Updated guidelines for children undergoing tonsillectomy

A tonsillectomy, a surgical procedure performed to completely remove the tonsils, is one of the most commonly performed surgeries on children in the United States.

A 2017 National Health Stat report showed that 289,000 tonsillectomy procedures were performed on children under the age of 15.

Children may need this procedure because they suffer from obstructive sleep-disordered breathing, obstructive sleep apnea, or recurrent throat infections.

The American Academy of Otolaryngology recently released an updated guideline regarding care for children undergoing a tonsillectomy. Guidelines for caring for patients before, during, and after a tonsillectomy were first released in 2011. In February 2019, the guidelines for caregivers were revised.

One major change is how pain is managed after surgery.

The typical recovery time for this procedure is 10 to 14 days. Some children experience little to no pain after surgery and have an easy recovery process, while others experience significant pain.

While a child's pain obviously needs to be managed, the new guidelines specify that clinicians should not administer or prescribe codeine to children under the age of 12 who undergo a tonsillectomy.

Instead, the guidelines indicate that clinicians should explore other pain management options such as ibuprofen and acetaminophen, with patients and their families. These new guidelines stress the importance of perioperative pain counseling to find the best pain management options for the patient.

Additionally, the updated guidelines emphasize a watchful waiting approach rather than surgery for recurrent acute tonsillitis until children meet the criteria for the surgical procedure.

For example, a child who has seven infections in one year or nine or 10 infections in two or three years should be evaluated for potential surgery.

Many kids do benefit from surgery due to suffering from recurrent infections, but they need to meet the criteria and have enough frequent infections to warrant the procedure.

We don't want to put children through surgery unless we know it's going to improve their quality of life. The wait and see approach is something clinicians should discuss with parents before children undergo surgery.

The updates to the guidelines allow for a dialogue between physicians and parents to determine the best treatment options for their child. These modifications were made to improve the quality of care for children undergoing tonsillectomies.

• Children's health is a continuing series. This week's article is courtesy of Dr. David Walner, who is director of Pediatric Otolaryngology at Advocate Children's Hospital in Park Ridge. Walner is one of 12 physicians who helped update the above guidelines.

Dr. David Walner
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