A tonsillectomy is the surgical removal of the tonsils, the two oval-shaped pads of tissue at the back of the throat. Recovery is typically straightforward but requires diligent management from parents and caregivers. Managing pain and ensuring adequate fluid intake are the most important priorities to support healing. This guide details what parents can expect during the recovery period.
The First 24 Hours: Immediate Post-Surgery Care
The initial hours following the tonsillectomy focus on recovery from general anesthesia. Your child will be groggy and may experience nausea or vomiting, sometimes containing small amounts of dark blood from the surgery site. This is a normal side effect of the anesthetic and usually subsides within the first day.
Once at home, encourage rest and quiet activity for the first night. Position your child with their head slightly elevated to help reduce swelling and promote comfort. The numbing medication used during surgery may provide temporary comfort, often lasting for the first 12 to 24 hours. Parents should begin offering small, frequent sips of cool, clear fluids as soon as the child is alert enough to swallow.
Strategies for Pain Management and Hydration
Pain control and fluid intake are closely linked; effective pain management is necessary to prevent dehydration. It is recommended to administer pain medication on a scheduled basis, rather than waiting for the pain to become severe. This pre-emptive dosing helps maintain a consistent level of comfort, encouraging the child to drink and swallow.
A common strategy involves alternating doses of acetaminophen and ibuprofen. Acetaminophen helps with pain, while ibuprofen, an NSAID, reduces swelling and discomfort. Coordinate with the surgeon about the precise schedule, often alternating medications every three hours to cover the six-hour dosing window for each drug. Aspirin and any medications containing it must be strictly avoided for two weeks following surgery due to the risk of bleeding.
Hydration is paramount, as refusal to drink can lead to dehydration and slow healing. Cool liquids are generally soothing; options include water, diluted clear juices, popsicles, and crushed ice. Offering small sips frequently (every five to ten minutes) is often more successful than presenting a large cup. Non-pharmacological measures, such as placing an ice collar or using a cool-mist humidifier, can also provide comfort.
Navigating the Recovery Timeline
Recovery typically spans ten to fourteen days, though many children feel significantly better sooner. The first few days involve a sore throat that can manifest as referred pain in the ears due to shared nerve pathways. Parents should expect a low-grade fever (up to 101°F) for the first few days, which is a normal response to surgery.
The formation of white or yellowish patches (slough or scabs) where the tonsils were removed is a normal part of healing. These are not signs of infection but a protective layer of fibrin covering the tissue. Pain levels often peak between days five and ten, coinciding with the time these scabs begin to shed.
As the scabs fall off in small, unnoticed pieces, a minor amount of blood-tinged saliva may be observed. During this period, continue quiet activity and avoid strenuous activity for a full two weeks. Children can usually return to school after seven to ten days, provided they are no longer taking prescription pain medication and are eating and drinking well.
Recognizing Serious Symptoms
While most recoveries are uncomplicated, certain symptoms require immediate medical attention. The most significant complication is post-operative bleeding, which can occur anytime within the first two weeks. If your child spits up bright red blood, passes blood clots, or is swallowing frequently as if clearing their throat, it may indicate active bleeding.
Additional warning signs include an inability to keep liquids down for several hours, which quickly leads to dehydration. Signs of dehydration include dry lips and mouth, crying without tears, or urinating less than two or three times a day. A persistent high fever above 102°F that does not respond to medication should prompt a call to the doctor. If there is concern about bright red bleeding or difficulty breathing, go to the emergency room without delay.