Clinical Reference Systems: Pediatric Advisor 10.0

What are the tonsils and adenoids?

The tonsils are grape-sized pieces of tissue in the back of the throat on each side. The adenoids are small pads of tissue at the back of the nose above the throat. The adenoids can't be seen when you open your mouth because they are behind the soft palate. Both tonsils and adenoids produce antibodies to fight infections. They are usually removed if they become so large that they interfere with breathing or swallowing.

How long will it take to recover?

After removal of the tonsils and adenoids, your child may lack energy and tire easily for several days. Your child may be restless at night and not sleep well. These problems gradually get better in 3 to 14 days. Your child may have problems with constipation for several days because of the codeine in the pain medication and because he will not feel like eating much.

Discharge Instructions After Surgery

1. Diet. The most important thing for your child to have in the first 3 days after surgery is liquids. This will help lessen problems with fever, constipation, and healing. Make an effort to give your child a drink (2 or 3 ounces) every hour during waking hours for the first 2 days after surgery. Soft drinks, fruit juice nectars, Jell-O, custard, Popsicles, or Gatorade are good choices. Frequent small feedings of soft foods and cool liquids usually are most comfortable. As your child's appetite gets better, encourage him to eat solid foods. There are no limits to the foods you may give your child. You can't hurt the throat by giving your child the wrong foods. Let your child have his favorite foods.

   Your child should not drink through a straw after surgery until his throat is completely healed. This may increase the risk of bleeding. Your child may feel sick to his stomach, throw up, or feel tired and cranky after surgery. This should get better within a few hours. Occasionally, nausea and vomiting is due to the codeine in the pain medication.

2. Pain Medicines. A very sore throat or ear pain is normal after the tonsils are removed. Expect pain in the ears between the 3rd and 7th days because the same nerve that goes to the tonsils also goes to the ear. Give regular does of pain medicine (any acetaminophen medicines, such as Tylenol) 4 to 5 times a day for a week. If your child has severe pain, use the prescription pain medicine as labeled. DO NOT USE ASPIRIN OR IBUPROFEN because these medicines increase the chance of bleeding. You can use cool compresses or ice packs on your child's neck to help your child feel more comfortable. You can also have your child suck on ice chips or chew gum.

3. Fever Medicines. It is normal for children to run a fever between 99ƒF (37ƒC) and 101ƒF (38ƒC) for the first few days after surgery. The fever will be worse if your child doesn't drink enough liquids and becomes dehydrated. Give acetaminophen for the fever.

4. Bad Breath. This is normal. It comes from a white to yellowish scab that forms over the tonsil surgery site. You can help your child's breath by giving him a mild salt-water mixture to gargle. After gargling, your child may spit up some bloody mucus. The scab breaks off during healing within 5 to 10 days and the bad breath will go away.

5. Bleeding. There should be no bleeding from the nose or mouth after your child returns home. Get up to check on your child once or twice during the first night after surgery. If there is any bleeding, take the child to the emergency room immediately. The ear, nose, and throat (ENT) doctor on call will check your child. Between the 5th and 10th days after surgery, the scab breaks off the surgery site and your child may spit up some bloody mucus. If the bleeding does not stop in 20 to 30 minutes, bring your child to the emergency room.

6. Activity. It is best for your child to rest at home for the first 48 hours after surgery. Activity may be slowly increased as your child's strength increases. There is no rule for the right time to go back to school, but a guideline is 7 to 10 days after the tonsils are taken out. Rough play and contact sports should not be allowed until 14 days after tonsil or adenoid surgery. Contact your child's school for make up work.

7. Other Medicines
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8. Additional Instructions

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9. Follow-up Appointment After Discharge

   Your child needs to be rechecked and has an appointment on ______________ at ________ o'clock with _______________________.

Call Your ENT Doctor Immediately If:

• There is any bleeding from the mouth or nose.
• The fever goes over 102ƒF (39ƒC).
• There are any signs of dehydration.
• Your child has vomiting that lasts more than 12 hours.

Call Your ENT Doctor During Office Hours If:

• A fever lasts more than 3 days.
• You have other concerns or questions.