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Forum Name: Pediatric Topics

Question: tonsillectomy/adnoidectomy in a 3 year old


 splume - Mon Sep 20, 2004 5:44 pm

My three yr old is getting this surgery done soon, I was told by a co-worker that when he had it done when he was a child, he almost died because he was outside playing like boys do, and started hemmorging and vomiting blood. Now I am really worried about my sons surgery, he is already a pretty rambuctious child. Are the risks that great? He currently is on his third week with enlarged tonsils and on his second type of antibiotics, you can't tell he's sick, but you can tell he has a hard time swallowing.I checked his throat again today, and now it seems as though there are brown patches on his tonsils as well as them being so big they touch the sides of his uvula. Should I reconsider the surgery and just let mother nature continue to take its course??
 Dr. Yasser Mokhtar - Tue Sep 21, 2004 2:07 pm

User avatar Dear Splume,

Tonsils and adenoids are there for a reason. But if their presence is harmful for the child, then they are not needed. If the tonsils are inflammed or infected 6 or more times in a year and/or an abscess has developed and the child is missing a lot of schoold days (talking abbout older children), or the child just spends time in bed and not enjoying himself then they ought to be removed as they will serve as a septic focus harming the child. About the adenoids, if they become enlarged, the child starts to snore, becomes a mouth breather, and he will have chronic ear infections, will be hard of hearing and will not follow well in class and he will be less attentive and have low grades.

Every surgery has its indications, contraindications and complications and alternatives. You will have to discuss all of those in details with the surgeon especially all the possible complications and then take an informed decision whether or not you would like your son to have the surgery.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 Dr. Heba Ismail - Fri Sep 24, 2004 2:22 pm

Dear Splume,
First of all, it should be clear to you as well as all parents that neither tonsillectomy nor adenoidectomy should be performed as prophylaxis against the "common cold" at any age! Always keep in mind that the tonsils and adenoids are part of the lymphoid tissues which serves essentially as a defense against infection.
Now you have not mentioned how frequently your child suffers tonsillitis. For a child to perform surgery, there are certain criteria required.
This includes a frequency of seven attacks of acute infection in the past year, five in each of the past 2 years, or 3 in each of the past 3 years, or more than any of these.
Factors such as severity of illness, the frequency of missing school or child care, any associated complications, or the presence of other medical issues also needs to be considered.
From your description, the tonsils appear to be enlarged enough to affect swallowing, which is also a reason for surgery, but only if they are persistently or chronically enlarged.
Before tonsillectomy is recommended, it should be ascertained that the enlargement is chronic and not the result of a recent acute infection. Tonsils can increase in size greatly during an acute infection and recede after its subsidence, either on their own or in response to a course of antibiotics. Tonsillectomy in children less than 2-3years is generally performed for obstructive sleep symptoms rather than tonsillitis.
If you find your child's is in need of surgery, then you should know that for children < 4-5 years, as in your child's case, separate tonsillectomy and adenoidectomy is preferred!
Minor hemorrhage occurs usually in > 10% of procedures. Severe hemorrhages occur occasionally and are another reason for carefully assessing the reason for surgery!
 splume - Fri Sep 24, 2004 5:14 pm

My son's tonsils are in the beginning of week four of being enlarged. He has been on Zithromax and just finished Augmentin. He is usually sick off and on for about 9 out of 12 months a year. Symptoms ranging from swollen tonsils and ear infections, vomiting & congestion w/ ear infections, or wheezing and vomiting. It is so "normal" to my family for him to be sick that we just clean him up and go on with our day as usual. He frequently gets nose bleeds in his sleep, occasionly during the day.. He on his 2nd kind of allergy medication. He snores at night and gets up several times, but I have never actually witnessed any type of "sleep apnea" episode. When he was an infant he had chronic Broncitis and Pneumonia. (Like once or twice a month) he is immune to Amoxiccillin and Zythromax did work really well until this current episode. I don't see any changes in him with the Augmentin either though. He is a hyperactive child and you can never tell he is sick except he sleeps longer. I am nervous about the possible hemmorraging after surgery, because he is so hyperactive, I don't know if I can possibly keep him confined to rest for 2 weeks.
 Dr. Heba Ismail - Sun Sep 26, 2004 3:42 pm

Daer Splume,
In your son's condition, it is obvious he is in need to perform surgery, for many reasons you've mentioned!
As regards bleeding, reasons for bleeding can be divided into medical causes and surgical causes.
The medical causes are usually looked for by certain labs your doctor will order before surgery, and if any bleeding tendency is found, he will manage accordingly.
Surgical bleeding can occur at any of three times:
During surgery or intraoperatively, and this may happen with even the most skillful doctors and usually all the settings are prepared to deal with such a situation.
Bleeding may then occur in the first 24 hours, and in my opinion , that is the most critical period. In children under 3 years, the child is usually kept overnight to avoid this complication. In patients older than 3, outpatient tonsil and adenoid surgery can be performed safely and may be mandated by insurance carriers. Discuss this with your doctor.
Secondary bleeding is the term used to describe the bleeeding that happened to your freind as a child. It extends from after 24 hours postoperatively to up to 10 days.
It is recommended that your child not exert in any effort during that period.That does not mean complete rest, just tell him not to run or jump up and down like a monkey. Keep an eye on him while playing.Try to engage him in video games or read him stories. If, however, bleeding did occur, remain calm, so as not to frighten him further, apply immediate pressure to the bleeding site using clean cotton or bandage and take him immediately to hospital!

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