Your child needs an operation called a tonsillectomy to take out the tonsils.
Your child also has obstructive sleep apnea (OSA). Your child will need closer observation while they are in the hospital.
What are tonsils?
The tonsils are small pieces of tissue at the back of the mouth, beside the tongue. They help fight germs. There is one tonsil on either side of the throat.
What is obstructive sleep apnea (OSA)?
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 tonsils have become big enough to cause some blockage in your child's air passages. This blockage means your child can have problems breathing when they are asleep.
If your child is having a tonsillectomy for OSA, some of what happens after the operation will be different from the other children having these operations.
This page explains what to expect while your child is in the hospital and how to take care of your child at home.
Reasons to remove tonsils
There are several different reasons to remove enlarged tonsils. Here are some reasons:
- They may interfere with breathing while a child is asleep.
- They may interfere with regular breathing while a child is awake.
- They may cause repeated infections.
The tonsillectomy operation is done to help reduce the infections and improve your child's breathing. An otolaryngologist/head and neck surgeon will do the operation. An otolaryngologist (say: OH-toe-lar-ring-GOLL-oh-jist) is a doctor who specializes in problems of 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 will need to stop eating and drinking.
Write down this information here:
The date and time of the operation:
When your child must stop eating:
When your child must stop drinking clear liquids:
Other information to remember:
During the operation
The doctor will give your child a special "sleep medicine" called a general anesthetic. This will make sure your child sleeps through the operation and does not feel any pain.
While your child is asleep, the doctor will remove the tonsils through your child's mouth. Your child will not get stitches.
The operation usually takes from 45 to 60 minutes.
You will be able to see your child as soon as they are 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 one hour or longer. After your child has stayed in the recovery room, we will move them to a special room on the inpatient unit. This room is called the constant observation room and has a nurse in it at all times. Your child will stay in this room overnight.
In the constant observation room
- Your child will be attached to a monitor that helps the nurse watch your child's breathing.
- Your child will be encouraged to take fluids by mouth, starting with sips of clear fluids (drinks you can see through), ice chips or freezies. Once your child can have sips, a health-care provider will have them take liquids from a cup.
- Your child will be given pain medicine every four hours or as needed.
- Your child's temperature and vital signs will be taken regularly.
- Your child will have an intravenous (IV) tube in their arm. Your child's IV will stay in place until discharge.
- Your child will be watched for difficulty breathing, bleeding or vomiting.
- If there are any complications, the doctor will be notified.
- When your child is fully awake, they can get up with help to use the washroom.
- Your child may throw up thick, brownish-coloured liquid if they swallowed some blood during or after the operation. This is normal. If your child keeps throwing up, we will give your child medicine through the IV to help settle their upset stomach.
- One parent may stay overnight with the 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
When your child has pain after the operation, they will be given pain medicine:
- by a liquid to swallow, or
- if they cannot swallow the pain medicine, we can give your child a suppository that goes into your child's rectum
These are ways we can help make your child more comfortable:
- humidified air to keep the throat moist
- raising your child's head and shoulders to help reduce swelling
Most children can go home after one night in the hospital
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, they should be able to go home in the morning.
Caring for your child at home
Pain
Your child will have some pain after the operation.
Your child will have a sore throat. They may also have an earache or jaw pain, which is caused by the sore throat. Five or six days after the operation, your child's sore throat, jaw pain or earache may get worse for a short time. This is normal.
Your child may also have a stiff neck. If this does not improve, call your doctor.
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 given to you by the pharmacist. Although these prescription pain medications can be beneficial, they may have potentially serious complications 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) and/or ibuprofen (such as Motrin, Advil or Midol) if they have pain. Give the dose printed on the bottle for your child's weight. Do not give your child acetylsalicylic acid (ASA, Aspirin) for two weeks after the surgery. ASA 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.
Drinking
It is very important that your child have lots to drink after the operation. Try to get your child to drink at least four glasses of liquid a day over the next few days. Let your child drink as much liquid or liquidy foods, such as Jell-O, as they want. Do not let your child have orange, lemon or grapefruit juices or citrus fruits for seven to 10 days. These contain acid, and your child may find them painful to drink.
Eating
When your child can drink liquids without throwing up, they may eat soft foods such as noodles, eggs and yogurt. When your child can eat soft foods comfortably, they may eat regular foods. But your child should not eat hard foods, such as toast or pizza crust, for two weeks after the operation. These foods may scratch their throat and cause pain and bleeding.
Mouth care
Your child's mouth may smell different for two weeks after the operation. Have your child rinse their mouth with water or gently brush their teeth. Do not let your child gargle, or swish anything around in the back of their throat.
Your child may have white patches where the tonsils were for several days. This does not mean that your child has an infection.
To protect your child's throat, make sure your child tries not to cough, talk loudly or clear their throat for seven to 10 days. Teach your child to sneeze with their mouth open. Do not let your child blow their nose for at least one week after the operation. They should dab their nose with a tissue if it is running.
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.
Activity
Your child should limit their activity for about one week after the operation. Do not let your child play rough or contact sports.
Your child can shower or bathe as usual.
Your child should stay away from crowds and people with infections and colds.
Your child can go back to school or day care seven to 10 days after the operation. Do not let your child go on long trips out of town for two weeks.
Your child may need a follow-up appointment with the otolaryngologist
If your otolaryngology doctor has asked to see your child again in the clinic, the clinic will make an appointment for your child.
Reasons to call the doctor
Please call your child's otolaryngologist, the otolaryngology clinic or you family doctor right away 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, having trouble breathing, or you have additional concerns, take your child to the closest emergency department right away.
Write down contact information here:
Otolaryngologist's name and number:
Otolaryngology clinic number:
Family doctor's name and number: