Should Your Child Have Their Tonsils Removed? Our Useful Guide (2023)

If your child has chronicthroat infections,it may seem like the tonsils do nothing but cause trouble. In actuality, they do have a role to play as a part of the body’s natural defense against germs.

However, when your child hasrecurrent tonsillitis,removing the tonsils can make a dramatic improvement in his or her life.

We’ve provided this guide for parents to help determine whether or not this procedure is right for your child.

What do the Tonsils do?

The tonsils are located at the back of the throat and the soft palate. They are responsible for trapping germs when they enter your body through your mouth or nose. When the tonsils come in contact with these bacteria or viruses, they activate yourimmune system.

Signs Your Child’s Tonsils Need to be Removed

If your child has experienced any of the following, we encourage you to speak with us about whether or not a tonsillectomy would be appropriate:


This is the most common reason for a tonsillectomy. Recurring infections that cause swollen lymph nodes and a fever may prompt the need to remove tonsils, especially if your child has six to seven infections a year, and the problem has been ongoing for the last three years.


Enlarged tonsils can make it difficult for your child to swallow.


Some children have larger tonsils, which may cause difficulty breathing during the night when your child is in a reclined position. This can cause a potentially serious condition calledsleep apnea, where your child will stop breathing for several seconds at a time throughout the night. Whenchildren fail to get restorative sleep, they can have problems at school, difficulty concentrating, irritability and poor coping skills.

What are the Adenoids, and Why are They Often Removed as Well?

Actually, the adenoids are a part of your tonsils. There are three different types of tonsils:

(Video) Tonsillectomy for Children - You Oughta Know (2021)

  • Two palatine tonsils, which are located on either side of your throat. These are the tonsils you can see when you look in a mirror.
  • The adenoids, which are located behind the roof of the mouth in the soft palate.
  • One lingual tonsil, located at the back of the base of the tongue.

The adenoids may also be enlarged and inflamed, which prompts their removal as well.

Is a Tonsillectomy the Right Choice for Your Child?

Tonsillectomies are some of the most common procedures we conduct. If you’re concerned about the frequent throat infections your child has had, please contact one of our ENTs for an appointment.

Is It Always Necessary to Remove The Tonsils?

When children have difficulty with chronic stuffy noses, continual snoring, and frequent bouts of strep throat, it may be time to “round up the usual suspects.” In this case, the “usual suspects” are frequently the tonsils.

While tonsil removal was once considered a rite of passage, theAmerican Academy of Otolaryngology (AAO)has developed specific guidelines to help ear, nose and throat doctors determine who are the most suitable candidates for a tonsillectomy.

According to the AAO, roughly a half million tonsillectomies are performed in the United States each year, making it the third most common pediatric surgery in the country. (The first two are circumcision and placement of ear tubes.)

Removal of the tonsils—lymph tissues in the throat that are about the size of a walnut—can dramatically improve a child’s quality of life by reducing the number of throat infections he or she experiences.

Is a Tonsillectomy Always the Right Choice?

What many parents should consider is that for children with fewer than seven episodes of throat infections in the past year, watchful waiting may be the best course of action.

Therefore, the AAO has created a set of guidelines and criteria to help guide ENT physicians in determining the best treatment for patients nationwide. These guidelines were created based upon extensive research and evidence-based practice in order to continually improve the quality of patient care.
While every case is different, parents should ask themselves the following questions:


The key word here is “severe.” A severe throat infection includes the following:

(Video) Tonsils and Adenoids Surgery

  • Fever of 101 or higher
  • Coated tonsils
  • Strep throat (as confirmed by a medical test)

In these cases, a tonsillectomy may be warranted.


An allergy or intolerance can make it difficult to treat chronic throat infections. Remember: antibiotics are not effective against a virus. Any sore throat or respiratory issue caused by a virus will not be resolved by antibiotics.


