pediatricians & parents, tell me of toddler tonsils

January 14, 2007 10:25 PM

our 2.5 yo son has giant tonsils and sleep apnea. listening to his labored breathing hurts us. contemplating a tonsilectomy on such a little guy hurts us, too. anybody wanna weigh in?
posted by oigocosas to health (41 comments total)

As a father of a 3 year old, I can understand your trepidation. The only advice I would begin to offer is to seek the advice of a pediatrician as well as an ENT (ear, nose, & throat) specialist. According to where you live, there may also be a Pediatric ENT you could call upon, and I would do so if at all possible.

My *PERSONAL* opinion is out with the tonsils. Your son will benefit more from restful slumber than the modest increase to his immune system by retaining them.

Good luck in your decision.
posted by Ynoxas at 10:44 PM on January 14, 2007

I had my tonsils out at almost 4 years old. I genuinely implore you to get them taken out. He's probably too young to tell you this if it's happening, but my parents' final straw with my tonsils was the terrifying dreams. Because I often woke up gasping, a lot of my dreams focused on running out of air. He really could use the extra oxygen he's not getting during sleep whether he dreams that he's dying or not.
posted by fujiko at 10:59 PM on January 14, 2007

I have giant tonsils. Giant enough that my dentist is in awe of them.

They cause a lot of problems (constant sore throats, tonsil stones) and I really wish that they had been taken out when I was younger. I am considering having them taken out now as a 32 year old adult.

My sister was the lucky one. SHE got her tonsils taken out AND she got to eat popsicles for a week! My 6-year old self was so jealous. So, yeah, I vote for having them taken out. Mine have only caused more problems as I have gotten older.
posted by Ostara at 11:09 PM on January 14, 2007

Out with the tonsils and he won't even remember it.
posted by kindall at 11:10 PM on January 14, 2007

Agreed with all of the above.
I'm sure after checking with your Pede-ENT your child will
thank you for it ( if he ever remembers it years hence); short-term discomfort trumps years of pain and ancillary risks.
My folks waited until I was 10-- by then I was sentient enough to be terrified of the hospital but miserable from years of infections, ear-aches, and post-nasal drippage...
posted by Dizzy at 11:25 PM on January 14, 2007

Developing brains need their sleep. The usual outcome of untreated sleep apnea is lowered IQ, poor school performance, excessive daytime somnolence, and increased illness.

The usual outcome of tonsillectomy is: forgotten within a couple of weeks.

You do the math.
posted by ikkyu2 at 11:39 PM on January 14, 2007 [2 favorites]

A tonsillectomy is not that bad, and you'll get rid of the adenoids at the same time. For some, it's very effective; for others, it doesn't do much. Either way, though, it really isn't that big a deal. I had mine out when I was fourteen, and I never regretted it. Anecdotal evidence from my father says it's not nearly as traumatic as it used to be.

But I never got my ice cream, dammit. Make sure he gets ice cream, and play the Bill Cosby shtick about tonsils for him when he's older - Google says it's on iTunes.
posted by spaceman_spiff at 12:23 AM on January 15, 2007

What I remember from childhood hospital time was thinking I was dying, drowning in a chemical smell, as the anesthetic dragged me under. I also remember waiting and waiting (probably only a few minutes) at night for my mother to come back when she had really gone home (past visiting time).

There's not much you can do about the operation, but I suppose things aren't as primitive now -- are the knives still sharpened flint or are they using bronze these days? -- and maybe the kid doesn't have to stay at the hospital at all. If he does have to stay and you have to leave, try to get him comfortable with the people who will be watching him when you're gone and try not to leave until he's sleeping.

Also, tell him the doctor said he can take the tonsils home. After the operation, give him a couple of live tadpoles in a pickle jar.
posted by pracowity at 12:25 AM on January 15, 2007

Having had my tonsils out at 28 - one of the most singularly miserable experiences of my life - I gotta say. Do it now. I suffered through years and years of (a) sleep apnea and (b) annual visits to the ER from upper respiratory and tonsil infections every winter due to similar circumstances as those of your son's.

