What are the Tonsils  

This factsheet is for the parents of children who are having their tonsils removed. The tonsils are small lumps of tissue at the back of your Childs throat. One on each side. The operation for removing them is called a tonsillectomy.

The tonsils are relatively small in the first year of life and increase in size as a child grows older. They are usually at their largest between the ages of four and seven years. The role of these pads is to help provide a defence against infection which, in this case, enters through the nose or mouth. Tonsils also help in the production of antibodies to fight the infection more effectively.

Why should the tonsils be removed?

There are a number of reasons why your child may need to have their tonsils (and possibly adenoids) removed, they include:
• Difficulty in breathing and sleeping usually at night if the tonsils are enlarged
• Difficulty in swallowing if the tonsils are enlarged
• Frequent infections of the tonsils
• An abscess on one or both of the tonsils

What happens during the operation?

Your child will come into hospital the day they are having their operation and it usually requires an overnight stay. If your child has a cold or an infection in the week before the operation, please let your nurse know.

 The operation may need to be cancelled until your child has fully recovered. The operation is done under a general anaesthetic. This means that your child must not eat or drink for about 6 hours before the operation. When your child is transferred to the operating theatre you will be able to accompany them as far as the pre theatre waiting room.

What to expect in the ward after the operation

After the operation your child will be returned to the children ward.  Your child may be a little sleepy when they first return to the ward and they may also feel a bit sick in their stomach for the first 24 hours. The nurses will check your child often during this period, by checking their temperature, pulse and breathing.

When your child wakes up and is feeling like they are ready to drink. They will be offered some ice chips. If this is tolerated, then they will be given whatever they feel like drinking. It is very important that your child is drinking enough fluid before they can go home.

Food will be introduced gradually and before being discharged the following morning your child will be offered a variety of foods for breakfast.
 
It is very important that your child takes their pain medicine while in hospital to help reduce the pain in their throat. 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?

You should expect to go home within 24 hrs of your child's operation, providing your child doesn't have too much pain and they are drinking enough. The doctors or nurses will let you know when you can go home, and talk to you about what you need to know when you go home. You will also be given information on follow up for your child at this time.

What do I need to know when my child does go home?

Medications
It is important that you continue with the pain medicine regularly for the first few days. 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 and drink.
Follow the surgeon's advice about pain relief. You can give your child over-the-counter painkillers such as paracetamol. This will be discussed with you before you go home.
If your child is prescribed antibiotics it's important to finish the course.

Activity and Rest
You should keep your child as quiet as possible for the first 2 days and then you should consult with your doctor as to when they should return to school or preschool. Your child should rest for a few days and stay at home to avoid contact with possible infections at school. Also keep your child away from crowded and smoky places, and from people with coughs and colds.

Diet and Fluids
Your child should eat regularly and drink plenty of fluids. It's best to encourage your child to begin chewing and swallowing as soon as possible Giving your child a dose of pain relief half an hour before meals may help to make eating more comfortable. Citrus, spicy foods and bananas should be avoided for the first few days as the acid in the food may cause the operation site to become tender.  Encourage your child to brush their teeth thoroughly, at least twice a day.

When should I call the doctor?
You should call the hospital if your child has any bleeding and the doctor may advise you to bring your child back to hospital. This bleeding can happen up to 2 weeks after the surgery. A small temperature is normal after surgery but if your child has a high temperature for a few hours call your doctor. If your child is unable to eat and drink then you should also contact your doctor.

Important points to remember

• Your child will have a sore throat so they need to continue to take their pain medicine when they go home
• It is important that your child eats and drinks a satisfactory amount when they are at home
• Call your doctor if your child has any bleeding

References:
The Children's Hospital at Westmead, Sydney Children's Hospital, Randwick& Kaleidoscope, Hunter Children's Health Network - 2005-2007.
Author:  S.Leonard,CNM & P.Watson, Healthwise.  August, 2008
Disclaimer: This information is intended as a guideline only and reflects the consensus of the authors at the time of publication.  The sources used are believed to be reliable and in no way replace consultation with a Health Professional.