Monday, February 18, 2013

Preparing Your Child for Tonsillectomy


Anna Tielsch-Goddard CPNP-PC

A tonsillectomy and adenoidectomy, often referred to as a "T&A," is one of the most common pediatric surgeries. 
The tonsils and adenoids are gland tissues that are found in the throat. These glands are part of the body’s immune system and help fight infection. Sometimes, the tonsils and adenoids can become infected and cause problems, such as bacterial infections known as tonsillitis or strep throat, or they can become so enlarged that they cause airway obstruction.
The tonsils are located in the back of the throat, and the adenoids are higher in the throat behind the nose and the roof of the mouth. The tonsils can be seen by shining light into the mouth and looking at the back of the throat. The adenoids are not visible through the mouth or nose and special pictures, such as an X-ray or CT scan, must be used to look at them.
If your child has any of the following, he or she may need to be evaluated by an ENT physician (an Ears Nose and Throat specialist) to assess whether your child may need to get his or her tonsils and/or adenoids removed:
  • mouth breathing
  • noisy breathing throughout the day
  • recurrent ear infections
  • snoring every night
  • restless sleeping
  • breath pausing while sleeping
  • frequent throat infections, and/or abscesses (pockets of pus) on the tonsils
Just having large tonsils alone does NOT necessarily mean that your child must have their tonsils removed. Each child should be evaluated individually.
Prior to surgery
Your child’s physician may want to order a blood or urine test prior to surgery. Most hospitals will call you to let you know when they want your child to stop eating and drinking, usually on the night before surgery. Do not let your child eat or drink anything after these times or most likely the surgery will be canceled the next day. This precaution is to reduce the possibility of complications from anesthesia, such as aspiration pneumonia, which can be caused from having liquids in the belly while being put to sleep. You should talk to your child about his or her hospital visit. Have your child pick out a familiar toy or blanket to bring along to the hospital.
Surgery
Your child will be asleep under general anesthesia for their T&A, and he or she will not be able to feel anything during the procedure and will not be in pain. The pediatric ENT surgeon will remove the tonsils, and the throat will be able to heal naturally without any stitches. The tonsils are removed through the mouth and there is no cuts or incisions into the skin. Most children are able to go home several hours after their surgery as long as they are breathing without difficulty, are able to swallow and have something to drink.
In some cases, your child will need to stay overnight in the hospital for observation. Your medical provider should let you know before the day of the procedure if this might be the case. Children that need to stay overnight after a T&A are usually younger then 2-3 years old, have prior sleep apnea symptoms, or have chronic diseases, such as seizures, and need to be closely monitored after having surgery.
After your child’s T&A 
It is important to be with your child or have a caregiver come to the hospital for the next few days after a T&A. An upset stomach for a few hours after surgery and feeling sleepy after the anesthesia are normal. Your ENT specialist will prescribe pain medication to give your child after the surgery. It is important to follow these guidelines and give your child the pain medication after the tonsillectomy.
Good fluid intake and no "horse play" after surgery are very important. Any surgery comes with risks and possible complications, even though these complications are very rare. Watch your child for any type of throat bleeding after the surgery. If there is throat swelling, throat bleeding, or your child is having difficulty breathing, this is an emergency, and you must bring them to the ER or call 911 for immediate treatment.
Most children are absent from school between 5-10 days after a tonsillectomy. They should not participate in gym or any type of strenuous physical activity for 14 days (or 2 weeks) after their surgery. Make sure your child is drinking adequately. Sometimes the throat can be sore and your child might not want to take fluids. It is important to make sure you give your child the prescribed pain medication, so that he or she will maintain appropriate fluid intake.
If you have any questions or concerns after your child’s tonsillectomy and adenoidectomy, you should contact your physician or nurse practitioner who is involved with their care.
References:
The American Academy of Otolaryngology- Head and Neck Surgery: Tonsils and Adenoids. Available at: http://www.entnet.org/HealthInformation/tonsilsAdenoids.cfm
Drake, AF., Carr, M. (2011).  Tonsillectomy. eMedicine Available at Medscape at: http://emedicine.medscape.com/article/872119-overview
United States National Institute of Health. Tonsillectomy. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003013.htm
Wetmore RF. Tonsils and adenoids. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 380
ANNA TIELSCH-GODDARD CPNP-PC

Anna Tielsch-Goddard CPNP-PC is a Pediatric Nurse Practitioner for Children’s Medical Center Dallas at Legacy. She practices on the Perioperative Surgery teams in both presurgical assessment and pediatric-surgery.

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