For pretty much as long as I can remember, Ethan has had massively huge tonsils. He was so sick on Thanksgiving when he was 2 that he slept all night and all day, only to wake up to puke. Luckily he only actually had tonsillitis that bad twice in his life when he was two, but what motivated me to seek out a consultation to an ears/nose/throat (ENT) surgeon was his sleep apnea. I noticed that he was an awful snorer and often had small spells of holding his breath and gasping in his sleep. It was actually the worst when he was fully upright in his car seat – it was awful to see him struggle.
Along with the sleep apnea, the poor child would puke more easily. If he had too much food in his mouth he would gag and puke easily, if he was crying too hard and couldn’t swallow all the excess saliva that accompanies that he would puke too. As a mom and a nurse, I just knew we needed those things out – as awful as it is to put your child through surgery.
How the Process Started
For us in Alberta right now, it is a 12-18 month wait to see an ENT, depending on severity. I took both of my boys to a general practitioner (GP) in January of this year to get the ball rolling. It was on my ‘before-I-have-a-baby’ to-do list. The GP agreed with me that Ethan’s tonsils warranted a consult to the ENT and so did Braden’s chronic congestion/breathing issues that he has in the winter. Within a week I received a call from the Alberta Children’s Hospital and I was told they wanted a home sleep study done on Ethan. They sent us a pulse oximeter to use one night and we mailed it back to them. We also were told we got our consultation with the ENT surgeon for July – 6 months after our referral – which lead the nurse in me to believe he was severe enough to be seen sooner. Braden didn’t get an appointment until a full year later in January 2017.
Unfortunately they wouldn’t let us officially let our boys have an appointment at the same time, even though they were referred to the same surgeon. Braden came to Ethan’s consultation regardless and I asked the surgeon to look at Braden’s adenoids anyway. He couldn’t see anything, but I am still keeping Braden’s appointment as he is asymptomatic in the summer months. Ethan’s appointment went really well and I was relieved to hear that the surgeon recommend to do a tonsillectomy and adenoidectomy because of his sleep apnea.
These days, from what I’ve learned and understand, they do T&A’s mostly for sleep apnea issues vs. chronic infections like they used to in the past. I was hesitant and leery to put our child through surgery, but it’s a decision that I don’t regret making, even only a couple of weeks out of surgery. Surgery is generally 2 months after consult, but I pushed for 3 for farming and family purposes so his surgery was scheduled for the end of October between his 4th birthday and Halloween.
How to Prepare Your Child for a Tonsillectomy
My nursing background is in pediatrics – working in the operating room and on the surgical floor, to be more specific, so I feel like I was very prepared as it was. I feel that freshly-turned-4 was a perfect age for Ethan to have this surgery because he was old enough to comprehend the basics of what was going to happen, and why he needed to have surgery to help get his “yucky tonsils” out of his throat. He was also old enough to not go insane and wonder why on earth he couldn’t have yogurt or breakfast the morning of his surgery.
We got a call and did our pre-op clinic visit over the phone the week before his surgery date, which was really really nice, as we’re >2 hours out of town. They told me to call the hospital the day before his surgery for a time to go NPO (to start fasting) and what time to arrive at the hospital.
This is a run down of how I explained things to our 4 year old about how his tonsillectomy was going to play out:
- He was going to go back to the Children’s Hospital where he met his surgeon with mommy
- When he wakes up in the morning of his surgery he cannot have anything to eat, but he can have an apple juice box before we go to the hospital (apple juice or water [clear fluids] 4 hours prior to surgery, no food for 8+ hours)
- We are going to pack a bag so that he can bring some toys to play with and so he can have a sleepover at the hospital with his daddy
- When we get to the hospital he is going to meet lots of nurses and see his surgeon again and they are there to help him feel better and take care of him
- He’s going to have some wires (monitors and an IV) attached to him so the nurses can make sure that his “numbers” (vital signs) are good and that he’s drinking enough water (his IV)
- He will change into special hospital pajamas and get to play on the iPad or watch Netflix as much as he wants
- He will need to have a LOT to drink – apple juice, water or flat ginger ale – and can eat as many popsicles as he would like to help his throat
- Mommy is going to put on a silly hat and gown so she can come back to the surgery room with him
- He’s going to have a special sleep so that the surgeon can take out his yucky tonsils
- The doctor is going to put a special ‘Darth Vader’ mask on his nose and mouth so he can have your special sleep (anesthesia gas; some anesthetists go right for an IV induction, ours didn’t)
- When he wakes up he will see nurses and he might be scared and his throat might feel sore, but it will be okay
- The nurses might let mommy come in to see him in the wake up (recovery) room – I was surprised they let me do this but they did call me back to calm him down
- He can drink as much apple juice and eat lots of popsicles and ice cream (day 2) as he wants
Advice For Parents
Even with all of my experience, it’s a whole new ballgame when it’s my own child. Unfortunately, our baby had surgery 3 months prior, so I was all the more prepared for Ethan’s surgery. Here are my tips for your child’s T&A:
- As I stated above, talk with your child, depending on their age, a lot about what to expect. I found this really helped Ethan so it wasn’t a big, scary surprise what was going to happen
- On that note: nothing can prepare them for what it’s going to feel like coming out of anesthesia and having the worst sore throat of their life (I had my tonsils out when I was 21, it’s awful)
- Take them shopping before and let them pick out special popsicles or freezies
- Bring their special blanket or stuffy, whatever they’re attached to, and will make them feel at home – Ethan got to take his blankie to the OR with him, it never left his side that he knows!
