Adenoidectomy with Obstructive Sleep Apnea: Caring for Your Child After the Operation

Your child needs an operation called an adenoidectomy (say: ADD-uh-noy-DECK-toe-mee) to take out his adenoids.

Your child also has obstructive sleep apnea (OSA). This means your child will need to be closely watched after the operation. Your child may also have to stay in hospital longer than the other children having an adenoidectomy.

This brochure explains what to expect while your child is in the hospital and how to take care of your child at home.

What are adenoids?

Adenoids
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The adenoids are located behind the nose.

Adenoids are lumps of tissue, up behind the nose. Adenoids cannot be seen when looking in the mouth.

Sometimes, adenoids become enlarged and can cause breathing problems.

 

What is obstructive sleep apnea?

Sleep apnea (say: AP-nee-uh) means that your child goes through long pauses between breaths while sleeping. The "obstructive" part of OSA means that the pauses are caused by an obstruction or blockage. OSA can occur when the adenoids have become large enough to cause some blockage of your child's air passages.

Removing enlarged adenoids

Your child may have had enlarged adenoids since birth, or they may have grown too large from repeated infections. The enlarged adenoids are interfering with your child's breathing, especially at night when he is sleeping. Taking out the adenoids will improve breathing. If your child often has ear infections, an adenoidectomy may help him have fewer ear infections.

An otolaryngologist (say: OH-toe-LAR-ing-GOLL-oh-jist) will do the operation. An otolaryngologist is a doctor who specializes in problems with the ears, nose, and throat.

Before the operation

Several hours before the operation, your child will need to stop eating and drinking. The doctor or nurse will tell you when your child must stop eating and drinking.

Write this information down here:

The date and time of the operation:

When your child must stop eating:

When your child must stop drinking clear fluids:

Other things to remember:

 

Surgery to remove the adenoids

The doctor will give your child a special "sleep medicine" called a general anaesthetic. This will make sure your child sleeps through the operation and does not feel any pain.

While your child is asleep, the doctor will take out the adenoids through your child's mouth. The doctor will then stop the bleeding. Your child will not get stitches.

The operation will take between 20 and 45 minutes.

You will be able to see your child when he is fully awake

A volunteer from the Surgical Waiting Room will bring you to see your child.

After the operation

After the operation, we will take your child to the recovery room, also called the Post Anesthetic Care Unit (PACU). This is where your child will wake up. Your child will stay in PACU​ for about 1 hour. Then your child will be taken to a special 'constant observation' room on the otolaryngology inpatient unit. Your child will stay in this room overnight. A nurse will watch over your child at all times.

Your child will be closely monitored overnight

  • An electronic monitor will be attached to your child to help the nurse watch your child's breathing.
  • Your child will be encouraged to take fluids by mouth. Your child will start with sips of clear fluids (fluids you can see through), ice chips, or freezies. Once your child can take sips, he can then drink liquids from a cup.
  • Your child's temperature will be taken often.
  • Your child will still have an IV in his arm. It may be needed for fluids or medicine.
  • Your child will be given pain medicine if needed.
  • The nursing staff will watch your child for vomiting or bleeding.
  • The nurses will notify the otolaryngologist if there are any complications.
  • When your child is fully awake, he may get up with help to use the washroom.
  • Your child may throw up thick liquid that is a brownish colour, if he has swallowed some blood during or after the operation. This is normal. If your child keeps throwing up, we will give him medicine through the IV to help settle his upset stomach.

One parent may stay overnight with your child. However, there is no space for a parent's sleep cot in the constant observation room.

Managing your child's pain after the operation

If your child has pain after the operation, we will give him pain medicine either through the intravenous (IV) tube in the arm or by a liquid to swallow. Your child should have very little pain after the operation.

Most children go home in the morning

Your child will be seen by the otolaryngology doctors the afternoon of the operation and early the next morning. If your child is drinking and had no problems overnight, he should be able to go home in the morning.

Caring for your child at home

Pain

Follow these instructions when your child goes home after the procedure.

You may give your child medicine for pain.

You may receive a prescription for pain medication before you leave the hospital. Follow the dosage instructions give to you by the pharmacist. Although these prescription pain medications can be beneficial, they are also potentially very dangerous if not used properly.

When using these medications, if you notice any changes in either breathing or level of drowsiness that concern you, stop the medication and seek medical attention. If your child is unresponsive, call 911 immediately.

Do not give your child over-the-counter medicine that may have a sedative effect (makes people sleepy) while giving the prescription for pain medicine. Examples of these medicines are decongestants and antihistamines. Discuss these medications with your pharmacist.

You may give your child acetaminophen (such as Tylenol or Tempra) if he has pain. Give the dose printed on the bottle for your child's age. Do not give your child ibuprofen (Motrin, Advil, or Midol) or ASA​ (Aspirin) for 2 weeks after the surgery. These medications could increase your child's risk of bleeding after the operation. Check with the nurse or doctor first before giving these medicines to your child.

Diet

It is very important that your child have lots to drink after the operation. Let your child drink as much liquid as he wants. When your child can drink liquids without throwing up, he may eat soft foods. Then he can progress to a regular diet.

Mouth care

Your child can rinse his mouth with water or brush his teeth gently. Do not let your child gargle.

Teach your child to sneeze with his mouth open. Do not let your child blow his nose for at least 1 week after the operation. He should dab his nose with a tissue if it is dripping.

To help your child breathe more comfortably, you can use a machine called a humidifier. This machine makes the air moist with a cool mist. Put it at your child's bedside.

Your child's voice may sound as if he is talking through his nose. This is normal. It may last for a few weeks or up to 3 months, if the adenoids were very large.

Activity

  • Your child should be as quiet as possible for about 2 or 3 days after the operation. Ask your otolaryngologist when it will be OK for your child to play contact sports again.
  • Your child may shower or bathe as usual.
  • Your child should stay away from crowds and people with infections and colds.
  • Your child may return to school or day care 5 days after the operation. You should not let your child go on long trips out of town for 2 weeks.

Your child may need a follow-up appointment

The otolaryngology clinic nurse will call you within 2 weeks of the operation to find out if your child has any problems and needs to see the doctor again. If your otolaryngologist has requested to see your child again in the clinic, we will make you an appointment for your child.

Reasons to call the doctor

Please call your child's otolaryngologist, the otolaryngology clinic nurse, or your family doctor, if your child has any of the following signs after going home.

  • fever of 38.5°C (101° F) or higher
  • vomiting (throwing up) that does not stop
  • pain that gets worse
  • refusing to drink
  • fresh blood in the nose or mouth

If your child is bleeding or having trouble breathing, or if you are worried, do not wait. Take your child to the closest emergency department.

Write down contact information here:

Otolaryngologist's name and number:

Otolaryngology clinic number:

Family doctor's name and number:

Key points

  • Your child will have an operation to remove his enlarged adenoids.
  • You child will be asleep and feel no pain when the adenoids are removed.
  • Most children can go home the morning after the operation.
  • It will take a few days before your child can return to his regular activities and diet.

Kathy Eres, RN

Tomka George, RN

Pauline Lackey, RN

Paolo Campisi, MSc, MD, FRCSC, FAAP

5/4/2012
Notes: