As part of our series on pediatric sleep apnea, we’d like to explain more about one of the potential treatments for sleep apnea in children – the tonsillectomy and adenoidectomy (T&A). Sleep apnea is no small matter for children. In addition to the health risk it represents, it can also lead to social problems for children, underperforming in school, bedwetting, behavioral issues, and other problems.
Most parents are highly concerned about the risks of sleep apnea and want to learn as much as possible about the condition and the tools available to treat it. This guide will help you make important decisions about whether a tonsillectomy and adenoidectomy (T&A) is the right choice for your child.
Indications for a Tonsillectomy and Adenoidectomy (T&A)
Your child misses a large amount of school due to tonsil or adenoid infections.
Your child has difficulty breathing (while sleeping or while awake).
Your child has difficulty swallowing or breathing due to enlarged tonsils.
National guidelines, as reported by the American Academy of Otolaryngology-Head and Neck Surgery, suggest your child experience a minimum of seven infections within the past year, five per year for the past two years, or three per year for the previous three years in order to have a tonsillectomy.
In some instances, a combination of recurring throat infections along with your child’s allergic reaction to antibiotic medications, an infected area near your child’s tonsils, or episodes of fever, swollen glands in the neck, mouth sores, and sore throat may indicate a need for this surgery even if the above conditions aren’t fully met.
Adenoidectomies may be recommended for children who suffer from long-term sinus infections, recurrent middle ear infections, or chronic middle ear infections (with fluid) after having tubes placed in the ears.
While infections were, once upon a time, the primary reasons T&A surgery was recommended (approximately 90 percent were prescribed for infections 30 years ago, according to the American Academy of Otolaryngology-Head and Neck Surgery), those numbers have dropped drastically. Today, infections account for only 20 percent of tonsillectomies and adenoidectomies prescribed today.
Adenotonsillar Hyperplasia with Obstructive Sleep Apnea
Failure to Thrive
Suspicion of Malignant Disease
Some children will need only one or the other of the procedures and not both. Though when both are necessary, the procedures are typically performed simultaneously.
Tonsillectomy and Adenoidectomy (T&A) Procedures
Once the need for a tonsillectomy and/or adenoidectomy is determined, parents often get nervous about what the treatments will entail, the risks they pose to your child, how to prepare for the procedure(s), and what the recovery will be like for their child.
What is a Tonsillectomy?
A tonsillectomy is a surgical procedure in which your child’s tonsils will be removed. The tonsils are small glands located on the sides of your child’s throat.
While tonsils do help the body fight off germs that enter through the nose and mouth, they are not essential for children to lead long, full lives.
What is an Adenoidectomy?
With adenoid removal, once again the most common forms of removal involve a scalpel or cauterization, which seals the area using a heated device. Stitches are usually not necessary after the surgery, which is conducted under general anesthesia and your child will be able to return home quickly after waking from the procedure.
While the two surgeries can be conducted separately, they are routinely performed at the same time with very similar results for follow-up care once the surgeries are completed.
Tonsillectomy and Adenoidectomy Risks
Part of making informed decisions for the health of your child is gathering all the facts. While you’ve probably heard much about the rewards for your child when it comes to tonsillectomy and adenoidectomy, it is equally important to understand that there are some risks involved including risks such as those listed below:
Dehydration. Many children don’t drink enough fluids afterward due to sore throats.
Difficulty breathing. This can occur as a result of post-surgical swelling.
Infections at the surgery site. Infections are always a possibility with any type of surgery.
Bleeding. This may occur during the surgery, immediately after the surgery has taken place, or later when your child is home.
While this isn’t an exhaustive list of risks and some may be specific to your child and his or her underlying medical conditions, it is always best to discuss your concerns with your ear, nose, and throat (ENT) doctor before making your final decision about this surgery so that those fears can be properly addressed.
Preparing Your Child for the T&A Procedure
While it is always wise to talk to your child (in an age-appropriate manner) about what will happen during the surgery so that your child doesn’t experience any fear going into the tonsillectomy and adenoidectomy, it is equally important to prepare your child physically. Depending on the age of your child, this will mean different things.
For all children, you should only give clear liquids up to the last two hours leading up to the surgery, or follow any other specific instructions provided by your ENT surgeon. Clear liquids include things like:
White Grape Juice
Children should have nothing to eat or drink within the last two hours before your scheduled time to arrive for surgery or as otherwise indicated by their doctor.
Other key details to note when preparing your child for T&A surgery include:
Avoid giving your child medication that contains aspirin within 10 days of the surgery (read all labels to be certain).
Avoid natural or homeopathic treatments within 10 days of surgery.
Be sure to buy plenty of popsicles, sports drinks, clear soups, juices, and soft foods for your child to eat after the surgery.
Have acetaminophen or other non-aspirin pain reliever and a thermometer at home for care after the surgery.
Write down all medications your child has taken in the 10 days leading up to the surgery and bring the list with you on the day of the surgery.
These types of things can have a huge impact on your child’s health during and after the surgery. If your doctor provides you with specific instructions make sure to follow those to the letter.
Tonsillectomy and Adenoidectomy (T&A) Recovery
For many parents, the focus is on what happens after the surgery. Recovery may take a few days, but you should begin to notice an improvement in your child’s overall health quickly afterward. Whether your child is having surgery to combat obstructive sleep apnea or because of recurring infections, you should see changes quickly.
Immediately after the surgery, your child may complain of a sore throat. There are some things you can do to assist with tonsillectomy recovery and to help build excitement with your child leading up to the surgery, such as:
Stock your freezer with your child’s favorite brand or flavor of popsicles.
Buy pudding cups, applesauce, and similar soft snacks in a variety of flavor.
Offer favorite flavors of oatmeal (or eggs however your child likes them) for breakfast.
Have non-aspirin pain reliever available.
Have plenty of games and coloring books on hand to avoid boredom.
Buy a movie for your child to enjoy (over and over – and over again after the surgery).
Give your child plenty of ice cream (without chunky things inside, of course)
Offer plenty of water, Gatorade, Pedialyte, or other electrolyte drinks to avoid dehydration.
Little things like these can make a dramatic difference in your child’s disposition, comfort level, and excitement while going through tonsillectomy and adenoidectomy recovery.
Tonsillectomies and adenoidectomies are not nearly as widely prescribed today as they have been in the past to overcome infections. However, they are very commonly performed to address sleep apnea in children. If you suspect your child needs T&A surgery, book an appointment with Houston ENT f& Allergy for an evaluation and to discuss your concerns.
She completed her undergraduate education at the University of Notre Dame in South Bend, Indiana. She moved to North Carolina to attend the Wake Forest University School of Medicine for her medical degree. She then went on to complete her residency at the University of Texas Health Science Center- Houston in 2001.