Depending upon the individual situation, even children with less frequent severe throat infections may still benefit from a tonsillectomy if they have underlying medical factors. These factors may include:

  • Peritonsillar abscess – pus collecting behind the tonsil
  • PFAPA syndrome. PFAPA stands for periodic fever, aphthous stomatitis, pharyngitis and adenitis. Aphthous stomatitis is another name for canker sores. Pharyngitis is swelling and inflammation of the back of the throat. Adenitis is another word for a swollen gland or lymph node.


If your child has large tonsils, he or she may have difficulty breathing during the night. This is called sleep-disordered breathing (SDB). The symptoms of SDB are:

  • Snoring
  • Mouth breathing
  • Sleep apnea (pauses for more than ten seconds when sleeping)
  • Poor school performance (resulting from lack of quality sleep).


Because children with Down syndrome have different facial anatomy, they may have trouble with sleep apnea and SDB. These differences include:

  • Narrower throat air passages
  • Enlarged tonsils
  • Enlarged adenoids
  • Difficulty coordinating airway movement
  • Large tongue
  • Low muscle tone

More information on Down Syndrome and how it can affect sleep can befound here.

Tonsillectomies Are Decided on a Case-by-Case Basis

Parents should realize that a tonsillectomy will not automatically solve their child’s throat problems. In fact, there are certain conditions that are resolved better by a tonsillectomy, and others where the tonsillectomy does not show any statistical difference.

That is just one reason it’s so important for children to have an ENT physician in Raleigh, a specialist who treats diseases of the ears, nose, and throat.

At Raleigh Capitol Ear, Nose and Throat, we specialize inpediatric ENTcare. We recognize that our young patients have very different scopes of need than adults, and we treat their problems accordingly.

(Video) Does your child need their tonsils out? Here's what you need to know.

How to Explain a Tonsil Removal to a Child

It’s often difficult for children to understand what tonsils are and why they may have to be removed. If your child is facing a tonsillectomy, you want to be sure he or she understands what is happening. Learning about the process will take a lot of the mystery—and fright—out of the procedure.

Following are some guidelines for explaining a tonsillectomy to your child:


Obviously, you can’t explain the procedure to your child if you don’t understand it yourself. Be sure you don’t have any misconceptions. Remember that, in general, tonsillectomies are performed as an outpatient procedure, so it’s unlikely your child will have to spend the night in the hospital.

Be sure to ask your ENT questions such as:

  • How long will I be able to be with my child before the operation?
  • Can I see my child in the recovery room?
  • What special preparations must we take the night before surgery?

If your child will have to spend the night in the hospital, be sure to ask about visiting hours and staying overnight in the room with your child.


It’s a big word, and children can be easily confused. Ask your physician if he or she has age-appropriateeducational materialson the procedure. Read the materials together. You may use a favorite doll or stuffed animal to give your child an idea of what the tonsils are, where they are located and what they do. You can also print pages from this educational coloring book for your child.


Your child will be full of questions, the most common of which is “why?” Explain with calming words in a manner he or she can understand.
Be wary of frightening words, such as “cutting” or “needles.” Tell the child that the doctor will fix the problem at the hospital.


Many children are afraid the operation will be painful, and it’s important they know about the special doctor called an anesthesiologist that gives medicine to make sure they sleep and won’t feel anything during the operation.

Some precautions: don’t use the word “gas” when describing the anesthesia because some children confuse it with the gas that goes in a car. If you’ve recently had a family pet “put to sleep” or described a deceased family member as “sleeping,” your child may panic at the thought of being “put to sleep.”

(Video) When Should I Consider Having My Child's Tonsils Removed?

Instead, you can tell your child that during the operation, he or she will be given medicine to sleep deeply so they won’t feel anything. Emphasize that after the surgery, your child will wake up and you will be waiting for them.


Tell your child that you will be there when he or she wakes up. Separation is one of the most common fears children experience when faced with surgery. It’s important to let them know that while you’ll be separated during the surgery, you’ll be waiting for them afterward with a favorite toy.


Don’t mislead your child by telling him/ her that they will instantly feel better after the operation. It’s fine to tell them to expect a sore throat that will get better. Also, mention that the doctor will give medicine to make the pain go away.


