that cause swollen lymph nodes and a fever may prompt the need to remove tonsils, especially if your child has six to seven infections a year, and the problem has been ongoing for the last three years.

Difficulty swallowing

Enlarged tonsils can make it difficult for your child to swallow.

Sleep difficulties

Some children have larger tonsils, which may cause difficulty breathing during the night when your child is in a reclined position. This can cause a potentially serious condition called sleep apnea, where your child will stop breathing for several seconds at a time throughout the night. When children fail to get restorative sleep, they can have problems at school, difficulty concentrating, irritability and poor coping skills.

 

What are the Adenoids, and Why are They Often Removed as Well?

Actually, the adenoids are a part of your tonsils. There are three different types of tonsils:

  • Two palatine tonsils, which are located on either side of your throat. These are the tonsils you can see when you look in a mirror.
  • The adenoids, which are located behind the roof of the mouth in the soft palate.
  • One lingual tonsil, located at the back of the base of the tongue.

The adenoids may also be enlarged and inflamed, which prompts their removal as well.

Is a Tonsillectomy the Right Choice for Your Child?

Tonsillectomies are some of the most common procedures we conduct.  If you’re concerned about the frequent throat infections your child has had, please contact one of our ENTs for an appointment.

Is It Always Necessary to Remove The Tonsils?

When children have difficulty with chronic stuffy noses, continual snoring, and frequent bouts of strep throat, it may be time to “round up the usual suspects.” In this case, the “usual suspects” are frequently the tonsils. 

While tonsil removal was once considered a rite of passage, the American Academy of Otolaryngology (AAO) has developed specific guidelines to help ear, nose and throat doctors determine who are the most suitable candidates for a tonsillectomy.

According to the AAO, roughly a half million tonsillectomies are performed in the United States each year, making it the third most common pediatric surgery in the country. (The first two are circumcision and placement of ear tubes.) 

Removal of the tonsils—lymph tissues in the throat that are about the size of a walnut—can dramatically improve a child’s quality of life by reducing the number of throat infections he or she experiences.

Is a Tonsillectomy Always the Right Choice?

What many parents should consider is that for children with fewer than seven episodes of throat infections in the past year, watchful waiting may be the best course of action. 

Therefore, the AAO has created a set of guidelines and criteria to help guide ENT physicians in determining the best treatment for patients nationwide. These guidelines were created based upon extensive research and evidence-based practice in order to continually improve the quality of patient care.
While every case is different, parents should ask themselves the following questions:


1. HAS MY CHILD EXPERIENCED A SEVERE THROAT INFECTION AT LEAST SEVEN TIMES IN THE PAST YEAR OR FIVE A YEAR IN THE PAST TWO YEARS?

The key word here is “severe.” A severe throat infection includes the following:

  • Fever of 101 or higher
  • Coated tonsils
  • Strep throat (as confirmed by a medical test)

 In these cases, a tonsillectomy may be warranted.

2. DOES MY CHILD HAVE AN ANTIBIOTIC ALLERGY OR INTOLERANCE?

An allergy or intolerance can make it difficult to treat chronic throat infections. Remember: antibiotics are not effective against a virus. Any sore throat or respiratory issue caused by a virus will not be resolved by antibiotics.  

3. IS MY CHILD’S SORE THROAT THE RESULT OF OTHER MEDICAL FACTORS?

Depending upon the individual situation, even children with less frequent severe throat infections may still benefit from a tonsillectomy if they have underlying medical factors. These factors may include:

  • Peritonsillar abscess – pus collecting behind the tonsil
  • PFAPA syndrome. PFAPA stands for periodic fever, aphthous stomatitis, pharyngitis and adenitis.  Aphthous stomatitis is another name for canker sores.  Pharyngitis is swelling and inflammation of the back of the throat. Adenitis is another word for a swollen gland or lymph node.

4. DOES MY CHILD SNORE?

If your child has large tonsils, he or she may have difficulty breathing during the night. This is called sleep-disordered breathing (SDB).  The symptoms of SDB are:

  • Snoring
  • Mouth breathing
  • Sleep apnea (pauses for more than ten seconds when sleeping)
  • Poor school performance (resulting from lack of quality sleep).

5. DOES MY CHILD HAVE DOWN SYNDROME OR OTHER DISORDERS THAT MAY AFFECT THE HEAD AND NECK?

Because children with Down syndrome have different facial anatomy, they may have trouble with sleep apnea and SDB. These differences include:

  • Narrower throat air passages 
  • Enlarged tonsils
  • Enlarged adenoids
  • Difficulty coordinating airway movement
  • Large tongue
  • Low muscle tone

More information on Down Syndrome and how it can affect sleep can be found here.