To put it in some perspective, the operation itself was nothing - out like a light, tons of pain meds, happy as an etherized clam for about 12 hours afterwards - but the recovery process for someone as old as I was is much, much worse, as I understand it. Take advantage of his bounce-back factor and relatively short power of recall while you can.
posted by mykescipark at 1:16 AM on January 15, 2007

My younger sis had awesomely huge tonsils and a hugely deviated septum besides. Of course, nobody knew this for a few years, and we older kids gave her a lot of guff for mouth-breathing. She had it all fixed up when she was in her teens, which necessitated taking a week off each time to be stoned on painkillers. Probably more convenient to do it at a young age, when the kid has no particular obligations to meet.

I, on the other hand, retained my tonsils, and now they're cryptic and occasionally kick out hideously, traumatically stinky tonsilloliths. Whereas the one ... um ... operation ... that I underwent at a young age, debate about the merits of which is strictly off topic, I don't even remember. I am not an ENT, and in fact it was an ENT's barfulous slideshow that guaranteed I will never be a medical doctor, but my guess is the sooner you slice 'em, the better.

And as an aside to pracowity, it's not exactly flint, but obsidian scalpels have a significant and growing fan base among surgeons. Sharper than stainless steel, quicker retraction of the scar tissue, less inflammation. Sometimes stone tools have the competitive edge. Pardon the pun.
posted by eritain at 1:16 AM on January 15, 2007

hafta say, seeking medical advice online is a dangerous game. Even something as seemingly innocuous as a tonsillectomy for OSA. While I agree with most of the above, and in general (with what little info we have been given) the snip would be recommended, no one here has mentioned the potential complications of a tonsillectomy. The chances of major complications are very small, however they do exist. The procedure and anaesthetic are very low risk. Unfortunately there is a small risk of post tonsillectomy haemorrhage at about 10 days post op. I can't be bothered looking up and linking to the american ENT association statistics (I'm sure someone else will), but I have seen it more than once.
Don't get me wrong, the most appropriate thing to do in this case may be losing the wobbly bits at the back of the mouth (and probably the less famous adenoids), but my point is you are not going to get a balanced view from the internet community.
Consider this scenario: you go ahead with the procedure. Your little Timmy is the one in a [insert a large number] and has a post-tonsillectomy bleed and dies. Sure the surgeon mentioned it when you were signing the consent form for the operation, but by then it was all "let's just do this thing". Can any of you people above who have given your opinions on what to do imagine how you would feel if in a months time oigocosas posts that now his kid is dead?
I'll pull my head in now, but just remember the internet is possibly the last place one should be seeking medical advice.
posted by dubious at 1:49 AM on January 15, 2007

I had mine out before the age of 4. It is actually pretty much my earliest memory I think, and not a particularly unpleasant one. I remember finding the anaesthetic and children's ward highly amusing, and don't remember any pain or discomfort while recovering at all (I'm sure there was a little, but it wasn't life-scarring...)

But, yeah, seek medical advice.
posted by bifter at 2:12 AM on January 15, 2007

I had mine out at three. Like most kids, I remember the popsicles and not the pain. (Though I do remember the night that my parents didn't stay with me...I was terrified...but those were different times.) And I've watched my friends' young children have surgeries, some major, some not. A couple years later, they barely even remember their time in the hospital. Little kids don't really understand what's going on at that point--it's going to be far more traumatic for you guys. But if the surgery is ultimately inevitable, you may as well get it out of the way and help the poor kid sleep!
posted by wallaby at 2:12 AM on January 15, 2007

I had mine out in 1956, during the summer, the last summer of the pre-Salk vaccine polio seasons, because they'd become far too infected to wait longer, until winter weather damped the polio virus naturally, as pediatricians often advised in those simpler times. I had them out at the old Fitzsimmons Army Hospital in Aurora, CO, because my Dad was stationed at a Naval Air Reserve base nearby.

They promised me all the strawberry ice cream I could eat, afterwards. I couldn't swallow for a week, and I didn't believe a word my parents said for years thereafter, on account of that unspeakable misrepresentation. I felt awful, for several days in that big hospital staffed with Army nurses, and I ran them out of sympathy, crying myself to sleep some nights, mourning my pain, my lost innocence, and lost ice cream.