You can use some of your child’s dolls, action figures or stuffed animals to show them what will happen during surgery. You may even wish to role play, giving your child an idea of the things he or she might see or hear.


Let your child know that he or she can ask you any questions. You may even work together on some questions your child wants to ask the doctor. This not only provides assurance, but it sets a good example. Your child needs to know that doctors, nurses and others are there to help. This positive interaction can set the stage for healthy habits moving forward.

All of the doctors at Raleigh Capitol Ear, Nose and Throat have extensive experience with pediatric tonsillectomies—it is one of the most common procedures we perform.

While a tonsillectomy is a routine, minor procedure, there’s no such thing as “routine” and “minor” when it comes to your child. A few simple assurances from you will go a long way toward easing your child’s fears.

Raleigh Capitol Ear, Nose and Throat: Compassionate Care Dedicated to You and Your Child

Did you know that we are the only office in Wake County that offers a comprehensive pediatric ear, nose and throat care that encompasses all aspects of evaluation and treatment?

In fact, our board-certified physicians have had five to six years of post-medical school training in the care of pediatric patients. Many of our patients are under 16 years of age, and we consider it a privilege to serve you and your child.

(Video) Parker Gets His Tonsils Out! (positive child tonsillectomy)

If you have any questions about a tonsillectomy or if it is the right choice for your child, pleasecontact usto schedule an appointment today.


Are you supposed to get your tonsils removed as a child? ›

If your child has a persistent sore throat or recurring tonsillitis and strep throat, your doctor may recommend a surgery known as a tonsillectomy to have his tonsils removed. If your child also snores at night and has pauses in breathing, this may indicate sleep apnea, and a tonsillectomy may be recommended.

Why don t doctors want to remove tonsils anymore? ›

Today, however, this once common procedure is no longer a standard operating procedure. Why? Dr. DeMarino says that, “There are fewer tonsillectomies due to skepticism in the medical community over its usefulness in infection control and more stringent guidelines.”

Do doctors recommend removing tonsils? ›

If the tonsillitis comes back often and is bacterial, doctors usually suggest removing the tonsils completely (total tonsillectomy).

What are the disadvantages of tonsillectomy in kids? ›

Having your tonsils removed is associated with discomfort and risks: The wound may hurt and swallowing may be painful after the operation. About 20 to 50 out of 100 children say they have severe pain afterwards. Temporary nausea, vomiting, swallowing problems and loss of taste might occur.

What is the best age to remove tonsils in kids? ›

A child at any age can have a tonsillectomy if the indications are severe. However, surgeons generally wait until children are 3 years old to remove tonsils because the risk of dehydration and bleeding is greater among small children.

What are the disadvantages of removing tonsils? ›

Common issues after a tonsillectomy include the following:
  • Moderate to severe pain in the throat for one to two weeks.
  • Pain in the ears, neck or jaw.
  • Nausea and vomiting for a few days.
  • Mild fever for several days.
  • Bad breath for up to two weeks.
  • Swelling of the tongue or throat.
  • Feeling of something stuck in the throat.
Sep 3, 2022

Do you really need your tonsils? ›

Tonsils are an essential part of the immune system, preventing germs from entering the mouth or nose. The tonsils typically shrink with age; but for some people, this does not happen. As a result, the tonsils can become overwhelmed and infected.

What are the benefits of tonsillectomy in children? ›

Enlarged tonsils can block your child's upper airway and cause snoring and mouth breathing. Tonsillectomy can help relieve these problems. Children who have a tonsillectomy because of repeated infections may have fewer and less severe infections for at least 2 years after the surgery.

Is it okay to not get your tonsils removed? ›

Surgery is typically recommended only if you have other related symptoms, such as difficulty swallowing, persistent pain, swelling of the glands in your neck, or one tonsil that keeps getting larger and larger over time. The good news is most of the time, having one enlarged tonsil is simply due to a minor issue.

What are the long term effects of tonsillectomy in children? ›

Adenoidectomy and tonsillectomy were associated with a 2- to 3-fold increase in diseases of the upper respiratory tract, and adenoidectomy doubled the risk of COPD and conjunctivitis. Adenotonsillectomy was associated with a 17 percent increased risk of infectious diseases.

