When should a kid's tonsils come out?

For many children, getting their tonsils out is a part of growing up.  But simply watching and waiting may be best for most kids under 18 who have fewer than seven throat infections in one year, according to the first national guidelines released by the American Academy of Otolaryngology (AAO). However, the guidelines point out that tonsillectomy can reduce the number of infections in children who have them more often.

"Over half a million tonsillectomies are done every year in the United States," said Dr. Richard M. Rosenfeld, the guideline's author, in a statement. "The tonsillectomy guideline will empower doctors and parents to make the best decisions, resulting in safer surgery and improved quality of life for children who suffer from large or infected tonsils."

According to the AAO, the surgery is the third most common for kids in the U.S. Antibiotics are often used to treat tonsillitis, or inflammation of the tonsils, but the tonsils are removed when the infections happen over and over again, or when a child has problems breathing while sleeping.

The tonsils, according to the American Academy of Pediatrics (AAP), are pink masses of tissue located on each side of the back of the mouth. They are a part of the body's protection from infections but sometimes can hold bacteria, leading to infection and causing more harm than good. It can be difficult for a pediatrician to diagnose tonsillitis: red and swollen tonsils or uncomfortable swallowing could be a sign, or your child could have no obvious signs of infection. The tonsils also may shrink with no treatment, the AAP says.

If your child has had five infections a year for two years, or three infections a year for the past three years, tonsillectomy also may be appropriate, the guidelines say.

The guidelines call for doctors to educate parents on how to best manage pain for their children after the surgery. Those tips include: drink a lot of fluids and give their kids acetaminophen or ibuprofen to help alleviate pain early and regularly. The AAO recommends that doctors do not routinely prescribe antibiotics following the surgery.

Following a tonsillectomy, your child may experience bleeding, nausea, fever or pain in the throat or ears.