The "Tonsil & Adenoid" One
Having surgery for the removal of tonsils and adenoids is so common in children. It’s like the bread and butter of Paediatric Surgery.
But what exactly does it mean, why does it happen and how do kids handle a surgery like this (not to mention, how do we as parents handle a surgery like this)??
Well, I’ve teamed up with Fiona from Mama Matters to chat to you about the medical side of this surgery AND the practical, parenting side of it — because they can be very different.
Fiona is a social worker trained in infant mental health and attachment and baby-led sleep coaching, so her perspective here is really insightful. First up, let’s hear from Fiona as she walks us through her experience after her littlest love Zali had this surgery done. Then I will follow up and walk you through the medical side of this surgery.
My daughter Zali was about 9 months old when I noticed her enormous tonsils during a crying spell. We had been through a respiratory specialist earlier in her life because she had always had noisy breathing – they landed on tracheomalacia, but I wasn’t convinced. She was always breathing through her mouth, sounded like a pug and struggled to breathe during breastfeeding, getting puffed out. Once I saw the tonsils, I took her back to GP who referred us to an Ear, Nose & Throat surgeon to have her tonsils and adenoids removed.
We then realised that she was having pauses in her breathing during her sleep, sometimes for over 10 seconds at a time. It was horrible to watch and to listen to. Her surgeon suggested operating around her 12 month birthday, but we ended up waiting until after 18 months. Obstructive sleep apnoea is usually an indicator for priority surgery.
Before her surgery date we had a hearing test at the hospital, where they found a lot of fluid in her ears and a fair bit of hearing loss. We hadn’t even noticed – we just thought she was a space cadet and a toddler in her own world, too busy to listen to us. We didn’t realise how much she wasn’t hearing! They recommended inserting grommets at the same time.
The trifecta: tonsils & adenoids removal, and grommets insertion- all under general anaesthetic. My baby girl. She was 22 months by the time she went in.
We had no idea what to expect for her surgery and recovery, as every man and their dog will tell you a different story.
“Would never know anything happened to her!”
“Oh it was AWFUL. I had mine done and it was worse than childbirth.”
“The younger the better.”
“You just have to get past day 5 and everything will be okay.”
“You just wait until day 10.”
The first hard part was of course separating with her for the operation itself. We were fortunate that we had a lovely Paediatric Occupational Therapist in the preoperative theatre that helped to familiarise Zali with the mask that would be going on her face to put her to sleep.
I had my big girl pants on that day and I held her hand and talked to her as she went off to sleep. I walked out to my car and howled. Like, I howled. It was such a release of emotion – we had been waiting for this surgery, had it cancelled before, and now it was happening.
Once she woke up, she was really unhappy. It’s hard to think back to this part. There was some blood under her nose, in her drool and in her ears. It was a sudden realisation that she had just had some pretty big surgery. She was screaming and unsettled and it took a long time for her to settle into sleep on me.
We spent a night on the ward because of her age and risk of a post-op bleed. She was quiet, didn’t eat much, and sore. The next 10 days was quite the rollercoaster.
At times it felt like she was doing really well – and, I guess she was. Other times, she was beside herself, wouldn’t take he medicine and was having the most enormous meltdowns I had seen in her. The nights were broken and we spent a lot of time cuddling on the couch. We were tired, cranky, she was sore, frustrated. It wasn’t bad all day every day, but it was bad every day, at some point. There were a lot of tears from both of us.
The main thing was to keep on top of her medications. The nurofen would sometimes burn her throat and make her vomit. Sometimes she would take medicine willingly, sometimes we had to cover it in sprinkles, put it in some Nutella, or some custard or ice cream. She survived off Nutella, pasta, yoghurt and milk arrowroot biscuits for a good 10 days.
I was prepared for the pain and sleepless nights but I wasn’t so prepared for the emotions and behavioural changes. She was really, really angry sometimes. She would cry and cry until she crashed out and fell asleep on the floor. I would offer my comfort but she would often not take it. That was really hard. Sleep would only happen on the couch, even in the night. She would wake during the night and only resettle on the couch. Sometimes we would just take her for a drive to help her get to sleep. She would wake frequently and be really unhappy.
Kids are amazing, aren’t they? What would usually knock us down and keep us in bed for two weeks, she really did just want to get on with it. It wasn’t easy, and I had some guilt at the time seeing how much pain she was in – but oh, was it worth it.