One night, an old battle axe Army capitan RN nurse, heard me snuffling after lights out, went down the hall, got a wheel chair, got me out of bed, promising to show me something that would help me quit feeling sorry for myself. She wheeled me down the darkened corridors to the elevators, and we rode up several floors, got off, and she wheeled me down more corridors, to a large darkened ward room with a few glowing night lights, filled with large metal cylinders, each making slow hissing noises, out of each of which stuck a human head. Fitzsimmons had a critical care polio ward, with about 20 iron lungs, and that old battle axe had wheeled me up there to help some of the kids in the iron lungs pass one of their many lonely nights in that awful summer.

I croaked a little at some of them, as she wheeled me from one extruded head to the next, and they whispered or spoke back, as they could, in time with their mechanically driven inhalations and exhalations, and maybe the novelty of my presence took their minds off their situation for a few minutes. But I took the whole experience to mean that if I didn't do exactly what that nurse told me to do, every minute she was around, that she'd put me in one of those things, and never let me out, like they'd already obviously done to all those other kids.

So, when she wheeled me out of there and returned me to my room a half hour later, I did surely shut up, and didn't make another peep, and lay in abject fear much of the night, hoping that my Mom would come and take me out of there, even if it was just back home, where she'd lie to me like she had about tonsils...

On balance, I'd say do it, but be damn careful what you say about the procedure, before and after, and don't promise popsicles or ice cream, or pooh-pooh your child's discomfort or fears. And for God's sake, don't let the Army take 'em out.
posted by paulsc at 2:45 AM on January 15, 2007 [4 favorites]

His tonsils may not always be so large. Young children’s tonsils are quite large in comparison to the throat, peaking at five to seven years of age. The tonsils will decrease in size after the ages of 8 to 12 years. This, in itself, is not a reason to remove the tonsils, in most cases.
Sleep apnea is serious, though. Is there a less invasive way to treat the apnea while your son grows into his tonsils?
posted by Violet Hour at 3:07 AM on January 15, 2007

Only your doctor or paediatrician can really give you the full facts. Having said that, you've come here for whatever random info people can give you so here's my 5 cents.

I have huge tonsils. Always have. And, worse, they got bigger and bigger. I currently snore so much my poor husband thinks he's going to find the bed sawn clean in half. A restful sleep is rare for me. If someone has a cold or sniffle, they have a habit of turning radioactive green and swell so much that, were they not firmly anchored, I could swallow them. Indeed, it feels like I am. They sit there, screaming rage and defiance, and sliding menacingly on the interior of my throat. Cortesoid sprays to shrink the bastards have not worked, alas. I have considered painting them with plutonium but I'm sure that would only encourage them.

My specialist has advised me to have my tonsils removed. The trouble is, (and particularly for an adult) this is a disarmingly major operation. Complete bed rest for the first week due to the risk of hemorrhaging, and home rest for another week after that (or so he advised me - YMMV). For me, at least, the risk now is much greater than when I was a kid.

I really REALLY wish I'd had them out when I too little to understand what the heck was going on.

Please see your doctor/paediatrician/ENT fellow ASAP.

(Paulc: well...just...wow. That's Stephen King territory right there)
posted by ninazer0 at 3:11 AM on January 15, 2007

I, too, have enormous tonsils. They were discovered in my early childhood and never addressed. They now cause me severe sleep apnea and I have to use a CPAP machine. I really, really wish my parents had had them taken out when I was two-and-a-half.
posted by Faint of Butt at 3:34 AM on January 15, 2007

I feel strongly both ways!

On the one hand, mine came out in 1959 at a Navy hospital in Valley Forge, Pa. While not as traumatic as paulsc's operation, I am one of those sad bastards that has the memory of an elephant, and I still remember every frigging detail of it. It did involve an overnight stay for me, and that's hard on a 4 year old.

But I digress... point is, as far as I can tell, I've been healthy or healthier than just about anyone I know. Missing tonsils and adenoids hasn't hurt me a tad, but my sisters have well-exercised immune systems from all the throat infections they've had over the years WITH their tonsils. The don't have my lovely resonant baritone voice, either.

