What to expect after your child’s tonsillectomy
Information on a tonsillectomy (removing the tonsils) may not be what you’re expecting from a sleep consultant, yet it is something I had to go through as a parent when my daughter was 4 years old. When I searched online I didn’t find much information from a parenting perspective, and what I did find was different to what we experienced (every child is unique after all). Here I give a brief rundown of our days post tonsillectomy and summarise with a few survival tips at the end.
My daughter had swollen tonsils (one that was very easily seen just by looking) yet the swelling was not caused by recurrent infections or sore throats. In fact she’d rarely had a sore throat, and never tonsillitis, until that point. And even after some “just in case” treatment, the tonsil remained large, and ended up causing obstructive sleep apnoea (OSA), blocking or obstructing her throat when she lay down. Sleep Apnoea is a potentially serious condition where breathing stops momentarily during sleep, and it ultimately means restorative, rejuvenating sleep doesn’t happen.
Sleep apnoea is common in people who snore (regardless of age) and one of those things that can go undiagnosed and untreated for years. My daughter started snoring too, and wetting the bed after being dry at night, so I knew something was up. For most children, the cause of sleep apnoea is an obstruction in the airway, often due to enlarged tonsils or adenoids. Thus removal of the tonsils and/or adenoids can remedy the situation.
I write this in the hope that it will help more parents wanting information in the future. If you’re like me and you want to know all you can beforehand, read on. If you’re a tad squeamish or you’d rather not know, stop here.
This is how it went when my 4-year old daughter had her tonsils removed:
The day of the op. Being one of the youngest patients meant my daughter was one of the first to be operated on. Yet we still had to wait, and as a mum I found that hard (my daughter on the other hand had lots of waiting room toys to play with so she was fine). When we met with the anaesthetist I was warned that some children would resist the initial anaesthesia gas. OK. They started the gas (in a lovely strawberry smelling mask) while I held her on my knee. What I wasn’t prepared for was the involuntary bucking my daughter did (admittedly only for a few seconds) and how hard I had to hold onto her while she threw herself around. When she was under and I was escorted out I lost it and burst into tears. This part of parenting is hard. But I did manage to compose myself.
And then I had to wait. Have I said that waiting is hard for me? While waiting I was able to make myself a coffee, only to not be able to find the milk. Which I was told was in the fridge. Where was the fridge? Right in front of me, and I couldn’t even find it. This experience had totally thrown me and I was turned into a momentary space cadet. I’m going to assume this is normal for all mums the first time their child needs surgery.
After what seemed like ages (but probably was no time at all), my daughter was wheeled out of recovery, asleep. When she woke she was given strong pain relief as she was too sore for an ice block or ice-cream. She also turned a bit green (which I’m told is due to blood in her tummy). But she felt good enough to eat tiny teddy biscuits before we went home (and those things are hard and pointy, so not too bad, right?)
All in all we were in at 7am and out at 3pm. However her throat was so sore she refused oral pain medication that night and we used suppositories instead (not pleasant for mum or daughter, but a necessary evil that resulted in faster pain relief).
Day one post op. She was ok, took regular medicine and ate a little too. Not too bad!
Day two. The spitting started, she said it was because she was feeling sick, so she took some anti nausea medicine as well as pain medicine. Then ate toast and danced around to her fairy DVD. Although she was a bit fussy with food and only took a few bites or sips of anything, the rest of her behaviour was on the normal scale. She took normal pain medicine and you wouldn’t know anything was up.
Day three. Today she woke in tears. She got very strong pain medication (tramadol) on top of the others. She was still spitting off and on, and complained of earache too. Then she started speaking like a ventriloquist as she refused to move her mouth (because it hurt too much). We started staggering the pain meds so she could have something every 2-hourly (including at night – welcome back sleep deprivation). She was so uncomfortable that even with the strong pain medication we only managed one 4-hr window of sleep, and she ended up in bed with me (and to be honest I wanted to monitor her on the strong drugs).
Day four. The boys were away from home so it was the girls, the cat, the dog and a stuffed monkey in bed during the early hours of the morning (until the dog chased the cat and chaos ensued), It was also Anzac day so we were woken early by the sound of canons, which seemed fitting given our tough night.