Tonsillectomies Are Decided on a Case-by-Case Basis

Parents should realize that a tonsillectomy will not automatically solve their child’s throat problems. In fact, there are certain conditions that are resolved better by a tonsillectomy, and others where the tonsillectomy does not show any statistical difference. 

That is just one reason it's so important for children to have an ENT physician in Raleigh, a specialist who treats diseases of the ears, nose, and throat.

At Raleigh Capitol Ear, Nose and Throat, we specialize in pediatric ENT care.  We recognize that our young patients have very different scopes of need than adults, and we treat their problems accordingly. 

How to Explain a Tonsil Removal to a Child

It’s often difficult for children to understand what tonsils are and why they may have to be removed. If your child is facing a tonsillectomy, you want to be sure he or she understands what is happening. Learning about the process will take a lot of the mystery—and fright---out of the procedure. 

Following are some guidelines for explaining a tonsillectomy to your child: 

MAKE SURE YOU UNDERSTAND THE PROCEDURE

Obviously, you can’t explain the procedure to your child if you don’t understand it yourself. Be sure you don’t have any misconceptions. Remember that, in general, tonsillectomies are performed as an outpatient procedure, so it’s unlikely your child will have to spend the night in the hospital.

Be sure to ask your ENT questions such as:

  • How long will I be able to be with my child before the operation?
  • Can I see my child in the recovery room?
  • What special preparations must we take the night before surgery? 

If your child will have to spend the night in the hospital, be sure to ask about visiting hours and staying overnight in the room with your child.

EXPLAIN THE TONSILLECTOMY 

It’s a big word, and children can be easily confused. Ask your physician if he or she has age-appropriate educational materials on the procedure. Read the materials together. You may use a favorite doll or stuffed animal to give your child an idea of what the tonsils are, where they are located and what they do.  You can also print pages from this educational coloring book for your child.

EXPLAIN WHY YOUR CHILD NEEDS A TONSILLECTOMY 

Your child will be full of questions, the most common of which is “why?” Explain with calming words in a manner he or she can understand.
Be wary of frightening words, such as “cutting” or “needles.” Tell the child that the doctor will fix the problem at the hospital.

CALM FEARS

Many children are afraid the operation will be painful, and it’s important they know about the special doctor called an anesthesiologist that gives medicine to make sure they sleep and won’t feel anything during the operation. 

Some precautions: don’t use the word “gas” when describing the anesthesia because some children confuse it with the gas that goes in a car. If you’ve recently had a family pet “put to sleep” or described a deceased family member as “sleeping,” your child may panic at the thought of being “put to sleep.”

Instead, you can tell your child that during the operation, he or she will be given medicine to sleep deeply so they won’t feel anything. Emphasize that after the surgery, your child will wake up and you will be waiting for them. 

EMPHASIZE THAT YOU’LL BE THERE AFTER THE OPERATION

Tell your child that you will be there when he or she wakes up. Separation is one of the most common fears children experience when faced with surgery. It’s important to let them know that while you’ll be separated during the surgery, you’ll be waiting for them afterward with a favorite toy.

EXPLAIN THAT YOUR CHILD WILL HAVE A SORE THROAT

Don’t mislead your child by telling him/ her that they will instantly feel better after the operation. It’s fine to tell them to expect a sore throat that will get better. Also, mention that the doctor will give medicine to make the pain go away.

TRY ROLE PLAYING

You can use some of your child’s dolls, action figures or stuffed animals to show them what will happen during surgery. You may even wish to role play, giving your child an idea of the things he or she might see or hear. 

ENCOURAGE QUESTIONS

Let your child know that he or she can ask you any questions. You may even work together on some questions your child wants to ask the doctor. This not only provides assurance, but it sets a good example. Your child needs to know that doctors, nurses and others are there to help. This positive interaction can set the stage for healthy habits moving forward.

All of the doctors at Raleigh Capitol Ear, Nose and Throat have extensive experience with pediatric tonsillectomies—it is one of the most common procedures we perform.

While a tonsillectomy is a routine, minor procedure, there’s no such thing as “routine” and “minor” when it comes to your child. A few simple assurances from you will go a long way toward easing your child’s fears.

Raleigh Capitol Ear, Nose and Throat: Compassionate Care Dedicated to You and Your Child

Did you know that we are the only office in Wake County that offers a comprehensive pediatric ear, nose and throat care that encompasses all aspects of evaluation and treatment?

In fact, our board-certified physicians have had five to six years of post-medical school training in the care of pediatric patients. Many of our patients are under 16 years of age, and we consider it a privilege to serve you and your child.

If you have any questions about a tonsillectomy or if it is the right choice for your child, please contact us to schedule an appointment  today.