• 05 MAY 15

    Tonsillectomy and Adenoidectomy – Child

    Preparing for a Tonsillectomy and/or Adenoidectomy – Child

    This information was prepared to answer your questions about tonsillectomy with or without adenoidectomy. Please keep this information and read it carefully. You may wish to write down any questions to ask the specialist  and/or nurse.

    Before surgery

    When your child’s surgery is scheduled, information about when and where to go will be given to you. You will also be given fasting instructions.

    Unless otherwise specified by your specialist, aspirin and non-steroidal anti-inflammatory drugs should NOT be used for at least seven days before the surgery.

    Please bring with you to hospital:

    • Clean pyjamas/night wear.

    • Any favourite cuddly toy or comforter.

    • A book or activity toy as there may be a wait before your procedure starts.

    On the day of surgery

    You will be allowed to accompany your child into the operating room and be with him/her till they fall asleep.

    The surgery will take about 45 minutes. Your child will spend about 3-4 hours in the Post Anaesthetic Care Unit (PACU)/Daystay unit. Most children go home after this time. If your child has not fully recovered he/she may need to stay longer and occasionally may need to stay overnight

    If your child has had surgery for sleep disordered breathing or obstructive sleep apnoea, they  may be kept in hospital for longer than 4 hours to observe their breathing.

    Before being discharged home, your child will be checked by the specialist and nurse. This is to make sure that there are no signs of bleeding, he/she is well hydrated, and the pain is adequately managed.

    If you have to drive a long distance home after the surgery, you may prefer to have a second adult with you for the journey.

    After surgery

    Pain

    Sore throat
    Your child will have a very sore throat after surgery. The sore throat will last for up tp 10 -14 days.    Pain may increase between the 5th and 10th day. Vague discomfort with yawning or eating can persist for several weeks.

    Your child will most likely tell you if he/she is in pain or he/she will cry. Other signs that will tell you your child is in pain include: not swallowing, drooling, spitting up, not talking, and refusing his/her favourite drink or food.

    You can control the pain by giving your child prescribed medications (see “Medication” section).. This should be given regularly rather than waiting for the pain to return.  Drinking enough liquid and eating the right food will also help (see “Hydration/Diet” section).

    For older children chewing gum between meals helps to relieve pain from muscle spasm at the back of the throat and jaw muscles and increases salivation and so encourages regular swallowing.

    Pain may be worst first thing in the morning when your child wakes up. Administer pain relief and wait for 20-30 minutes before offering food or drink to allow the medication time to work. Paracetamol is the ideal pain reliever to use before food as anti-inflammatories such as Ibuprofen can irritate an empty stomach.

    Earache
    Earache is common after tonsillectomy and/or adenoidectomy. This is because the same nerves that sense pain in the throat also go to the ears. The earache can change from being a little bit painful to being very painful and can also increase between the 5th and 10th day after the operation. Earache should be managed in the same way as the sore throat.

    Medication
    Several methods of pain control are used to keep your child as comfortable as possible. These will be discussed with you in the specialist’s rooms and on the day of surgery. Medication will be given in the operating room and the PACU/daystay unit. This medication provides pain relief when he/she first wakes up. It will last four to six hours.

    You will be provided with medications on discharge either with a prescription to take home, or medication will be supplied through Ascot Pharmacy prior to your discharge. Usually a combination of 2 or 3 different pain killers will be prescribed that can be taken in rotation, so as not to exceed the safe daily dosages. It is a good idea to hold a dose back in reserve to be given in the middle of the night if necessary.

    A dose of prophylactic antibiotics is usually given in the operating theatre. Antibiotics are not routinely prescribed to take home, as there is little evidence that this reduces the chance of post-operative infection and is more likely to contribute to post-operative nausea and vomiting. Your surgeon may make an exception to this In certain cases .

    Difflam gargle or spray is useful as it contains a local anaesthetic for the back of the throat, especially in the first few days after surgery.

    Pain relief next due:_______________________________________________________________
    _______________________________________________________________________________                      _______________________________________________________________________________

    Hydration
    After surgery, start giving your child clear fluids. This can include: water, apple juice, flat ginger ale or lemonade, ice blocks and jelly. Your child may prefer cool fluids. Avoid citrus juice.

    If you child vomits, wait a half hour before starting the fluid again.

    Adequate fluid intake is needed to: ensure good hydration, decrease pain and nausea, prevent stiffening of the throat muscles, stop a crust from forming, and make swallowing easier.

    Adequate fluid intake means at least 125ml or ½ cup every two hours. You do not need to wake your child at night if he/she has had enough fluids during the day.

    Your child has had enough fluids during the day if he/she urinates at least three times a day.

    Diet following tonsillectomy
    A normal diet is started the day of surgery and  eating well is crucial to making a speedy recovery, reduces the chance of post-operative infection and the act of chewing and swallowing clears the back of the throat to aid healing. There are no restrictions on what they can eat, but very hot food or spicy food is better avaoided.

    Your child will need to be kept in the hospital until your surgeon/ nursng staff are satisfied that he/she is eating and drinking enough to manage at home.

    Bleeding
    Bright red blood in your child’s throat or vomit, and/or coffee ground vomitus is a sign of bleeding.

    There is a possibility of bleeding after surgery. The risk is about 3-5% after tonsillectomy. The risk is highest on the day of surgery itself and then between the 5th and 10th day after surgery. Blood may come from the nose, mouth, or be seen in spit or vomit. Good hydration and eating well reduces the risk of bleeding. Minor bleeding usually settles with rest and sucking ice chips / blocks.

    If bleeding occurs that is anything more than a spot or streaking of saliva, contact your GP or specialist but do not delay bringing your child into your local A&E right away if there is significant fresh bleeding lasting longer than 10 minutes. Rarely patients may be taken back to the operating theatre to control post-operative bleeding.

    Infection
    It is normal for the back of the throat to be covered in a yellow layer where the tonsils have been removed . This is called slough and gradually clears away as the throat heals. It is not a sign of infection. However if patients do not eat and drink properly, this slough can build up and become infected and cause bleeding.

    If you and your child have chosen to be given back their tonsils after they are removed, it is important that they are handled in a safe manner. They will begin to rot after a few days and should be disposed of or buried in a responsible manner.

    Time off school / childcare

    It is recommended that your child rests at home for 2 weeks after a tonsillectomy and avoids children’s parties / activities / sports during that time. It is normal to feel tired and lethargic .

    Follow Up

    Your follow up appointment in the specialist rooms will be 3-4 weeks following your surgery. This visit should be scheduled prior to or at the time of your surgery. If you do not have an appointment made please contact Nicky at the specialist rooms on 09 6235644.

    Appt: ________________________________

    Contact your specialist if:

    • Persistent vomiting, more than three times in a day.

    • Pain that does not lessen even after giving your child his/her prescribed medication.

    • Your child has a high temperature, above 37.5ºC for longer than four hours.

    • A sore throat or earache that lasts longer than 10 days after surgery and is not improving.

    • Your child is generally unwell.

    The Day Stay nurses are available 730 am-6.00pm, Monday to Friday, to answer any enquiries regarding discharge advice.
    Phone:  520 9500 (operator) 520-9575 (Daystay reception.)

    After hours please contact your Specialist, GP, local A&E clinic, if you have any urgent enquiries.

ENT Group Clinic

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