When should a kid's tonsils come out?
January 3rd, 2011
12:21 PM ET

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.

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soundoff (77 Responses)
  1. tom

    Parents/doctors need to be aware of sleep apnea in children too. My nephew at age 8 snored (like an adult) due to his tonsils obstructing his airway. Once removed, he slept much better and his behavior improved. In this case, the tonsils were otherwise healthy, but they were affecting his sleep.

    January 3, 2011 at 13:15 | Report abuse | Reply
  2. John

    My son was around 8 when he had his removed. Oddly enough he stopped wetting the bed after removal. It seems he would stop breathing and strain so hard while asleep to breath he would wet the bed. No more tonsils he sleeps like a baby and doesnt wet the bed. So in this instance I think removal was the correct decision.

    January 3, 2011 at 13:42 | Report abuse | Reply
  3. GetReal

    Stop feeding kids dairy products and the tonsillitis may go away, as well as any sinus or ear infections that may be recurring. This is per Frank Oski, former head of pediatrics at Johns Hopkins – don't take my word for it. Soy products are also irritating to sinuses. Nobody needs dairy – this is a myth. And tonsillectomies may lead to hearing loss in the future. Tonsils are there for a reason.

    January 3, 2011 at 13:44 | Report abuse | Reply
    • mommyof5

      Talking about "the top doc at johns hopkins" may lead many to believe your right... or they are, but there are hundreds of "top docs" at hopkins! Most agree that calcium from natural food sources is best, but m/ost do understand that for the general public, it is more cost effective to get much of it from cheese and other dairy. I haven't seen a direct connection in any of my or my childrens issues with tonsils relating to the consumption of dairy. I belive it is an important staple, though always warn them to drink more water and eat the leafy greens, and limit the milk intake to a few cups a day ay most... more for the poor cows!(and the cost!) Just eat smart, stay fit, I guess we don't own a tv or a game console, but we choose life is more fun without one... I just own a little fancy phone but I can take my news on the go and that keeps me a healthy weight, and in good shape.

      January 4, 2011 at 00:47 | Report abuse |
  4. Robble

    Girls need dairy if they expect to live well past menopause.

    January 3, 2011 at 14:16 | Report abuse | Reply
    • pedsMD-Minnesota

      No human needs dairy- dairy is biologically suited for baby cows. If you are referring to calcium intake, there are PLENTY of sources of dairy in other foods, not to mention that emerging research is suggesting that calcium intake after menopause is not the major factor for post-menopausal women developing osteoperosis.

      January 3, 2011 at 20:39 | Report abuse |
    • HealthWise

      Really? Girls need dairy? I'm guessing that's because of the calcium. In order for calcium to be usable and absorbed in the body Did you know almonds, spinach, and collard greens have more calcium than milk> They also contain more vitaimins, micronutrients, and enzymes than pasterized milk will ever have. It amazes me how little the public knows about their own health. Also, the calcium in pasterized milk is insoluable. It's useless. Elephants, giraffes, hippos, etcc..name any large land mammal with the strongest bones on the planet-herbivores.

      March 7, 2014 at 10:25 | Report abuse |
  5. MrsBrooks

    Tonsils are not only removed for tonsilitis. They are also removed due to kids having constant ear infections. I was pretty much born with ear infection and had them about every 2 weeks until I was 3. My pediatrician remmoved my tonsils and I have never had another ear infection since. While it's not the best choice for everyone, sometimes it just works better.

    January 3, 2011 at 14:43 | Report abuse | Reply
  6. MrsBrooks

    **spelling error** should have said "removed"

    January 3, 2011 at 14:43 | Report abuse | Reply
  7. fairlady

    When my son was five, he was underweight, had dark circles under his eyes, snored like a buzzsaw, had sleep apnea and would eat only soft foods like peanut butter sandwiches. His ENT recommended that his tonsils be removed. After the surgery, my son started to grow, the dark circles went away, he breathed all night and didn't make a peep while he slept, and he started eating steak and crunchy fruits and vegetables. I suppose it's not for everyone, but I am glad I listened to his extremely reasonable, compassionate doctor.

    January 3, 2011 at 15:20 | Report abuse | Reply
  8. HH

    I grew up in the 70s, and had a pediatrician who insisted the surgery wasn't necessary although it was almost routine where I lived. I wish the idiot parents hadn't listened to him.

