This fact sheet includes information about care at home for children discharged from hospital after having their tonsils and adenoids removed. For information about why your child requires the surgery and what to expect, see our fact sheet Tonsillectomy and adenoidectomy (T&A).

Care at home

It is normal for your child to have a sore throat, ear pain, bad breath, voice changes and white patches in the throat after their surgery. These problems can happen for up to two weeks after tonsils and adenoids are removed. These things do not mean that there is an infection.

Check on your child at least twice during the night for the first two nights to see if there is any bleeding or difficulty with breathing. If your child is under four years old, it may be best to sleep in the same room.

• If your child is swallowing a lot this may indicate bleeding. If bleeding occurs, take your child to the nearest emergency department.
• If your child has had their adenoids removed, do not let them sniff or blow their nose for two weeks. It may be up to a month before your child can breathe properly through their nose.

Eating and drinking

Eating and drinking is very important after surgery as it will help clean and heal the throat. There are no restrictions on what your child can eat. Your child may prefer to eat softer foods, but it is fine to eat hard foods, such as toast or cereals.

Make sure your child also drinks plenty of fluids throughout the day for the first few days following surgery. If they are not eating a normal amount, giving them some drinks containing sugar (e.g. juice or cordial) will ensure they are getting some calories for energy.

• Give pain relief medicines 30 to 60 minutes before eating to relieve the pain of swallowing.
• Your child may find drinking chilled or icy drinks and food soothing.
• Your child should continue with teeth brushing morning and night.

Nausea and vomiting

If your child vomits, stop giving food for an hour, then give fluids if they feel better. If they can take fluids without vomiting, start them on small amounts of food.

If your child continues to vomit, contact your GP or your nearest hospital emergency department.

Returning to usual activities

Your child may not feel like doing very much for up to 10 days after their surgery. Many children need two weeks home from school or kindergarten. The amount of usual activity your child participates in should be guided by how they feel.

• It usually takes three weeks before healing is complete. Your child should not go swimming until after this time.
• Try to keep your child away from people with coughs and colds.

Pain management

It is normal for your child to have a very sore throat and ears after having tonsils and adenoids removed. Your child will need pain medication for up to two weeks and their pain may get worse before it gets better.

The 4th or 5th day after the surgery is a common time for the pain to get temporarily worse.

Signs of pain in younger children may be crying more often, or refusal to eat or drink.

Medication

It is important that your child is given regular pain relief for the first week after the operation including paracetamol (e.g. Panadol^®) and other medications prescribed by their doctor.

• Paracetamol can be given up to four times a day, with at least four hours between doses.
• Do not give any medicine with paracetamol in it more than four times in 24 hours.
• Your child’s doctor may also prescribe an anti-inflammatory medicine such as celecoxib or ibuprofen (e.g. Nurofen^®) to assist with pain relief. Celecoxib and ibuprofen work in a similar way, so they must not be taken together.
• Do not give any medication containing codeine.
• Check the medicine packaging for the correct dose. Your doctor may recommend a different amount, depending on the weight of your child.
• It is important to give pain medications regularly rather than wait for the pain to happen before giving medicine.

If your child's pain is not controlled using the medications they were prescribed, please visit your local doctor who may suggest different medications.

Other ways to relieve pain

Help your child to understand what to expect by using simple age appropriate language. It is important to be honest with them about the surgery and recovery.

It can be useful to use distraction techniques together with pain relief medicine so that your child doesn’t focus on the pain too much. Some distraction techniques include:

• helping your child with a favourite quiet activity (e.g. reading a book)
• comforting your child by touching, stroking or giving a massage.

When to see a doctor

You should monitor your child at home for any problems that might occur during their recovery.

If your child has any of the following, you should take them to your GP or nearest hospital emergency department:

• fresh bleeding from the nose or mouth, or in their vomit
• frequent swallowing (this may indicate bleeding)
• vomiting more than four times within the first 24 hours after the surgery
• cannot drink at all
• a temperature of 38°C or more.

Key points to remember

• It is normal for your child to have a sore throat, ear pain, bad breath, voice changes and white patches in the throat after their surgery.
• Check on your child at least twice during the night for the first two nights after surgery to check that there is no bleeding or difficulty breathing.
• Eating and drinking is very important after surgery – give pain relief medicines 30 to 60 minutes before eating to relieve the pain of swallowing.
• Give your child regular pain relief as prescribed by their doctor for the first week after the operation.
• If your child has fresh bleeding from their nose or mouth, difficulty breathing, cannot drink, has a fever or is frequently swallowing, you should take them to your doctor or nearest hospital emergency department.

For more information

• Contact your treating surgeon or hospital.
• Kids Health Info fact sheet: Tonsilectomy and Adenoidectomy
• Kids Health Info fact sheet: Tonsilitis
• Safer Care Victoria fact sheet: Making a decision about tonsillectomy support parents in making an informed decision about tonsillectomy for their child together with their doctor.
• Safer Care Victoria videos: These videos include parents sharing their thoughts about how they made the decision to have their child’s tonsils removed.

Developed by The Royal Children's Hospital Surgery and Otolaryngology departments with input from Safer Care Victoria. We acknowledge the input of RCH consumers and carers.

Developed August 2021.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.