The fixes to her breathing was instant. That first post-op snooze was silent. Her lips were sealed and she was breathing through her nose. Her noisy breathing was gone! It completely fixed her up. No more sleep apnoea. When she sleeps now, instead of wriggling around into all sorts of ridiculous positions and snorting and snuffling throughout the night – she closes her eyes, lips together, and just stays in the one spot breathing silently. Oh, and she is hearing things we hadn’t realised she had never heard before! I won’t forget the moment she came running to me when she heard the sound of the washing machine. It was really beautiful watching her discover another part of the world she had been missing.
This was absolutely the right thing for Zali. It has changed her life. It is big surgery, and I would recommend if you have other kids at home, to arrange extra care for them if possible. Stay on top of the pain medication, because it can be a gnarly spiral if you miss it and then they are too miserable and in too much pain to open their mouth for more. Get the Sick Happens medicine tracker! I could not have lived without it. I couldn’t keep up with the nurofen & Panadol doses and I am so grateful I had that system.
And surrender to the emotions, the cuddles, the disrupted sleep. It’s temporary and your kiddo needs you.
What is a tonsillectomy and adenoiectomy?
This is commonly known as a T&A and it refers to the surgical removal of the tonsils and adenoids.
Why do children need this surgery?
There are many reasons why this surgery might be needed for your child. Some examples include:
— Breathing complications
— Swallowing complications
— Sleep Disturbances
— Recurrent infections such as tonsillitis
What do you need to do?
Generally, your child will need to be reviewed by an Ear, Nose and Throat (ENT) Specialist to decide/advise whether this surgery is appropriate and the best course of action for your child and their symptoms. Your GP will give you a referral for this specialist appointment.
Keep in mind, the wait times to see a Paediatric Specialist can be weeks, months or years depending on the severity of your child’s symptoms. It’s very frustrating, and seems crazy to make kids wait this long, but unfortunately it’s a supply and demand situation. Keep calling to ask what the waitlists are like, and you never know what may happen if you call on the right day. Please, please be kind though — they are still people on the other end of the phone, and they are doing the best they can.
Once the surgery has been booked, your surgeon or nursing staff will give you a list of instructions to follow.
Fasting times are CRITICAL. Your child needs to have an empty stomach before the surgery, because they will have a general anaesthetic. This means that they will be giving medications to put them to sleep, and their muscles will be relaxed = this means they will be unable to breathe on their own. If they have food and drink in their stomach, the chances of vomiting are high, which then could be aspirated into the lungs and cause serious complications. As crappy as the fasting part is, please PLEASE do it!
Depending on individual policies and procedures of the hospital you are at, parents are generally allowed to come into the room until your child is asleep — but this is up to the discretion of each hospital. It’s best to ask them at your appointment beforehand what to expect here.
Some procedures will require an intravenous cannula inserted in your child’s arm BEFORE the procedure, others will do this once they are asleep. Again, just ask what will happen before the surgery.
The tonsils and adenoids are removed through the mouth, and it can take between 30-120 minutes. Afterwards, your child will remain in recovery until they are safe to return to the ward or daystay area.
What to expect after the surgery?
How your child wakes up is a lottery. Some children wake up as if nothing happened at all… others will wake up screaming for hours or will vomit. Unfortunately there is no way to predict which way your child will go. Prepare for the worst and hope for the best.
Most kids will stay in hospital overnight for observation, and of course a parent/caregiver stays with them.
You will be given discharge instructions which will explain:
— What your child can eat and drink (it is now advised for children to return to as normal a diet as possible. So no more custard and jelly’s for days)
— Managing they pain: Make sure you keep up with Their pain relief and TRACK THEM! Apparently days 5-7 are the worst for pain. Grab your Sick Happens Medicine Tracker here or grab your Health Tracker here
— Concerning symptoms to look out for and when to come back: Such as post-operative bleeding
— Follow up appointments
Useful resources
https://www.rch.org.au/kidsinfo/fact_sheets/Tonsillectomy_and_adenoidectomy/
https://www.rch.org.au/kidsinfo/fact_sheets/Tonsillectomy_and_adenoidectomy_discharge_care/
Where can you find more information about Fiona from Mama Matters?
“I’m Fiona. I have worked in perinatal mental health and parenting for most of my career now. I am passionate about child development, baby brains (and baby brain!) and attachment. I am here to support new and seasoned mothers to navigate the trials and tribulations of raising well-adjusted babies with confidence and connection”