    My strep infections and even allergies improved when I had them out as an elective procedure when I was 19. I've never regretted it, just wish I'd done it sooner. The recovery time was horrid, though, since I was an adult. Parents – do it while the kid is younger and there's less pain.

    January 3, 2011 at 15:36 | Report abuse | Reply
    • Cary

      Whereas, my daughter never had problems with allergies until AFTER she had hers out at 15. Go figure!

      January 3, 2011 at 17:19 | Report abuse |
  9. Jenny

    When my son was 3, his doctor strongly suggested that he have his tonsils removed. He kept having sore throtes. This entire thing is a scam brought on by the medical industrial complex. Have a tonsil abcess?-have surgery! Diseases out there-have an immunization. Health care should be holistic, based on the wishes of parents and indivuduals and free to all!

    I am not saying that all doctors are bad, but they completely ignore other therapies like holistic medicines used to remvoe the contaminants from our children's systems. Once I changed my son's diet to a preservative free organic diet from whole foods, he got much better. Organic food is the best medicine for infections and the "viruses" that can potentially harm our children.

    I've recently switched to homeopathic care for my child, especially for his ongoing sore throats. It works great!

    January 3, 2011 at 15:42 | Report abuse | Reply
    • T. Charles


      By writing "viruses" it sounds like you do not believe that viruses exist. If you believe that your son will remain healthy by eating organic foods, using homeopathic medicine, and not getting vaccinated, you are in for a rude awakening one of these days. It is true that every once in awhile vaccines can cause (usually minor) complications, but they prevent untold thousands of deaths a year. The same cannot be said of homeopathy.

      January 3, 2011 at 16:50 | Report abuse |
    • mommyof5

      I'm a strong believer of not putting things in your body that you don't need... but if every child is getting vaccinated, and the side effect or chances of issues are so small, then well basically, just make sure the benifits(potential) are out weighing the risks. Diet is the best thing for children health... making sure what they put in their bodys on a daily basis is most important over what they have to put into it once every few years. Be smart, use commen scense. Organic isn't a first choice for me, but I would rather eat food out of my backyard than from a supermarket, but I can't raise everything, so be smart when shopping, for your children, and yourselves.

      January 4, 2011 at 00:39 | Report abuse |
  10. JodyAnn

    I had my tonsils out at age 27. Afterwards I had to take three rounds of antibiotics due to intensive infection. Was a horrific nightmare. Was off work two weeks, couldn't eat nor talk. Then had to have an addiitonal procedure in the office as my voice was altered due to the healing process. The same day of my surgery there was a 3 year old having the same thing. She was eating McDonalds before we left the hospital. Let em do it while they are younger!!!!!! Glad those evil tonsils are gone..haven't been really sick with anything until this last year and I got the H1N1 flu. Oh by the way I am 44.

    January 3, 2011 at 16:04 | Report abuse | Reply
  11. Kay

    I only wish I had mine out as a child. I'm 43 and my snoring peels the paint off the walls of my home; however, my apnea is not "severe" enough to be provided with one of those sleeping machines. Every winter, as soon as I get that first cold, I have a dry throat that hangs around for months on end. I had one doctor (as an adult) that said mine should have come out when I was a child but basically that it was too late. Argh!

    January 3, 2011 at 16:34 | Report abuse | Reply
  12. KR

    I had my tonsils out at the age of 25, and I regret I had not done that earlier. Since then I quit getting colds, being sick often, and no more strep throat infections!

    January 3, 2011 at 16:38 | Report abuse | Reply
  13. Danielle

    I am all for having them removed as a child. I was one of the kids that had maybe 2-3 infections per year every year growing up. Or "not enough" for my doctors to let me have a tonsillectomy. The older you get the worse the surgery is, and at 21 I had to have them removed after having tonsillitis for 2 straight months and trying multiple antibiotics. I even had to have steroid shots to reduce the swelling until I could get them removed. It was the worst experience ever, and then I had to spend 2+ weeks out of college (I had complications with the scabs and bleeding), and the whole experience was a disaster. In the past 3 years now I havent had any major illnesses except for one bout of the flu. My children will definitely be having them removed as children, just to prevent the hassle I went through.

