Tonsil surgery in children. The tonsils, also called tonsils, are almond-shaped organs. They help to fight infections and are part of our immune system. They trap invading pathogens and render them harmless.
The tonsils are located as lumps on the left and right in the back of the throat. The uvula, the appendage of the soft palate, hangs between the tonsils. The tonsils are clearly visible when you look at the back of your child’s throat, especially if they are red and swollen.
Symptoms of inflammation of the Tonsil surgery in children
If the tonsils can no longer cope with the amount of invading pathogens, they can become inflamed. The tonsils swell and hurt. Sometimes white dots are visible on the tonsils. Symptoms of an inflammation of the tonsils are:
- sore throat
- difficulty swallowing
- risk of high fever
- feeling tired and lethargic
- bad food
- bad breath
You can often feel thickened lymph nodes in the neck. Very large tonsils can obstruct breathing, making your child restless asleep and snoring. This is also referred to as ‘sleep apnea syndrome’.
When is tonsil surgery necessary?
When surgery on the tonsils is needed, it mainly depends on:
- how often your child has complaints
- the severity of the complaints
- the duration of the complaints
Important arguments for deciding on surgery are:
- a regularly recurring throat infection
- obstructed breathing during sleep (sleep apnea)
The severity of the complaints is weighed against the risk of the procedure. The child’s age also plays a role: the younger your child is, the more reluctant your doctor is.
In general, the operation is not performed until two years of age. However, there is no absolute age limit, the severity of the complaints is the most important factor.
How can you prepare your child for tonsil surgery?
You can start at home to prepare your child for the admission and the procedure. With a booklet or medical supplies you can familiarize your child with the hospital in a playful way. Tell your child:
- that some blood may come out of the mouth or nose after surgery.
- that it may be a little nauseous after surgery
- that it will have pain in the throat
- that it should drink a lot after surgery
- that it can eat a lot of popsicles
In many hospitals, the pedagogical staff organize special preparation afternoons. The pedagogical employee uses a suitcase with all kinds of hospital equipment, such as a cap with a balloon, an infusion tube, a surgical gown, an apron, a cap and a smoelje. Your child may view and play with these items so that they can become familiar with them. The older children can often watch a photo book or a video.
What happens in the hospital for tonsil surgery?
The admission On the day of the operation, your child will be admitted to hospital. It is advisable to bring the following to the hospital:
- pajamas or nightgown
- beloved toys (bear, stuffed animal, booklet)
- drinking bottle or cup
- medicines that your child may use at home
- health insurance or insurance papers
- punch plate
- for yourself: something to read
Staying sober You usually have to come to the hospital with your child early in the morning. Your child is no longer allowed to eat or drink at home. Keeping your child sober is very important. If your child is not fasted, the anesthesia may cause stomach contents to enter the lungs. Your child must be fasted before surgery. Ask at the hospital:
- how much time your child needs to fast before surgery
- what your child can and cannot eat and drink before the operation
If your child is still an infant, he will need to fast for a shorter period of time, as he cannot go without food for long.
Cold or sick If your child has a cold or is ill, it is important to contact the pediatric ward. Sometimes the admission is postponed. Even if your child has been in contact with a childhood disease (such as chicken pox), it is important to report this because of the risk of infection.
Preparing for surgery
In every hospital the preparation can be slightly different, but in general it comes down to the following. On the ward, your child will be wearing a surgical gown and a bracelet. Usually his temperature is also measured again. Then you take your child to the operating theater together with a nurse or pedagogical employee.
There is a special room where you and your child can wait for you to be picked up. In this room you can put on an apron, hat and slippers. A nurse will take you and your child to the operating room. In some cases, a pedagogical staff member will also accompany you.
Your child may sit on the lap of the operating room nurse. Your child will receive patches on the chest to monitor the heart rate. Furthermore, a small meter with a plaster is placed on one of the fingers to check the oxygen level in the blood.
Depending on what has been agreed, your child will receive a cap for the mouth and nose or an injection. The anesthetist will administer the anesthetic. Some hospitals allow you to stay with your child until they are under anesthesia.
The operation Most operations on the tonsils of children in children consist of a quick procedure. The almond is ‘cut’ off its stem with special tongs. The blood that comes out of the wound must not get into the trachea and must be spat out immediately by your child. That is why anesthesia should not last longer than until just after the moment when the last tonsil was cut.
The removal of the tonsils has no noticeable effect on your child’s defenses. The tonsils are only a small part of the body’s lymph node system. Risk of complications
There is some risk with every operation, including the removal of the tonsils. The risk is mainly formed by the possibility of subsequent bleeding.
In children, a so-called ‘open nose speech’ may exist after surgery, especially if the tonsils were very large and the tonsils of the nose were removed at the same time. This altered voice is almost always temporary. In some cases, speech therapy assistance is needed for a short time.
What happens after the tonsil surgery?
After the operation, your child will go to the recovery room. The recovery room is also called the recovery or the recovery room. Your child will be closely monitored in the recovery room. If your child is waking up, you will be called and you can go there. Your child will have a sore throat immediately after the procedure. Often it also has some old blood in the mouth. The pain your child has after the short anesthesia in combination with the spitting of blood may be traumatic for your child. That means that he often thinks back to this unpleasant event.
If your child is well awake, he can return to the children’s ward. Drinking a lot is very important, usually your child needs a lot of encouragement to do this. Water, lemonade without stinging, apple juice and popsicles are very suitable. Extra cold moisture has a positive effect, because the cold has an analgesic effect on the throat.
If everything went well, your child can go home. If your child has an elevation or a subsequent bleeding, it must stay in the hospital for another night. It is pleasant for your child if you can sleep with your child at night. That gives a safe, familiar feeling in the unknown environment. When you are discharged from the hospital, you will often be given suppositories with paracetamol for your child against the pain. The nurse will tell you which and how many painkillers you can give your child at home. This depends on the age and weight.
It is nice for your child if you can go home with your own transport and do not have to use public transport.
What can you expect when your child is back home?
During the first days after the operation, your child may still feel a little ill and may complain of a sore throat, especially when swallowing. The pain can radiate to the ears. The pain can be well controlled with paracetamol suppositories. The pain usually disappears after a few days.
A gray-white coating develops at the site of the tonsils: this is normal and not a sign of inflammation. This will disappear after about a week. Sometimes your child has a bad taste in his mouth and it smells from his mouth. The first evening and night after surgery, you should wake your child every two hours to give them a drink.
The first day after the operation, your child can eat custard, yogurt and porridge that is not too hot. The second and third days after surgery, your child may eat soft or ground foods and bread without crust. From the fourth, your child can eat everything again, except hard foods, such as apples or carrots. This is allowed again after ten days.
Your child must stay indoors for four to seven days. Then he can go out and go to school again. Your child should not be allowed to swim for two weeks.
General advice and precautions
It is very important to be aware of subsequent bleeding. If your child suddenly gets more blood from the nose or mouth, contact the hospital. During the day you can contact the ENT outpatient clinic; evenings, nights and weekends with the hospital emergency department. If your child has a temperature of over 39 degrees Celsius, it is best to notify your doctor.
More help or information about tonsillitis
You can prepare for admission by requesting information in advance from the pediatric ward of the hospital where your child will be admitted. Most children’s wards have a brochure with information about this. You can also contact the Child and Hospital Association with questions and problems.
Source: Dr. JAM Engel (consultant)
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