Removing Tonsils and Adenoids: Is It Right for Your Child?

Tonsils and adenoids are part of your body’s immune system. These small clusters of tissue help filter bacteria and viruses that enter through your nose and mouth.

But for some kids, they can become more trouble than they’re worth.

How can you know whether surgery to remove them is the right call? Pediatric otolaryngologist Rachel Georgopoulos, MD, explains the possible benefits and drawbacks.

Benefits of a tonsillectomy and adenoidectomy

If your child struggles with frequent throat infections, loud snoring or other breathing problems during sleep, their doctor may recommend surgery.

A tonsillectomy is a procedure to remove the tonsils, while an adenoidectomy removes the adenoids. They often happen during the same surgery.

Here’s a look at the potential benefits of these two procedures.

Fewer throat infections

Tonsils are one of the body’s first lines of defense, helping to keep bacteria and viruses out. But sometimes, they themselves can become infected.

“Sometimes, strep tonsillitis can cause the tonsils to get inflamed and enlarged, which impacts breathing and swallowing,” Dr. Georgopoulos explains. “Removing your child's tonsils may improve their symptoms and quality of life.”

This is especially true for children whose recurring infections cause them to miss lots of school days.

Fewer ear and sinus issues

Some kids have no problems with their adenoids. But for other kids, they cause chronic issues like:

• Inflamed adenoids (adenoiditis)
• Sinus infections
• Congestion and nasal drainage
• Hearing issues, including frequent ear infections

Having an adenoidectomy — either with or without a tonsillectomy — can sometimes help relieve these symptoms.

Better sleep and breathing

Airway obstruction is one of the most common reasons doctors recommend a tonsillectomy and adenoidectomy. This is when the tonsils and/or adenoids block airflow to the lungs. It’s more common at night, and it can affect the quality of your child’s sleep.

“Some kids have tonsils and adenoids that are simply too large for their airways,” Dr. Georgopoulos explains. “When they lie down to sleep, that extra tissue can partially block their breathing.”

This can lead to sleep apnea, when breathing briefly stops and starts during sleep. If your child has sleep apnea, you may hear loud snoring and pauses in their breathing followed by a gasping “catch-up” breath. Sleep apnea can also cause restless sleep, sweating at night, daytime tiredness and bed-wetting.

“Removing tonsils and adenoids to help correct airway obstruction is so effective that many kids no longer experience sleep apnea afterward,” she adds.

Feeling better, in general

When chronic infections or poor sleep become the norm, it can take a toll on your child’s overall health — and on your whole family’s well-being.

“The effects of poor sleep carry over into the waking hours,” Dr. Georgopoulos points out. “Children may seem restless or irritable. They might struggle with attention and focus, and have trouble coping.”

On top of all that, you may be dealing with frequent doctor visits, missed days of school and repeat doses of antibiotics.

But surgery can bring much-needed relief. Once kids heal, they often:

• Sleep more soundly
• Get sick less often
• Feel better overall

Disadvantages of a tonsillectomy and adenoidectomy

Both of these procedures are common and generally safe. But it’s still important to weigh the pros and cons before moving forward.

“Most kids do just fine without their tonsils and adenoids,” Dr. Georgopoulos says.

Still, doctors are careful to recommend surgery only when the benefits clearly outweigh the risks. Possible risks and downsides include:

• Pain: A tonsillectomy and adenoidectomy can cause throat pain, especially in the first few days after surgery. Swallowing may be uncomfortable, which can make eating and drinking difficult at first.
• Recovery time: “Most children recover within about two weeks, but those days can be challenging for both kids and caregivers,” Dr. Georgopoulos acknowledges.
• Surgical risks: Both procedures require general anesthesia. While pediatric anesthesia is considered very safe, it still carries small risks that should be discussed with your child’s healthcare provider.
• Bleeding: One of the main concerns after a tonsillectomy is bleeding, which can happen during surgery or in the days afterward. Serious complications are uncommon, but they can happen and may require additional treatment.

“The good news is that surgeries to remove tonsils and adenoids are among the most common outpatient pediatric surgeries,” Dr. Georgopoulos shares. “Most children recover quickly and without lasting negative effects.”

Final thoughts

If your child has frequent throat infections — especially ones that last for three or more days and include a fever and swollen lymph nodes — talk with their doctor about whether a tonsillectomy and adenoidectomy would help. In this case, “frequent” means:

• Six to seven episodes in one year
• Five or more episodes over the course of two years
• Three episodes per year over the course of three years

Deciding whether to have your child’s tonsils and adenoids removed isn’t always straightforward. But for some kids, surgery can be life-changing.

“Have a conversation with your child’s pediatrician or an ENT specialist,” Dr. Georgopoulos encourages. “Together, you can decide what’s truly best for your child.”