What are Tonsils? Why Do Children Often Have Tonsil Problems?
Tonsils are lymph nodes located at the back of the throat. They play an important role in the immune system by trapping and preventing pathogens that enter the body through the mouth and throat. Therefore, they act as the “first line of defense” against infections.
For children, especially those under 10 years old, tonsillitis is often a common problem because their immune system is not fully developed. This causes the tonsils to work harder to fight off pathogens entering the body. Additionally, children’s tonsils are larger in size, making them more prone to inflammation and infection compared to adults, whose tonsils shrink and function less as their immune system matures and strengthens.
Signs and Symptoms That Require Tonsil Surgery in Children: At What Age Can Surgery Be Performed?
Tonsil surgery in children can be considered from the age of 2-3 years and above. However, the decision to operate depends on various factors affecting health and quality of life, such as causing the child to miss school or experience slow growth. Indications for surgery include the following symptoms:
- Having tonsillitis more than 5 times per year for 2 consecutive years or 3 times per year for 3 consecutive years
- Severe inflammation, chronic sore throat, frequent fever, pus in the tonsils, and no improvement after antibiotic treatment
- Enlarged tonsils causing airway obstruction, snoring, sleep apnea, or difficulty breathing
- Difficulty swallowing or frequent choking
- Abnormal enlargement of one tonsil, which may raise suspicion of malignancy
Tonsil surgery helps reduce recurrent infections, prevent complications, and improve the child’s quality of life, such as easier breathing and better sleep.
How Should Parents Prepare When Their Child Needs Tonsil Surgery?
- Prepare the child’s personal items for recovery at the hospital for 1-2 nights, such as a handkerchief, toothbrush, towel, favorite toys or books, to help the child feel safe and relaxed during the hospital stay
- Talk and explain the surgery process to the child gently to reduce anxiety and stress. Encourage and patiently answer the child’s questions to build confidence and readiness for surgery
- Strictly follow fasting instructions before surgery and watch out for any sneaky eating or drinking that could affect surgical safety
Step-by-Step Tonsil Surgery Procedure in Children and Standard Safety
Tonsil surgery in children is a standardized and safe procedure, starting with diagnosis to select the appropriate surgical technique. The general steps of tonsil surgery in children are as follows:
- Thorough basic health examination, including blood clotting assessment, allergy history, and current medications, especially those affecting blood clotting such as aspirin, ibuprofen, vitamin E, and fish oil, to consider discontinuation before surgery
- Fasting from food and drink for at least 6-8 hours before surgery to prevent aspiration during anesthesia
- Upon entering the operating room, the anesthesiologist will administer anesthesia via mask or intravenous injection to prevent pain and keep the child unconscious and immobile, which could interfere with surgery. Vital signs are closely monitored throughout for safety
- The surgeon places a mouth gag to open the mouth wide and clearly view the tonsils, enhancing safety and precision during surgery
- The tonsils are removed using various techniques according to the treatment plan, such as conventional scalpel, electrocautery, radiofrequency, laser, or ultrasound, to remove the tonsils completely without external wounds
- Check the wound, stop bleeding using electrocautery and pressure without suturing, then remove instruments from the mouth
- The surgery takes about 15-60 minutes depending on the size of the tonsils and complexity of the condition. In cases where the child snores, has sleep apnea, or chronic nasal congestion, adenoidectomy may be performed simultaneously, which may extend the surgery time
Recovery After Tonsil Surgery
- The child will be cared for and monitored by doctors and nurses in the recovery room for 1-2 days. If there are no complications such as bleeding or breathing difficulties, the child can go home the next day
- After returning home, the child should rest adequately and avoid strenuous activities for at least 1-2 weeks
- Sleep with the head elevated using pillows to reduce neck swelling and help breathing
- Maintain oral hygiene by gently brushing teeth
Caring for the Tonsil Surgery Wound
The wound in the throat will appear as a white patch, which is normal and will gradually disappear within 7-14 days and fully heal in 2-4 weeks. Wound care should include the following:
- Avoid clearing throat, coughing, or sneezing forcefully as it may cause bleeding from the surgical wound
- If there is bleeding or severe pain, sucking on ice chips or applying cold compresses to the neck can help
- Take painkillers or medications strictly as prescribed by the doctor
- If there is excessive bleeding from the throat, blood clots, increased breathing difficulty, abnormal breathing sounds, persistent high fever, severe neck pain, inability to swallow or drink, or significant swelling of the neck or face, seek medical attention immediately
- Attend follow-up appointments to check the wound and assess recovery
Foods to Eat and Avoid After Tonsil Surgery
- During the first 1-3 days after surgery, give the child liquid and cold foods such as milk, sweetened drinks, yogurt, and ice cream to help reduce throat pain and irritation at the surgical site
- After 1 week, the child can eat soft, easy-to-swallow foods such as rice porridge, soft boiled rice, and soft bread, while avoiding hard, chewy, crunchy, very hot, spicy, sour, or fried foods as they may irritate the wound and increase the risk of wound rupture or bleeding
Tonsillitis in children is a common condition, especially in preschool to elementary school age. Although it can initially be treated with medication, frequent infections or impacts on breathing, sleep, or development may make tonsil surgery a suitable option. If you have questions about tonsil surgery, you can consult a pediatrician or an ear, nose, and throat specialist at Phyathai Phaholyothin Hospital. We have experienced specialists and modern medical equipment, providing attentive service to ensure children receive safe and precise treatment.
Dr. Siripen Mukbanditpong
Ear, Nose, and Throat Specialist
Phyathai Phaholyothin Hospital
