Does your child need a tonsillectomy?

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Does your child need a tonsillectomy?

Tonsillectomies are one of the most common surgeries performed on children — but the decision to do one should not be taken lightly.

There are two main reasons to do a tonsillectomy, but neither is black and white. Each patient and each situation is different. It’s important to understand the gray area (there is a lot of it) in order to make the best decision.

Tonsils (and adenoids) can grow large enough to block the airway, making it difficult to breathe. This can be especially noticeable when a person is lying down, such as during sleep, when gravity brings the tonsils down onto the airway. This leads to a condition called obstructive sleep apnea (OSA), which can be serious and lead to health and behavioral problems in children.

Sometimes the story is so clear (smartphone videos from parents can be very helpful), and the tonsils so large, that the decision to do surgery is straightforward, and the surgery is very helpful. But often it’s not so clear, especially when the tonsils (or adenoids) aren’t that large. When it’s not clear, very often the doctor will order a sleep study, called a polysomnogram (PSG). During this study, the child is monitored during sleep to get a better sense of exactly what is happening.

These studies are very helpful, but they aren’t perfect. Not only are they a measure of just one night, which may or may not be typical, but they don’t always predict whether or not a child will have the health and behavioral problems we worry about, or whether they will get better after surgery. This can be especially true when a child is overweight, as being overweight can cause or worsen apnea, and the apnea may or may not get better with a tonsillectomy. Also, PSGs are expensive and not always widely available. That’s why doctors differ in how often they order PSGs and how they use the results.

Children who are severely affected by recurrent throat infections (more than seven episodes in one year, five in each of two years, or three in each of three years) may be helped by a tonsillectomy. However, just having a sore throat doesn’t count. To meet criteria, there needs to be fever, enlarged lymph nodes, pus on the tonsils, or a positive strep culture — and the child should have been seen and all the details confirmed and documented.

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