A tonsillectomy is a common surgical procedure involving the removal of the tonsils, masses of lymphoid tissue located at the back of the throat. The surgery is most frequently performed on children to address recurrent throat infections or obstructive sleep-disordered breathing, such as sleep apnea, where enlarged tonsils block the airway. The procedure is done under general anesthesia. Most children return home the same day, but recovery requires careful management over the following two weeks.
Managing Pain and Discomfort
Throat pain is an expected and significant part of recovery, often described as similar to a severe sore throat. This discomfort typically peaks between the third and seventh day following the procedure, when the healing tissue is most inflamed. The pain can also feel like a persistent earache. This is known as referred pain because the nerves supplying the throat and the ear share a common pathway.
Pain management relies on a consistent schedule of prescribed medications to prevent the pain from becoming severe. Acetaminophen and Ibuprofen are commonly alternated to provide relief and reduce inflammation. The goal is to make the child comfortable enough to drink fluids. It is important to avoid giving a child Aspirin or any product containing it, as this medication carries a risk of post-operative bleeding.
Non-pharmacological measures can offer additional comfort and help soothe irritated throat tissues. Applying an ice collar to the neck can reduce localized swelling and pain. Using a cool mist humidifier in the child’s room, especially at night, can prevent the throat from drying out, which often worsens pain upon waking. For the first few days, parents are advised to wake the child during the night to administer pain medication and encourage sips of fluid to maintain consistent pain control.
Essential Guidelines for Diet and Hydration
Maintaining proper hydration is the single most important factor for a successful recovery and helps prevent complications. Children should be encouraged to drink small, frequent sips of cool, clear liquids, even if swallowing is painful. Signs of dehydration include dark urine or a persistent high fever, which requires immediate attention.
The diet should consist primarily of soft foods for the first one to two weeks after the surgery. These foods require minimal chewing and are less likely to irritate the sensitive surgical sites. Excellent choices include:
- Mashed potatoes
- Scrambled eggs
- Applesauce
- Yogurt
- Cold items like ice cream or popsicles
Certain foods must be avoided because they pose a risk of injury to the healing throat tissue. Anything sharp, crunchy, or scratchy, such as chips, crackers, or toast, should be kept away for two full weeks. Acidic foods or juices, like orange juice or lemonade, can cause a painful stinging sensation and should also be avoided during recovery. While dairy products are acceptable, they can sometimes temporarily thicken mucus, which may feel uncomfortable for the child.
The Typical Recovery Timeline
The recovery period typically spans about 10 to 14 days before a child is fully back to their normal routine. The first 24 to 48 hours are marked by significant fatigue and a low-grade fever, which is a normal response to the surgery and anesthesia. During this time, children may be lethargic and have difficulty swallowing, making consistent fluid intake a challenge.
Pain levels often increase noticeably around days three to five, coinciding with the natural formation of thick, white or yellowish scabs over the surgical site. These scabs are a layer of fibrin and are a normal part of the healing process, not a sign of infection. They may also cause bad breath. As the pain begins to subside, the child’s energy levels should gradually improve.
The scabs naturally begin to flake off and dissolve between days five and ten, which is when the risk of minor bleeding slightly increases. A return to normal eating and activity is a gradual process. While quiet indoor activities can resume relatively quickly, all strenuous activities, including sports, should be avoided for a full two weeks to prevent bleeding complications. Most children are ready to return to school or daycare after seven to ten days, provided they are no longer requiring daytime pain medication.
Recognizing Serious Post-Operative Issues
While complications are uncommon, parents must recognize signs that require immediate medical attention. The most serious potential complication is post-operative bleeding, which can occur at any point up to two weeks after the surgery. The risk is highest in the first 24 hours and again when the scabs fall off. Active bleeding, indicated by the child spitting out bright red blood or vomiting material that looks like coffee grounds, necessitates an immediate trip to the emergency room.
Any persistent fever above 102°F (38.9°C) that does not respond to medication should be reported to the surgeon. While a low-grade fever is common, a high or sustained temperature may signal an infection or severe dehydration. Severe dehydration is recognizable by a lack of urination for eight hours or more, listlessness, and a dry mouth. If the child refuses to drink any fluids, or if pain is not controlled despite regular medication, medical advice should be sought promptly.