What is highest risk after tonsillectomy? ›

The most frequent serious complication of tonsillectomy is posttonsillectomy hemorrhage, occurring at a rate between 0.28% and 20%.

What percentage of children have a tonsillectomy? ›

Incidence of evidence-based indications for tonsillectomy was 4.2 per 1000 person years; 13.6% (2144/15 760) underwent tonsillectomy. Incidence of childhood tonsillectomy was 2.5 per 1000 person years; 11.7% (2144/18 281) had evidence-based indications, almost all with Paradise criteria.

What age is too late to get tonsils removed? ›

The answer to that, frankly is, no. ENT surgeons remove tonsils from patients of all ages for a variety of reasons, though it is less common in adults. While the number of tonsillectomies has significantly declined over the last 40+ years, this is still a procedure that many people can benefit from.

Is there an alternative to tonsillectomy? ›

During a laser tonsil ablation, laser energy is used to reduce the tonsils as much as possible by vaporizing the outer surface of the tonsils. The goal is to shrink the tonsils, and laser ablation does this. This can result in a significant difference in the amount of obstruction the tonsils may be causing.

Is life better after tonsillectomy? ›

Tonsillitis can be painful as well as frustrating. However, a successful tonsillectomy can improve your overall quality of life1. A study found that patients experienced improvements to their quality of life 14 months after surgery and at seven years. There was also a reduction in the number of sore throat episodes1.

How long should a child stay home after tonsillectomy? ›

The child should rest at home for the first 48 hours. Activity may increase as strength returns. Generally children return to school approximately 10 days following a tonsillectomy, and about three days after an adenoidectomy. All children should avoid swimming and vigorous activity for 14 days after surgery.

Does your immune system weaken after tonsillectomy? ›

According to the results of this study, tonsillectomy not only does not reduce the function of the immune system, but also can improve the immune response.

Which is the best candidate for a tonsillectomy? ›

Who Is a Candidate for Tonsillectomy. Candidates for a tonsillectomy are those who have had recurrent tonsillitis, difficulty breathing during sleep or while awake, bleeding from the tonsils, or have enlarged tonsils that are causing some discomfort or difficulty in your daily life.

When are you most likely to hemorrhage after tonsillectomy? ›

Overall, post‐tonsillectomy hemorrhage occurred in 71 (21.8%) patients and 5 (1.5%) patients required a second surgery for hemostasis. Post‐tonsillectomy hemorrhage often occurred on postoperative day zero or six.

Can you be too old to get your tonsils removed? ›

Children who have sore throats often or who snore might have their tonsils taken out. But tonsillectomies aren't just for kids. Adults can need them, too. It's done the same way in children and adults, but an adult's risks and recovery can be different.

Should I get my 6 year olds tonsils removed? ›

A health care provider might recommend removing the tonsils if a child gets a lot of tonsil infections (called tonsillitis). Experts define "a lot" as when a doctor diagnoses a child with at least 7 infections a year, more than 5 infections a year for 2 years in a row, or three infections a year for 3 years.

How do you know if tonsils need to be removed? ›

Surgery is typically recommended only if you have other related symptoms, such as difficulty swallowing, persistent pain, swelling of the glands in your neck, or one tonsil that keeps getting larger and larger over time. The good news is most of the time, having one enlarged tonsil is simply due to a minor issue.

How common is tonsil removal? ›

Even though tonsillectomies are somewhat less common today, surgeons in the U.S. still perform over 500,000 procedures every year. If you have frequent tonsil infections or difficulty breathing during sleep, ask your healthcare provider if a tonsillectomy could help.

How can I shrink my tonsils naturally? ›

This is one of the best home remedies for enlarged tonsils. Take a glass of hot water, add a teaspoon of salt to it and gargle. Do this three to four times a day for best results. It will reduce the inflammation and will also help to treat infections.


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4. Does he need his tonsils out? | Sore Throats in Children - Nina Shapiro, MD
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