What to expect
Immediately post op – The pain is usually not too bad. The area where the operation was performed has local anaesthetic in. This is the time to ensure that your child starts eating and drinking. Give them regular panadol and nurofen. The local anaesthetic will wear off in approximately 10 hours.
Day 1 – This is usually the worst day of pain. Give your child regular pain relief. Give them as much fluids as they will drink as well as giving them regular icy poles. The throat will look white, this is normal. Your child may complain of sore ears, this is also normal.
Day 2 – 3 – Give them regular pain medication regardless of whether they are in pain or not. The pain is usually better than day one. Keep their fluids up. If your child doesn’t feel like eating then they don’t have to but drinking is essential. Also ensure they have regular icy poles. They may complain of feeling like they have tonsillitis, this is also normal.
Day 4 – 7– Give your child pain relief only as required.
Day 8 – 10 – It is not unusual for the pain to increase for 24 hours. This is normal. Give regular pain relief for this 24 hour period. After this period the pain usually subsides.
Pain relief?
Panadol – Take this regularly for the first 3 days regardless of whether you are in pain or not
Ibuprofen [Nurofen] – You can take nurofen if the panadol is not effective pain relief for you and provided you are not allergic to it or have asthma. A large study has demonstrated that the use of nurofen post tonsillectomy does not increase the risk of bleeding after this surgery. We recommend you take the nurofen no more than 3 times a day and to take it during a meal as it can cause significant stomach upset.(Cardwell, Siviter et al. 2005)
Oxynorm – Oxynorm is a safe drug in paediatrics provided it is given in the correct dose. The first time you give your child oxynorm give them the dose no later than 3pm in the afternoon. This will allow you to assess their response to the medication. Give oxynorm if your child is complaining of pain which is not settling with nurofen and panadol. You do not need to give this medication regularly.
Painstop – Painstop has an unpredictable response in some patients. There have been some adverse outcomes with painstop post adenotonsillectomy due to some patients metabolizing this medication at a faster rate than other patients. We do not recommend painstop for this reason.(Ciszkowski, Madadi et al. 2009, Kelly, Rieder et al. 2012)
Does my child need antibiotics?
A white coating over the back of your child’s throat and bad breath is normal. This is not an infection. Several large studies have demonstrated that there is no benefit from taking antibiotics after having a tonsillectomy. For this reason we do not routinely prescribe antibiotics post tonsillectomy
How much water should my child drink?
You need to ensure that your child does not become dehydrated and one of the best measures of this is your child going to the toilet regularly. Ensure that your child drinks enough water to be going to the toilet or having a wet nappy 3 times per day at least.
What should I give my child to eat?
Your child can eat and drink anything they like. There are no absolute rules for what you must do after having your tonsils out. In general, most people prefer to eat soft food. Some food groups will hurt to eat and drink, including citrus, toast and spicy food. You do not do any damage by having these however your child may find them painful to eat.
How many icy poles should I give my child?
Aim to give them at least 5 icy poles per day. You can substitute ice cream for icy poles.
How much time do they need off school / kindy?
As a general rule most children have one week off. They can go to daycare or school in the second week if they feel up to it.
What to do if my child gets bleeding?
A very small amount of bleeding post operatively is very common. On approximately day 7 many people notice that they spit up a very small amount of blood, approx. 1ml. If this does happen give them a cool drink of water and an icy pole. If this continues then proceed to the emergency department at the Gold Coast Public hospital where there is an ENT surgeon on call 24 hours per day.
Cardwell, M., et al. (2005). “Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy.” Cochrane Database Syst Rev(2): CD003591.
Ciszkowski, C., et al. (2009). “Codeine, ultrarapid-metabolism genotype, and postoperative death.” N Engl J Med361(8): 827-828.
Kelly, L. E., et al. (2012). “More codeine fatalities after tonsillectomy in North American children.” Pediatrics. 2012 May:129(5).