While in the hospital
- Surgery doesn’t take long, it should be done in less than an hour – it’s being discharged out of recovery room that may take some time
- If your child is having day surgery, minimal stay is for 6 hours so bring toys, iPad, video game for your child and a book or some magazines for you
- If staying the night, don’t worry about pajamas for your child – a hospital gown/PJ’s work best to accommodate monitors and IVs
- Bring your own pillow – you likely will only get a small cot or recliner chair to sleep in, might as well have a piece of home to try to get as comfy as possible
- Bring your own snacks, you likely won’t want to leave your child – however I had a wonderful nurse that MADE me go get lunch when Ethan was napping which was awesome!
Help them recover
- Push push PUSH fluids. The more they drink – the better they’ll do and they’ll get annoyed, but still do it!
- Buy infant acetaminophen (Tylenol) for home – they’ll appreciate the smaller/concentrated dose, and give it every 4 hours for the first 48 hours – trust me!
- Buy rapid melt acetaminophen for when you run out of the infant bottle (it’s expensive). I found some “Life” brand at Shoppers Drug Mart
- MAKE THEM REST! Kids will want to be kids and push through it, but I regret that I didn’t make Ethan slow down a bit more, especially in the first few days. He did nap every day for 5 days after, but I pushed him too hard on day 2 by letting his cousin come over to play and taking Ethan to the rink for Braden’s skating lessons 🙁
- Use a cool mist humidifier in their room, as close to their face as possible. It will provide some much needed moisture in the air if they are mouth-breathers, which they probably are.
- The guideline we were given was no school until they aren’t on pain meds any more, which made a lot of sense to me. I found Ethan needed exactly a week off of school and he didn’t need pain meds at all by day 8 and he was down to 2-3 times a day by, day 4 or so
- No vigorous exercise or sports for 2 weeks. Ethan was fully recovered, per my assessment, by day 10 so I let him run around and go to skating at this time
I checked Ethan’s throat fairly often, as they are susceptible for post-op tonsil bleed up to (and even beyond) 10 days after surgery. If you can get a good look, you will see this in your child’s throat the “scabs” are white sloughed areas where their tonsils used to be, as shown here:
And just 2 days later (sorry for the blurry photo), you can see that very minimal scabbing is left and he was totally back to his normal self and normal diet.
A Few Things That Surprised Me
There are just some things the surgeon won’t tell you, and these are a few we experienced.
The biggest shock was the night terrors. Ethan never ever had a night terror before, but his big brother Braden gets them when he’s really overtired. Ethan had them as soon as he got home from the hospital about 1-3 hours into his night sleep and then luckily he was fine after that and slept peacefully through the night. They lasted until day 11 post op and then disappeared as quickly as they came on. Google tells me that other children who have had a tonsillectomy experience the same thing, and it is on quite a few children’s hospitals post-op care sheets that came up in my search, but nothing was mentioned to us.
It was terrifying for Ethan and for us because he was awake but not “awake”, lucid or coherent. He was panicking and holding his breath and wouldn’t exhale. All we could do was hold him until he calmed down and was able to go back to bed. It’s not recommended, and also really hard to wake up a child from a night terror – so don’t bother trying.
Change in Breathing
Speaking of breathing, I feel like Ethan has to retrain his body to not have sleep apnea. When he was waking up in a panic, it’s like his body was trained to compensate for his huge tonsils and adenoids and wouldn’t let him breathe deeply. It’s amazing to me
I knew this from my personal experience having my tonsils removed that a voice change was inevitable. What I didn’t expect was his tiny, squeaky voice. It’s like it hurt (understandably) to really exert any volume with his voice, so he was really soft and squeaky for about the first week. Now he has a brand new, strong voice that isn’t garbled and muffled by huge tonsils!
If your child is having a tonsillectomy or any other surgery, I hope sharing our experience helps you! Best wishes!
Disclosure: This blog post is not to be taken as medical advice, I am sharing my experiences as a parent whose child had a tonsillectomy and adenoidectomy. For medical advice, always seek the advice of a health care professional. Thank you.