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Parents and grandparents might remember when getting your tonsils out and living on ice cream for a week was a regular thing. From the early 20th Century through the 1960s, tonsillectomies were one of the most common surgeries performed in America. With more effective antibiotics now available, pediatricians are more conservative about recommending removal. However, tonsillectomies are still a standard and relatively simple procedure: more than 500,000 children have their tonsils removed yearly. But how do you know when your child needs to have their tonsils removed? When should you wait it out instead?
What Are Tonsils?
Healthy tonsils are superstar germ killers. They’re part of our toolkit for fighting infections. That’s one reason we don’t recommend taking them out without an excellent cause. We have two pink, oval-shaped tonsils on either side of the back of our throats. They’re made of lymphatic tissue and contain germ-fighting white blood cells. They catch germs that enter our bodies when we breathe or swallow. However, our tonsils can become swollen or infected, causing pain, discomfort, fever, and other symptoms. Our tonsils grow until puberty and then shrink as we age: one reason tonsillitis is most common in children.
What Conditions Can Affect My Child’s Tonsils
Tonsillitis is the most common condition affecting the tonsils. It’s a bacterial or viral infection that causes redness and swelling. Tonsillitis is primarily a childhood illness most common in kids ages 5 to 15. Strep throat, tonsil stones (which cause yellow or white lumps) and mononucleosis can also affect children’s tonsils. Enlarged tonsils, caused by infection or other factors, can block your child’s airway and cause sleeping disorders, including snoring and sleep apnea.
When Should I Consider Having My Child’s Tonsils Removed?
Recurrent throat infections and sleep disorders related to breathing obstructions are the two most common reasons for a tonsillectomy. Sometimes, repeated sore throats and tonsil infections can hurt your child’s quality of life, causing exhausting episodes of sickness and missed school. Sleep disorders caused by enlarged tonsils can also have a significant negative impact, leading to growth disruptions, behavioral problems, or problems in school.
However, since our tonsils play a vital role in fighting infection, physicians are cautious in recommending surgery and follow strict guidelines. The American Academy of Otolaryngology provides guidelines to help providers make thoughtful recommendations and guide families. As pediatricians, we consider removal when infections are severe and recurrent. AAO guidelines recommend considering a tonsillectomy if your child has at least seven severe sore throat episodes in the last year, at least five per year in the previous two years, or at least three per year over three years. We also want to confirm your child isn’t simply experiencing a sore throat. Other signs we look for include fever, tender lymph nodes, positive strep tests or fluid in the tonsils (tonsillar exudate).
Sleep disorders are another reason we recommend removing the tonsils. In fact, in the 21st Century, more tonsillectomies are done because of sleep-disordered breathing than infections. When your child is sleeping poorly because of obstructed breathing, it can cause a range of physical and behavioral health challenges.
Our body can still fight infection if we remove the tonsils. There are hundreds of thousands of cases each year where doctors feel removal is warranted and will improve a young patient’s quality of life.
Why Are Pediatricians Cautious About Tonsillectomies?
With the advent of highly effective antibiotics, doctors are much less likely to recommend a tonsillectomy than 50 years ago. There are several reasons for this shift in thinking. First, instead of treating tonsils as a problem, we now realize they play a vital role in our immune system. When they’re working right, they help us fight infection and disease. Another reason is that a tonsillectomy is a surgical procedure that requires sedation. Removing the tonsils is a straightforward outpatient surgery that usually only takes around half an hour. Usually your child can go home the same day and takes just a week or two to recover. However, any surgery requiring anesthesia comes with risks. If you and your pediatrician suspect your child may be a candidate for removal, the AAO recommends careful documentation and “watchful waiting” for at least a year to ensure it’s the right path.
At Loudoun Pediatric Associates, your child’s health and well-being are our top priority. We take the time to work with parents and weigh the risks and benefits of any procedure. We sometimes recommend removing a young patient’s tonsils if frequent infections impact quality of life and meet carefully crafted guidelines. We also explore tonsillectomy as an option if breathing problems cause sleep disorders that harm your child’s development. However, in many cases we recommend an alternate route. Either way, observation and documentation are a must. If your child has a sleep disorder or recurring throat infections they can’t shake, let’s talk and get the process rolling.