Monday, 6 August 2018

Tonsils in Children: Should They Be Removed or Not?

One of the hardest things for a parent to endure is to watch their child undergo a surgical operation. To see their beloved child in pain, lying in the recovery ward; it almost makes them think about whether or not the procedure was worth it.

A guest post by Angel Jeslie "AJ"

The question on why children should undergo surgery isn’t new. However, it’s still widely discussed to this day. About 530,000 children under 15 years of age in the US have tonsillectomies each year.

Tonsillectomy is the second most common surgical procedure that children encounter, and it entails a precise removal of the tonsils. Typically, they have the procedure done between the ages three and seven.

Tonsils are masses of tissue located inside the mouth behind the nasal passages. Their purpose is to act as the first line of defense against bacteria and germs by activating the body’s immune system early.

Due to the entry of bacteria, the tonsils can become infected. The resulting inflammation that occurs; known as tonsillitis, generates symptoms such as a sore throat, fever, bad breath, and difficulty breathing. However, one of the most common misconceptions is that children undergo tonsillectomies as a treatment for tonsillitis, when in fact the majority of operations are to combat sleep apnea.

The Benefits

Between the ages of 2 and 7, a child’s tonsils can become enlarged and cause a partial obstruction of their airway. Enlarged tonsils are the main cause of sleep apnea, which is the condition wherein a child snores and has irregular breathing patterns at night.

According to researchers at the University of Michigan, children that snore regularly could be more prone to having Attention Deficit Hyperactivity Disorder (ADHD). By having their tonsils surgically removed, children are able to sleep better and snore less.

The disruption of a child’s breathing at night can reduce the amount of oxygen which enters their brain and lead to a number of symptoms like daytime irritability, difficulty waking up, and morning headaches. Getting a tonsillectomy done will improve a child’s sleep and avoid the secondary symptoms from surfacing.

Enlarged tonsils can also cause bedwetting even for children that are already toilet-trained. Because of the extremely deep slumber that sleep apnea elicits, they can easily lose bladder control while in bed. Removing the enlarged tonsils will allow them to get a good night’s rest and they should be able to get back to their old training in no time.

Tonsillitis can be a reason to have tonsils removed but it’s not the primary one. According to the American Academy of Family Physicians, tonsillectomy is recommended for children who have experienced at least 7 episodes of throat infection in the past year, more than 5 throat infections per year for the last 2 years, or more than 3 episodes per year for the past 3 years.

The Drawbacks

Although tonsillectomy has plenty of benefits for children, the downsides also need to be considered.

Tonsils in children usually grow to a maximum size by the age of 12 and begin to shrink at around 20 years old. After that, they play no useful role within the body. As with any type of surgery, there is an element of risk and some of these include potential bleeding, swelling, infection, or adverse reactions to anesthetics.

Bleeding after surgery can occur for 3 – 4 percent of children. If it does happen, it usually starts around a week after the operation. But in some cases, it can occur as much as two weeks later. This will normally warrant a trip back to the hospital.

Bleeding mostly stops by itself but in a few infrequent cases, a second surgery may be needed to cauterize the wound. This entire ordeal can be unpleasant for children as they will be dealing with immense pain in the mouth. Morphine or a prescribed painkiller may be needed to help them cope.

Postoperative symptoms frequently include a fever, while some children experience ear pain. White plaque can form at the back of the throat and scabs may be visible in the throat. Bad breath is another common symptom and is totally normal for a child that has just had his/her tonsils removed.

For a short time after the surgery, it will be difficult to eat due to the pain involved with swallowing. Soft foods are advised such as gelatin, soup, cold slushies, or milkshakes. Ice-cream can be given as a reward for good behavior.

After a few days, they can advance and eat a bit more varied foods such as mashed potatoes or pudding. Avoid spicy or citric foods as these will irritate the back of the throat more and cause discomfort.


It is important to note that there are no permanent disadvantages to tonsillectomy and most of the symptoms which manifest after surgery only last for a couple of weeks, at most. A doctor can help evaluate a child to isolate if a tonsillectomy is necessary; but in the end, the decision falls to the parents. Carefully weigh the risks versus the benefits of carrying out the procedure.

Pharmaceutical Microbiology

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