Tonsillectomy

What to expect?

The aim of this procedure is to surgically remove your child’s tonsils. The procedure is carried out under general anaesthetic and your child will be asleep throughout the procedure.

Alternative treatment options will have been discussed with you in the ENT clinic.

Benefits

The procedure prevents recurring episodes of tonsillitis and helps alleviate obstructive sleep apnoea. This is when your child’s breathing repeatedly stops and starts during their sleep.

Fasting before surgery

Before having a general anaesthetic, it is important that your child’s stomach is empty, so please make sure that the guidelines below and on the next page are followed:

If your child’s surgery is in the morning:

• Your child can eat and drink normally until 12:00 midnight the day before surgery
• From 12:00 midnight until 7:00 am your child may have a drink of water, or weak squash only. No fruit juices or fizzy drinks
• If your child is on formula milk feeds, they can have one just before 3:00 am
• If your child is being breast fed you may allow a feed up until 5:00 am – this does not apply to formula milk
• After 7:00 am your child must not eat or drink anything at all
• If your child is on medication please make sure this is given before 7:00 am, unless you have been instructed otherwise

If your child’s surgery is in the afternoon:

• Your child may have a light breakfast, such as toast or cereal and a drink before 7:30 am
• Between 7:30 am and 12:00 midday your child may drink of water, or weak squash only. No fruit juices or fizzy drinks
• If your child is on formula milk feeds, they can have one just before 7:30 am
• If your child is being breast fed you may allow a feed up until 10.00 am – this does not apply to formula milk
• After 12:00 midday your child must not eat or drink anything at all
• If your child is on medication, please make sure this is given before 12:00 midday, unless instructed otherwise

Items to bring into hospital

• Any medicines, tablets or inhalers that your child is currently taking
• A favourite toy or comforter
• Details about any special food or dietary requirements
• If you are staying with your child overnight, please bring nightwear, a towel, toothbrush and toothpaste for both of you

Please bring in the above items even if your child is booked for day case surgery as this may change.

Following the operation

If you have a mobile phone, please provide the number so that a recovery nurse can contact you after the procedure. If you do not have a mobile phone an alternative method of communication can be arranged.

Your child will be closely monitored on the ward by nurses for several hours following the operation.

If your child suffered from obstructive sleep apnoea, they may need to stay overnight to be monitored. Your surgeon should have made this decision when seeing you in clinic.

Risks

As with all operations there are some risks associated with having a tonsillectomy and these are:

• An approximate 1 in 200 risk of bleeding in the first 4 to 8 hours after the operation
• An approximate 1 in 20 risk of bleeding 1 week after the operation
• There is a risk of developing an infection about 1 week after the operation
• There is a small chance of damage to teeth or dental caps and crowns as well as bruising to the lips and gums

These risks will be discussed with you by the doctor who will be happy to answer any other questions you may have.

Post-operative information

Immediately after the operation it is normal for your child’s throat to be sore and they may feel nauseous (sick). Your child will be given medication to help with any discomfort.

Your child may also experience earache after a tonsillectomy. This is because the nerve which supplies the throat is also connected to the ears. This will resolve once the throat has healed.

Once home, your child will need to take pain relief such as paracetamol and/or ibuprofen regularly for 1 week particularly 30 minutes before meals. This will enable your child to eat and will help with their recovery. The pain relief can be continued to be taken as needed.

Due to the healing process, it is normal for your child’s sore throat to feel worse before it gets better. This is usually around the 5th day after surgery.

Eating and drinking

After their operation your child may start to eat and drink as soon as they wish. It is important to resume your child’s usual diet as soon as possible. Chewing and swallowing will help relieve pain and remove any debris from the tonsil beds, helping to prevent infection.

It is also advisable for your child to drink plenty of fluids, such as water and squash after each meal, particularly after eating dairy products.

Do not worry if you notice white patches on your child’s throat - these are normal and will stay until your child’s throat has healed properly.

Leaving hospital

Your child will need 2 weeks off school or nursery while they recover, and heal.

Your child should avoid contact with anyone who has a cold or who is unwell and should avoid smoky and crowded environments for 2 weeks to reduce the risk of infection. For the same reason your child is advised not to use public transport to travel home from hospital.

There is a possibility that bleeding can occur from the tonsil bed for up to 2 weeks after the operation.

If your child has any fresh blood in their saliva or if they vomit fresh blood, please bring your child to Gloucestershire Royal Hospital Emergency Department immediately, or call the Emergency Services on Tel: 999 if you are on your own.

Your child will be assessed and may need to be re-admitted to hospital for treatment and monitoring.

Follow up

Your child will not need a follow up appointment, but if you have any concerns or need advice in the first 24 hours at home, please contact the Paediatric Day Unit or the Paediatric Assessment Unit at night. After this time, you should contact your GP for advice, or call NHS 111.

Contact information

Paediatric Day Unit

Gloucestershire Royal Hospital

Tel: 0300 422 8452

Tel: 0300 422 8453

Monday to Friday, 7:00 am to 7:00 pm

Paediatric Assessment Unit

Gloucestershire Royal Hospital

Tel: 0300 422 8305

Tel: 07798 695 981

NHS 111

Tel: 111