Should Your Child Have A Tonsillectomy

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 (or tonsillectomy) 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.

Should You Remove The Tonsils?

However, 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, alpthous stomatitis, pharyngitis and adenitis.  Alphthous 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’s syndrome or other disorders that may affect the head and neck?

    Because children with Down’s 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.


    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, a specialist who treats diseases of the ears, nose, and throat.



    Richard M. Rosenfeld, M. M. (2011, January). Talking Points for AAO-HNS Tonsillectomy Guideline.

    Dr. Salley R. Shott, M. (2012). Associated Conditions with Obstructive Sleep Apnea.