Tonsillectomy and adenotonsillectomy for children

A tonsillectomy is surgery to remove the tonsils, while an adenoidectomy removes the adenoids. When both are taken out, this is called an adenotonsillectomy.

The tonsils sit at the back of the throat, and the adenoids are higher up behind the nose. These tissues help fight infection in early childhood but become less important as your child grows. Removing them will not affect your child’s ability to fight infections.

Signs your child needs a tonsillectomy/adenotonsillectomy

If your child has frequent tonsil infections (tonsillitis) over a short period of time, their consultant may recommend a tonsillectomy to prevent further episodes.

Sometimes, the tonsils and adenoids are larger than usual, which can partially block the airway and cause:

• Difficulty breathing through the nose, leading to mouth breathing and snoring
• Sleep apnoea — when breathing briefly stops during sleep

Another less common reason for removing the tonsils and/or adenoids is to help with:

• Frequent ear infections
• Persistent glue ear — when sticky fluid builds up in the middle ear and affects hearing

Is a tonsillectomy/adenotonsillectomy right for your child?

Surgery can help resolve the problems caused by enlarged or repeatedly infected tonsils and adenoids. Removing the tonsils will prevent further tonsillitis, although your child may still get sore throats from other infections. Breathing and sleep problems, such as obstructive sleep apnoea, usually improve after surgery.

It’s important to remember that recovery takes time and your child will have some pain afterwards, but you'll be given advice on how to manage this at home.

As with any surgery, there are risks and benefits. Your consultant will talk these through with you and answer any questions so you’re fully informed before making a decision.

Alternatives to tonsillectomy/adenotonsillectomy surgery

Depending on how severe your child's symptoms are, it may be possible to wait and see if things improve naturally as they grow, as tonsils and adenoids shrink with age. However, this can take several years.

If tonsillitis is caused by bacteria, antibiotics may be prescribed, but they won’t prevent repeated episodes in the long term. If your child’s symptoms are linked to inflammation in the nose, then steroid sprays or drops may be an option.

Tonsillectomy and adenoid surgery are usually performed as day cases. This means, in most cases, your child will not need to stay overnight in hospital. Both surgeries are performed under a general anaesthetic and via the mouth. This means there are no visible cuts on the skin.

Your child's mouth will be held open using a device called a gag. The surgeon will then remove the tonsils and/or adenoids using specialist steel instruments. At the same time, they will use a technique called diathermy, which uses heat to help remove tissue while sealing blood vessels. This reduces bleeding.

After surgery, your child will be taken to a recovery ward where they will be closely monitored.

How to prepare for surgery

Before surgery, you’ll be asked to complete a pre-admission questionnaire, and sometimes your child may need to come in for a short pre-admission appointment.

You will also be asked to sign an informed consent form on behalf of your child. Signing the form means that you understand what will happen during and after the procedure, its risks and benefits, and alternative options, as explained to you by your care team.

Your child will need to fast ie to stop eating and drinking (including chewing gum) for at least 6 hours before their operation. The admission letter will give you exact timings.

On the morning of surgery, your child should have a bath or a shower, avoid moisturisers and remove any make-up or jewellery. They’ll change into a hospital gown before the operation.

If your child develops a cold or infection in the week before surgery, please contact the hospital, as the operation may need to be postponed.

Who will be involved?

Your child’s operation will be carried out by a specialist consultant ENT (ear, nose and throat) surgeon. A consultant anaesthetist will give the anaesthetic and monitor your child throughout. Specially trained nurses and recovery staff will provide care before, during and after the procedure. 

The operation

A tonsillectomy or adenoidectomy usually takes about 30 minutes. If both are removed together, the operation can take up to 1 hour. The procedure is carried out under a general anaesthetic, so your child will be asleep and will not feel any pain.

After the operation, your child may experience some throat or jaw pain, which can be managed with pain relief.

What happens straight after surgery

After surgery, your child will be taken to the recovery area. Specially trained nurses will monitor them closely as they wake up, under the guidance of the anaesthetist.

Your child’s hospital stay

Most children go home the same day, usually about 6 hours after their operation. Occasionally, an overnight stay is needed so the team can monitor their recovery more closely.

Recovery time

Most children are back to normal within 2 weeks, though this can vary. Your consultant will guide you on what to expect.

Short-term side effects

Your child may feel sick after the operation, but this usually passes within a day. The anaesthetic may make them clumsy or forgetful for about 24 hours. Some pain is normal, but they’ll be given pain relief to help manage any discomfort.

After the operation

Your child will wake up within a few minutes. They’ll be given pain relief, usually by injection or suppository (medication placed in the bottom). They should be able to drink and have some light food within a couple of hours.

Once home, encourage them to keep eating and drinking as this supports their recovery. They may feel more tired than usual in the first week, so plenty of rest is important.

Wound care

There are no cuts or stitches and the throat will heal naturally. It may look white as it heals, which is a normal part of recovery.

Pain relief

Pain can last for up to 2 weeks and often gets worse around 5–10 days before gradually improving. It’s important to give oral painkillers regularly as prescribed, rather than wait until your child is in pain. Keeping pain under control helps your child eat and drink, which supports healing.

Eating and drinking

It can be tempting to only offer soft foods, but your child should drink and eat as normally as possible. Small, regular meals can help and it's important they have plenty of fluids.

Smoking

Keep your child away from smoky environments, as this can affect the healing process.

Time off school

Most children need 1–2 weeks off school to recover.

What your child should/shouldn’t do after surgery

• Avoid crowded places and smoky environments
• Eat and drink normally
• Have plenty of rest
• Take regular pain relief

Like any operation, removing the tonsils or adenoids carries some risks. There’s a small chance of bleeding. If your child bleeds from their nose or mouth, go straight to your nearest A&E. Other possible risks include:

• Infection in the throat
• Damage to the teeth, lips, gums or tongue — this is more likely if your child has loose or wobbly teeth

Seek medical advice if your child develops:

• A high temperature or chills
• An unexplained cough, shortness of breath or chest pain
• Increasing pain, redness, swelling, bleeding or discharge in the throat

Most children recover without complications and your consultant will explain how to reduce any risks.