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When many of today’s parents were growing up, the cure-all for recurrent throat infections was tonsil surgery. Medical opinion has changed, however, and now this procedure is less common. Find out when your child’s tonsils should be taken out and-perhaps more importantly-when they shouldn’t.

Not very long ago, if a child had a couple of sore throats, a trip to the hospital was in order, and his or her tonsils and adenoids would be surgically removed. But thanks to new information about the role of tonsils and the availability of improved antibiotics to treat tonsil infections, surgery has become far less common. In fact, over the past ten years, the number of surgeries performed on children to remove the tonsils has dropped significantly.

What Are Tonsils and Adenoids?

The tonsils are a pair of small almond-shaped structures on either side of the throat just behind and above the tongue. There structures act as a defense against infections that invade the body through the nose and mouth. Tonsils are part of the body’s protective lymphatic system, which dispatches cells that literally and literally devour bacteria. Adenoids are tissue located at the back of the nose, above the tonsils. They, too, help fend off respiratory-tract infections.

What Is Tonsillitis?

Occasionally, the tonsils become overwhelmed by a bacterial infection. This infection, known as tonsillitis, is one that children often come down with between the ages of three and six. The symptoms of tonsillitis are similar to those of the flu, so it may be difficult to distinguish between the two. The primary symptom is a sore throat that makes it difficult to swallow. Others are headache, fever and chills. The tonsils become fiery red and swollen. You may also notice specks of white discharge on the infected tonsils. Occasionally, the adenoids swell too, lending a nasal quality to the child’s voice.

How Is Tonsillitis Treated?

Even though tonsillitis is primarily an uncomfortable nuisance, you should never leave it untreated because it can lead to the formation of a painful abscess in or around the tonsils. If the symptoms last more than 48 hours or your child has a history of tonsillitis, see your pediatrician. He or she will examine your child’s throat and take a throat culture. If tonsillitis is diagnosed, your doctor will probably prescribe a 10-day supply of an antibiotic. The symptoms should disappear within a few days, but it is important to finish all of the medication to keep the infection from making a come back.

When Is Surgery Called For?

Today, tonsils and adenoids are generally removed only when they become so enlarged that they obstruct breathing, distort speech, or cause swallowing difficulties that may result in weight loss and poor nutrition. Doctors may also recommend surgery for chronic, severe or stubborn tonsillitis that doesn’t clear up. However, don’t insist on a tonsillectomy because of misconceptions. The operation is usually performed when the child is six or seven.

What Exactly Does the Surgery Entail?

A tonsillectomy and adenoidectomy is a surgical procedure requiring general anesthesia. During the operation the tonsils and adenoids are cut away and the cut area is left to heal naturally. It is a simple operation but like all surgery, it involves a small amount of risk. The procedure can be performed either in a hospital, which requires a stay of a day or two, or it can be done as outpatient surgery, in which a child can recuperate at home.

You can expect your child’s throat to be very sore for several days after the operation. Soft foods, including custards, soups, and especially ice cream, can help soothe the pain. You can tell your child that he or she can look forward to playing as usual and going back to school within a week after the operation.

Our thanks to Jerome A. Paulson, M.D., Associate Professor of Health Care Sciences and Pediatrics, George Washington University, Washington, DC, for reviewing this article.

The Truth About Tonsils

When it comes to tonsillectomies, it’s hard to figure out where the myths end and the facts begin. Don’t try to talk your doctor into removing your child’s tonsils on the basis of any of these misconceptions:

“Tonsils are useless.”
Not true. Medical scientists continue to report new evidence that shows tonsils are a valuable part of the body’s defense mechanism against invading germs and viruses.

“My child is always sick.”
Chances are your child is going through a normal stage of growth, irrespective of the condition of his or her tonsils. Before a child can build up antibodies to fight off “bugs,” he or she must be exposed to them. So, a certain number of mild respiratory diseases are expected during a child’s early years.

“He’ll be healthier with them out.”
It’s a myth that a tonsillectomy and adenoidectomy makes a child less susceptible to colds, sore throats and other respiratory diseases. Nor does the operation relieve an allergy or a chronic problem such as asthma.

“They’re swollen.”
What you perceive as swelling may be the tonsils’ normal size. Tonsils are very small at birth, then enlarge gradually, reaching maximum size at age six or seven. Thereafter, they usually shrink to walnut size. Adenoids grow between the ages of three and five and then shrink, eventually disappearing altogether during puberty. Unless a medical problem is diagnosed, enlargement alone is no basis for surgery.

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