Should my child’s tonsils be removed?
Dear Doctor,
What are the signs of tonsillitis in a child and why does it happen? My 5-year-old has been diagnosed with tonsillitis. We thought she was just having a bad cold or flu. In what instances would it be beneficial to have the tonsils removed?
Stacey Cheah
DEAR STACEY CHEAH,
THE tonsils are lymphatic tissue, which form part of our body’s defence mechanism. The tonsils are situated on either side at the back of our throat. They help to defend our body against bacteria or viruses in food or the air. The tonsils swell up in response to an infection and cause all the symptoms that your child may have experienced.
Common signs and symptoms of tonsillitis are:
• Throat pain
• Fever
• Reduced appetite
• Hoarse voice
• Difficulty in swallowing
• Earache
• Cough and cold
• White spots on the tonsils
• Swollen lymph nodes in the neck
In young children, you may also observe drooling of saliva or dehydration as the child finds it painful to even swallow his or her own saliva and fluids.
Tonsillitis may be caused by bacterial or viral infections. However, it may not always be possible to differentiate between the two.
Your doctor may take a throat swab to confirm this or start your child on antibiotics if a bacterial infection is suspected. If it is due to a viral infection, antibiotics are not needed but your doctor may start your child on other medications to reduce the fever and pain.
Previously, tonsillectomy (surgical removal of the tonsils) was thought to be the solution for any case of tonsillitis.
However, with the advent of improved medical care and effective antibiotics, the waitand-watch approach is adopted by most doctors before subjecting their patient to surgery.
Your doctor may consider performing a tonsillectomy for the following reasons:
• Persistent or recurrent tonsillitis.
• Recurrent ear infections associated with tonsillitis.
• Breathing difficulties, especially during sleep.
• Obstructive sleep apnea (when the child stops breathing during sleep because her airway is blocked by the enlarged tonsils).
• Collection of pus behind the tonsils which is difficult to treat.
Also bear in mind that a tonsillectomy does not reduce the risk and frequency of infections your child gets. She may still get episodes of sore throat even if her tonsils have been removed.
It is advisable to go through her full medical history with your doctor before deciding if surgery would be beneficial for her.