When Do Children Need Their Tonsils Removed?

Tonsillectomies used to be considered rote procedures for children who routinely suffered from throat infections and/or breathing problems. Located right at the back of the mouth – and at the side entrance of the throat – tonsils are strategically designed to “catch” bacteria and viruses.

Tonsils and adenoids are comprised of masses of immune cells - and are part of the lymphatic system. The idea being that these lumps of tissue become infected first – giving the immune system the chance to  fight bacteria or viruses in a less threatening location – before invaders attack more critical parts of the body.

Criteria for Removing a Child’s Tonsils

In some individuals, the tonsils and/or adenoids (a portion of tissue directly above the uvula) become chronically infected. They can also be enlarged, causing breathing problems.  When this is the case, a physician may refer you to an ENT specialist to determine whether a tonsillectomy is recommended.

Because removing tonsils (which may also include removing the adenoids, if necessary) does require sedation and permanently eliminates parts of the lymph system, it should only occur when we feel the invidual’s overall quality of life will be improved.

Thus, we use precise criteria before recommending the surgery. These criteria include things, like:

Multiple (7 or more), chronic throat infections in a year

Children should exhibit 7 or more throat infections (tonsillitis or strep throat) in the previous year OR at least 5 episodes of throat infection in the previous two years.

Studies have shown that even children who suffer repeat throat infections – 6 or fewer – per year still benefit from their tonsils because these episodes typically decrease with age.

Sore throats accompanied by other symptoms

Sore throats are one thing, but they mean something more when accompanied by other symptoms. Thus, another criteria are sore throats that are accompanied by at least one of the following symptoms: fevers of 100.9°F, tender lymph nodes or lymph nodes that measure 2mm or greater, a gray or white/ish coating (tonsillar exudate) or a positive StrepA β-hemolytic streptococcus culture.

Sleep disordered breathing

Here’s the other side of the coin: sometimes, children have enlarged tonsils and/or adenoids for no apparent reason. They may have been enlarged from the get-go, or might remain perpetually enlarged after an infection – never returning back to their natural, flat-ish size along the sides of the throat.

When this happens, children can experience sleep disordered breathing – most notable because they snore. As we try to tell anyone and everyone, chronic snoring is not normal.

Breathing disruptions mean children are unable to slip into deep sleep patterns and this can creep into other aspects of their lives – including daytime lethargy, bedwetting, behavioral problems, difficulty concentrating, etc. Of course, chronic lack of sleep is also bad for overall health – making children more prone to illness and infection in general.

Other, related signs a child may need tonsillectomy

Children with chronically enlarged tonsils and/or adenoids may also present with other, related symptoms. These include:

• Problems in school (as noted above)
• Restless sleeping or sleeping with obvious breaks in intermittent breathing
• Chronic stuffiness because enlarged tissues block the upper-airway
• Repeat ear infections
• Breathing through the mouth all the time and/or dry mouth
• Speaking as if they are stuffed up (that muddled, slightly nasally sound in their voice)

Looking for an ENT who only recommends tonsillectomies on a needs-must basis? Schedule an appointment with us here at Palouse Specialty Physicians. We’ll discuss all the pros and cons and we’ll also outline a “watch and wait” protocol since enlarged tonsils often recede as children grow older and their mouths and throats grow larger.

Published on January 23, 2018