Wednesday, February 13, 2019 Written by Dr. Jeffrey Dorrity, ENT

When to Remove a Child’s Tonsils

February in South Dakota is prime time for ice fishing, snowmobiling, and day dreaming for warmer summer days to come. February also happens to be Kids ENT Health Month. Parents are often busy taking their children to their primary care physician during this time for ear, nose, and throat (ENT) related problems such as ear or tonsil infections. As I speak with parents I often get asked the question, "I was told that my child has large tonsils, how do I know if they need their tonsils out?"

If tonsils are noted to be enlarged on routine examination, but they have otherwise not caused any problems, then likely no intervention is needed. Most often as the child grows, the tonsils will become smaller and they will not pose a long-term issue. The American Academy of Otolaryngology-Head & Neck Surgery is the national organization for ENT physicians. This month it released an updated guideline about tonsillectomy (tonsil removal surgery) in children.

Acute strep tonsillitis is a common infection that results in a significant sore throat and requires treatment with antibiotics to reduce the risk of having secondary health problems. This is why when you or your child is evaluated for a sore throat that a throat swab is performed to see if the infection is related the strep  or not. The result of this test also helps the primary care physician determine the appropriate treatment. The guideline for tonsil removal surgery in frequent strep infections is if the child has 7 infections in one year, 5 infections each year for two consecutive years, or 3 infections each year for three consecutive years. If your child is otherwise healthy, continued observation is typically recommended if they do not meet these criteria. The reason for waiting is that although significant problems are rare, there are risks associated with surgery.

Enlarged tonsils can affect your child's breathing at night. If your child has enlarged tonsils and you have noticed that your child has restless sleep and pauses or stops breathing during sleep then they may have sleep disordered breathing. Sleep disordered breathing is an obstructive breathing that typically results from large tonsils and adenoids. It can be associated with daytime sleepiness even after a full night of sleep, bedwetting, behavior issues, trouble in school, or asthma. Removing the tonsils in these cases can often result in much improved sleep and improvement in the associated issue.

If you have a question about your child, speak with your primary care physician, or schedule an appointment for your child with myself or Dr. Mancell at Prairie Lakes Ear, Nose & Throat Dr. Mancell and I see children for tonsils, tubes, and other common issues at Prairie Lakes Mallard Pointe in Watertown.

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