Preparing Your Child For a Tonsillectomy

Does your child suffer frequently from sore throats, ear infections, difficulty breathing, snoring or sleep apnoea? Chronic tonsillitis may be the problem. Your family physician may refer your child to an ear nose and throat specialist, who may recommend a tonsillectomy. A tonsillectomy is a simple one hour day surgery where the tonsils are removed from the mouth, leaving no external incisions. However, no matter how simple, surgery can be daunting for both parents and children alike. Along with being a doctor, I am also a parent to a toddler, and I can fully appreciate the awesome love we feel towards our children and the responsibility to keep them safe and healthy. Hence, I have a special interest in treating toddlers, babies and pregnant women. The best way to abate anxiety on an upcoming tonsillectomy is to be well informed – knowledge is power!

Understand What’s Ahead

The first step to preparing your child for tonsillectomy begins with making sure you are up-to-date on what the procedure entails. This will allow you to explain things to your child and address their fears (as well as any of your own).

 

The Procedure

• The tonsils are lymphatic tissue located at the end of the nasal passage that become inflamed in response to infection around the throat and nose, causing them to enlarge.
• During a tonsillectomy, general anaesthesia is given to the child, and the tonsils are burned using an electric unit through the mouth, which is kept open with a clamp.
• Your child cannot eat or drink for 6 hours before the surgery. This includes water.
• Your child will be put on an IV before, during and after the procedure, until they are discharged from the hospital. This is to supply anaesthetic before and during surgery, as well as prevent dehydration post-operation.
• You will not be able to accompany the child into the operating theatre, but will meet them afterwards in the recovery room.
• Most private hospitals will have private recovery rooms, whereas you may have to share a room in public hospitals.
• Overnight stays in the hospital are rare, and most children will be discharged the same day as the tonsillectomy.
• If you should choose to go private, depending on your insurance plan and the surgeon’s fees, it can cost between $300 to $2000. The public system is of course free, but can involve waiting times of up to a year.

 

Post-Operative Recovery

• Recovery after the surgery generally take two full weeks, during which your child will need constant monitoring and care at home. You may have to take time off work to look after them, and they must have time off school. If possible it may be best to schedule the surgery during school holidays.
• The back of the throat will be sore, and will develop white scabs during the recovery period, which will subsequently peel off and will return to the normal pink flesh colour upon full recovery.
• Dehydration is the main culprit for post-operative complications such as bleeding and infection, thus frequent drinks of cold water (half a cup every hour) is needed. Also, it is important to minimize talking and get plenty of bed rest with lots of pillows elevating the upper back. Serious bleeding occurs in 1-3% of patients, but with proper caution, your child will not be one of them.
• One week after procedure you should schedule a check-up with your family physician to make sure everything is going well.
• The first few days after surgery are not painful, but pain during swallowing and in the ear (the ear and tonsils share the same nerve) is generally increased from day 5-7 post operation. Contact your family physician if you feel the prescribed pain medication is not working. Do not wait for pain to manifest to provide relief. Make sure your child takes the pain medication (usually Panadol or Painstop) as prescribed – every 6 hours – even if they are not complaining of pain or you have to wake them up at night to take their medicine. Antibiotics may also be prescribed and should be taken as recommended to reduce the chance of infection. Do not give your child aspirin or ibuprofen (Advil or Neurofen) within 10 days of surgery.

 

Be Child Focused

Studies prove that children who are explained about tonsillectomy adjust and recover better than those who are not. I can also attest from personal experience that children cope better when they know what to expect and what is expected of them. But be careful not to frighten your child with “you will be cut open” or “the doctor will sew you with a needle” or “burn your tonsils”. Use non-threatening language instead, saying “the doctor will fix the problem” “make you healthy so you can play more”. It is also important to not lie, though. Specially be upfront on how they will not be with you in the operating theatre and how they will experience some pain afterwards. If children are given a chance to prepare mentally, they will cope better. Also, focus on the positives, such as the fact that they will get to eat all the ice cream they want afterwards! And finally, when speaking to your child, ensure you remain clam yourself as I can assure you that they will pick up on your tone and body language more than what you are telling them!

 

Do a Tour of the Hospital

I recommend doing a hospital tour ahead of the surgery. It can be a great way to familiarize your child to the environment they will face on the day of the procedure. You can also request the nurse to talk to them about the surgery beforehand and show photos of the operating theatre so your child gets to know the space and people he/she will be with in the operating room. Afterwards you can also read to them children’s story books on tonsillectomies.

 

Some More Practical Tips

• Bring a favourite toy or blanket on the day to the hospital, which the child can take with them into the operating theatre.
• Bring a portable DVD player to spend time in the recovery room afterwards. Most hospitals will have play rooms, but your child may not wish to leave their bed.
• Jaw stiffness may result from the clamps that are used during tonsillectomy. Chewing gum afterwards can stimulate saliva production to ease recovery as well as reduce jaw stiffness.
• Bad breath and voice change is normal. Maintain normal teeth cleaning and flossing.