A tonsillectomy and adenoidectomy (T&A) is a common surgical procedure performed on children, primarily to address recurrent throat infections or breathing problems during sleep. The tonsils are two pads of tissue at the back of the throat, and the adenoids are a patch of tissue high up behind the nose. Removing both can significantly improve a child’s health. Understanding the recovery process is important for parents to manage their child’s comfort and ensure a smooth return to normal activity.
The Critical First 24-48 Hours
The immediate hours following the procedure are often the most unpredictable as the child recovers from general anesthesia. Common initial reactions include grogginess, irritability, and sometimes nausea or vomiting, which typically subside as the anesthesia leaves the system. Close observation is necessary during this time, especially monitoring breathing patterns.
Swelling in the throat is expected, which can temporarily cause increased snoring or mouth breathing. Parents should keep the child’s head slightly elevated to help reduce swelling. Initial sleep may be restless due to discomfort, so it is important to wake them periodically for fluids and pain medication to prevent dehydration and manage pain.
The primary goal during this initial phase is ensuring the child starts taking in fluids, even in small amounts, before going home. This early intake prevents dehydration and helps soothe the throat. A low-grade fever, typically under 101.5°F (38.6°C), is a normal response to the surgery during the first couple of days.
Pain Management and Medication Strategy
Pain control is important throughout the recovery to ensure the child drinks enough fluid and rests comfortably. The most significant throat pain usually occurs between days two and seven, though discomfort may last up to two weeks. The pain can often radiate to the ears, known as referred pain, because the nerves supplying the throat and ears are connected.
A common strategy involves rotating over-the-counter pain medications, specifically acetaminophen and ibuprofen, to provide continuous relief. These medications can be staggered so the child receives a dose of one medication every three hours, alternating between acetaminophen and ibuprofen every six hours. This regimen helps manage pain without exceeding the maximum dose of either drug.
Maintain a strict dosing schedule for the first several days, giving the medication before the pain becomes severe. Parents should wake the child, even at night, to administer the medicine and encourage fluid intake. Under no circumstances should aspirin or aspirin-containing products be given, as these medications increase the risk of bleeding.
Beyond pharmacological treatment, non-drug comfort measures provide additional relief. Applying a cold pack to the neck can help soothe the throat area. Using a cool-mist humidifier in the child’s room, especially at night, helps keep the throat from drying out, which often exacerbates pain. Encouraging the child to chew gum or eat chewy foods, if tolerated, may also help relieve muscle spasms and referred ear pain.
Diet and Hydration Progression
Hydration is the most important aspect of post-operative recovery, taking precedence over solid food intake. Fluid intake helps soothe the throat, manage pain, and prevent scabs from falling off prematurely due to dryness, which can lead to bleeding. Parents should offer fluids frequently, aiming for small, consistent amounts throughout the day.
The diet progression begins with clear, cool liquids, such as water, diluted apple juice, or electrolyte drinks. Using fun cups, popsicles, or ice chips can help encourage the child to drink. Once clear liquids are tolerated, the diet can advance to soft, smooth foods like pudding, mashed potatoes, smooth yogurt, and scrambled eggs.
Certain foods and drinks should be avoided for up to two weeks to prevent irritation or injury to the healing throat tissue. These include acidic drinks (like orange or grapefruit juice), spicy foods, and anything with a rough texture, such as chips, crackers, or toast. Crunchy items could scrape the healing sites and cause bleeding.
It is common for children to have a diminished appetite and lose some weight during recovery. Temporary refusal to eat solid food is not a concern as long as the child is consistently drinking fluids. Refusal to drink, however, is a serious sign of a problem and may lead to dehydration.
Monitoring the Healing Process and Warning Signs
The full recovery period typically lasts around 10 to 14 days. Several expected symptoms indicate normal healing during this time. White or yellowish patches will form where the tonsils were removed; these are scabs, not signs of infection, and they typically fall off in small pieces between five and ten days after surgery.
Bad breath is a common side effect due to the presence of scabs and healing tissue. Low-grade fever up to 101.5°F (38.6°C) can occur for a few days. Ear pain is often referred pain from the throat and can last for up to two weeks.
Parents must be aware of specific warning signs that require immediate medical attention, as the most serious risk is post-operative bleeding. Bleeding that appears as bright red blood, more than just streaks in the saliva, or blood clots necessitates an immediate trip to the emergency room. Frequent swallowing may also indicate the child is swallowing blood, a sign of internal bleeding.
Signs of dehydration, such as dry lips and tongue, decreased urination (no urine for eight hours or more), or crying without tears, require seeking care. A persistent high fever above 102°F (38.8°C) that does not respond to medication should prompt a call to the doctor. The child should be kept home from school or daycare for at least one week and must avoid strenuous activity and rough play for two weeks to minimize the risk of bleeding.