This is the day we discovered a heat pack draped over her head and ears helped with earache. She ate noodles and almost two ice blocks worth of slushy. There was a lot of lying around on the couch as the pain medication wore off.
That night she woke crying on numerous occasions and we were back to 2-hourly pain meds and lots of cuddles.
Day five. She sounded like a squeaky ventriloquist now. Her voice changed and she wouldn’t move her mouth again. This made her very hard to understand and I think we were both getting frustrated (on little sleep). She got even harder to understand when she resorted to only grunting responses later in the day. Today was definitely the toughest in terms of pain so far.
Day six and seven. By now it feels like same ol same ol. Still on lots of pain medication. Her breath smells very bad and she has sore ears.
Day eight. cabin fever kicked in, so even though she still had sore ears (even with all the pain medication), we went out to see a kids show. This was a bad move as she got tired very quickly and then had a very bad night in terms of pain. Lesson learnt?
Day nine. I got talked into going out again as we had tickets to see Sleeping Beauty on stage. Although she still got very (very) tired, she had a great time out today. Wahoo! Things started looking up.
Day ten. Today she didn’t want her pain medication! Although she still sounded very squeaky as her voice hadn’t come right, she only had medicine at breakfast (at 6.30am yawn) and at dinner.
Day eleven. No meds at all. She outright refused them even after none overnight…. and we’re back to normal life.
Ten days of ups and downs and stress were over and that was it. Easy! But not something I’d want to do again in a hurry. If you managed to read through the full ten days it’s only fair I give you some tips from my experience.
- Be prepared – stock up on books, movies, games, toys; whatever quiet activity you think your child will enjoy doing at home. Same goes for food – grab their favourites along with some iceblocks and/or icecream. But also be prepared for them to NOT to want it. (I expected my daughter to want to eat jelly and ice-cream so I made lots of jelly… of course she didn’t eat it….). Toddlers and preschoolers are still fickle, even when “sick”.
- Keep up the pain medication, religiously (prevention is better than dealing with the pain once it’s hit – trust me!). This means giving them medication initially even if they say there’s no pain. Yes this means waking them at night too.
- Talk to your surgeon if the pain seems extreme – pain levels and tolerance will be different for everyone. If your child is in obvious pain even after they’ve taken what’s prescribed, discuss this with your surgeon. You may be able to get something stronger.
- Give lots of cuddles and hugs. Physical touch increases levels of oxytocin. Oxytocin (sometimes called the cuddle hormone) is a feel good hormone that has been found to reduce pain (latest findings tend to support this for inflammatory pain, the effects aren’t so great with nerve pain). It also has some other amazing benefits that can help the recovery process including improving the immune system, better sleep and less stress, which leads to better recovery. Sugar can also help with pain, but just like the jelly, my daughter wasn’t having a bar of it.
- Let them eat whatever they like (it doesn’t have to be soft food) but beware of citrus and anything acidic. Orange juice is not soothing for a raw inflamed throat (you don’t have to take my word for it, but apple juice is better if you want to go down the sugar/juice route).
- Make slushies out of the iceblocks – I don’t know why, but a slightly melted iceblock that has been mixed around in a cup was much more appealing to my daughter than sucking or biting the iceblock itself. We stuck to lemonade ones too (Google told me to keep away from red foods so you’d know if bleeding was an issue).
- Try hot and/or cold packs. Everything I found online said cool / ice packs were helpful for pain. Ironically we found heat packs were better and more soothing, especially for sore ears. Go figure.
- Expect a bit of a rollercoaster with good days and bad days (and just roll with the punches). To me it seemed pretty random. I’d read the oainw as worse when the scabs slow off, but I was beyond figuring out the timing by then.
- Realise every child is different. Chances are your child’s experience of pain and how they react to it will depend on a lot of things. I asked our surgeon if he could predict the amount of pain a patient experienced based on the state of the tonsils or how the op went. His answer? A resounding No. He had no way of predicting the level of pain his patients would experience. Bummer.
As a parent we hate seeing our children in pain, and this experience can be just as hard on you as on them. I’m hoping if you have a child with a tonsillectomy coming up that this has been somehow helpful for you in terms of what to expect (get back to me afterwards). I didn’t mean to scare you as there are children who bounce back with very little pain. Unfortunately that wasn’t our experience. If you’ve been through something similar, how did your experience compare? Do you have any other tips to share?