When to Remove Your Child’s Tonsils – And When Not To
Why tonsil surgery is less common today for kids
Why tonsil surgery is less common today for kids
Back in the 1950S, ’60s and ’70s, if you were a child with infected tonsils, chances are they were going to be removed.
Today, however, the procedure is much less common. Thanks to research into the procedure and less invasive alternatives, doctors now have a new approach to treating tonsillitis.
Tonsillitis, the condition that leads many children to have their tonsils removed, occurs when tonsils — the oval-shaped glands in the back of the throat — become inflamed or infected. The tonsils will be visibly red, enlarged and irritated, says Leesa Li-Fossum, MD, a pediatrician at Scripps Coastal Medical Center Eastlake.
What causes tonsillitis in children?
Tonsillitis can be caused by viral infections — think upper respiratory infections or colds — or bacterial infections, the most common of which is strep throat.
Viral cases of tonsillitis are most likely to occur when children start going to daycare, while bacterial causes, like strep throat, are something to watch for typically from ages 5 to 15.
Non-surgical treatments
Regardless of what causes the tonsillitis, doctors today have specific protocols to follow when deciding whether to remove a child’s tonsils. Dr. Li-Fossum says it’s almost always better to avoid surgery, when possible.
“There are certain medications that can be used, like high-dose intranasal steroids, that calm down inflammation. These can be trialed to assess for symptomatic improvement before proceeding with surgery,” she says.
Research also found that many people who had their tonsils removed to prevent sore throats still got sore throats. This is because the pharynx (the back of your throat that extends down into the esophagus) and the tonsils are two different structures, but oftentimes are both thought of as “sore throats” when infected. The ones who benefitted from a tonsillectomy had experienced recurring tonsillitis prior to surgery.
When is tonsil removal recommended?
Guidelines state that a child should be considered for tonsil removal only if they have seven documented tonsil infections in one year, five per year in two consecutive years or three per year in three consecutive years.
“Those are the indicators that would make us say, ‘You need to be evaluated by an ENT (ear, nose and throat) doctor and see if those need to come out,’” Dr. Li-Fossum says.
The most common reason children have their tonsils removed today has nothing to do with sore throats or infections but rather, Dr. Li-Fossum says, “obstructive causes, like sleep disordered breathing or sleep apnea.”
She notes that mouth breathing can be another indication that a child’s breathing is obstructed and something might need to be removed.
Weighing the pros and cons
“I understand why parents sometimes feel like it’s better to just take the tonsils out,” she continues. “But as physicians, we really weigh all the pros and cons to make sure we help give your child the best outcome.”
This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.