    January 3, 2011 at 17:01 | Report abuse | Reply
  14. mc

    I had my tonsils out when I was 23. I never had a problem with sore throats when I was younger like my brother and sister did. They had theirs out while they were kids. My problem started when I was about 21. I started getting sore throats and found that I had large white bumps on my throat which turned out to be solid rock like formations. It would come and go but I eventually learned it was a form of tonsilitis that occurs in adults who haven't had their tonsils out. Little crypts form and food particles, bacteria, and even fungus get cuaght in them and form rocks ranging from very tiny to quite large til they dislodge. The surgery and recovery were painful and I had to be out of work for 2 weeks and could barely talk when I returned but I'm glad I did. I haven't had any "rocks" form since then and it also improves bad breath since those little rock things stink terribly. Best decision ever.

    January 3, 2011 at 18:00 | Report abuse | Reply
  15. r

    That's right. Get an evaluation from an ENT. Any child with recurrent tonsillitis and/or enlarged tonsils should have them removed.

    January 4, 2011 at 00:04 | Report abuse | Reply
  16. mommyof5

    I have always had issues with mine since I was a child. My doctor reconmended I have them removed when I was around 12. My parents decided not to. I have had many issues with them since, but my cure is to actually get the junk out. I "poke" them with a steril and gloved finger, and most of the junk comes out. It irritates it for a few hours, but I seem to go much longer between serious issues when doing it this way. My doctor shakes his head at me, says whatever works, but still reconmends surgery even now. I just dont have time for the downtime or I could consider it.

    January 4, 2011 at 00:31 | Report abuse | Reply
  17. entandallergy

    Wait a minute!, shaky conclusions based on evidence that the authors themselves say is lacking. Not exactly a confidence-building set of recommendations for adequately managing a common childhood illness.

    The recommendations note that, after a 12 month period of “watchful waiting”, fewer than 40% of patients had a reduction in the frequency of infections. They cite this as a reason to wait. I would contend that the 60% or more patients who do not improve after this period of waiting is a good reason not to wait and to go ahead and remove the tonsils. They then go on to note that a good, randomized trial comparing the benefits of watchful waiting vs tonsillectomy has yet to be done. Again, this seems to contradict the recommendation to wait.

    And while there may be “little evidence to show benefit” there is also no evidence to show harm in giving antibiotics to kids after surgery except a gross generalization that “too many antibiotics may cause resistant organisms” (which is actually nearly impossible in an individual child after a single surgery with a single course of antibiotics. Instead you would need multiple courses of antibiotics in the same child to cause resistant organisms), and that allergic reactions to antibiotics happen occasionally.

    The evidence of “little benefit” for postop antibiotics looked only at studies using common complications as data points such as postop fever, pain, hemorrhage, and dehydration. They did not consider more serious, though rare, complications such as cervical infections, cervical spine osteomyelitis, or Lemierre’s syndrome. Meanwhile, a simple search of the literature reveals bacteremia in 20% of patients after tonsillectomy and multiple case reports of the aforementioned devastating complications. With this in mind it seems reasonable to favor postop antibiotics.

    Many Ear, Nose and Throat doctors find these guidelines to be highly controversial. To learn more about the controversy and vote in our poll about the appropriateness of these recommendations visit our blog at http://bit.ly/frQni7

    Brian Broker, MD
    ENT and Allergy Specialists

    January 6, 2011 at 23:49 | Report abuse | Reply
  18. Name*Bridget

    I'm 50 and I'm having my tonsils out soon. Can't wait but I am a little apprehensive about the recovery.

    January 9, 2011 at 07:14 | Report abuse | Reply
    • Beth

      Bridget, I am right there with you. Let me know of your recovery on this. Good Luck.

      January 16, 2011 at 19:08 | Report abuse |
  19. Becky

    I can only go on my experiences so here it is...I suffered tremendously with step and constant sore throats for years! Finally I had them removed when I was in my twenties. Yes, it was a miserable experience but it was the best thing for me. I am now in my forties. My first child had his out when he was 3 due to constant sore throats and my middle son when he was 5 for similar reasons. Both recovered very well after surgery. Hardly any sore throats for either of them since. My youngest is 10 just had surgery last week. He had been suffering for over a year causing him to miss out on plenty of school days. He is on his 6th day of recovery. He is having a tougher time but I know in the end it will be better for his health.

    January 17, 2011 at 12:56 | Report abuse | Reply
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