The only downside... I am generally not into parents making the decision of which of my body parts to dispose of before I can participate. It's in the same territory as cicrcumcision, and (presently) irreversible.

Having them out because Junior is keeping you up or grossing you out is YOUR problem, not Junior's.
posted by FauxScot at 3:50 AM on January 15, 2007

Mine are out. I got indoctrinated with "Peter Ponsil and his Tonsil" beforehand. I have a vague memory of being surprised by the instant transition from breathing ether to waking up elsewhere, and a vague memory of a sore throat, and a distinct memory of orange-flavoured jelly. My immune system still appears to work.
posted by flabdablet at 4:40 AM on January 15, 2007

I had mine (and adenoids) out when I was 6, I got ice cream!

The only scary part was waking up face down witha string of bloody saliva coming from my mouth to a bloody spot on the bed. Soon forgot because of the ice cream.

And the nurses all doted on me 'cause I was such a little trooper.

Did I mention the ice cream?
posted by Mick at 5:14 AM on January 15, 2007

Adding my voice to the "have 'em out" chorus. I had mine out when I was 6 - I was in pain for about a day, and got to eat all the Italian ices (it's a New York thing) I could shovel down my face. The worst part of it was throwing up post-anaesthesia. Just do it.
posted by deadmessenger at 5:42 AM on January 15, 2007

Confer with an ENT that you trust. I snore like a wind tunnel and it turns out that I have mild-moderate apnea. The ENT I saw said that for me there probably isn't a current surgical procedure that will help, so I'm looking at other things.

You're getting a lot of pro-tonsilectomy advice. Fabulous. Don't let it color your son's situation too much, since he is unique.

A good ENT will order a sleep study to start and will take it from there.
posted by plinth at 5:46 AM on January 15, 2007

Having my adenoids out at 3 in a hospital overseas is also one of my first memories and while it sounds to me like you should totally do it, here's another vote for making damn sure the kid is taken care of at all times. I, too, remember the smell of gas and the feeling of being abandoned and the terror of being poked and prodded by scary doctors just before everything went dark. But this was eons ago and I'm sure it's better now. And a lack of oxygen at that age is far more damaging, I would imagine. And yeah, ice cream soothes all wounds not on the scale of iron lung horrors.
posted by CunningLinguist at 5:49 AM on January 15, 2007

My almost-12 year old son will be getting tonsils and adenoids out in one week. We waited to see if he would grow out of it and he got more and more severe cases of tonsillitis. I regret the infections, the lack of energy, and the poor sleep. He's been taking 2000 mgs of antibiotic a day, and will continue until surgery. His tonsils did not go down as he got older and now I am kicking myself as he has to have the surgery and a rougher recovery because he's older.
posted by aliksd at 6:02 AM on January 15, 2007

My oldest son didn't have large tonsils but rather had small nasal passages and therefore, a form of sleep apnea. Our family doctor mentioned that about two thirds of growth hormone production occurs during deep sleep so if deep sleep wasn't reached long enough, his growth could be stunted. He is the third shortest boy in his 8th grade class so there might be something to that.
posted by justlisa at 6:23 AM on January 15, 2007

Nthing the suggestion to consult a specialist, preferably an ENT who specializes in kids and does lots and lots of surgery on kids. Can your pediatrician recommend someone?

My youngest had sleep apnea, brought on by over-large adenoids. She had them removed at age 4. I was able to go right into the operating room (all gowned up) and sit beside her head as she went to sleep, and then was right there when she woke up. She had two days of pretty significant discomfort, but recovered nicely after that. She has been fine since - no sleep problems whatsoever. The ENT felt that adequate sleep was vital to her development, and thus the surgery was required. I am very glad that we made the decision, but I do think that an evaluation by a qualified expert will help you decide.
posted by Flakypastry at 7:27 AM on January 15, 2007

Our oldest daughter had tonsils and adenoids out at 5, done as same day surgery with a Pediatric ENT at Children's Hospital in Chicago. Everything went well but expect about 2 weeks recovery. She seemed fine within a few days, so a week and a half after surgery we went on a family camping trip which was just too much for her. So, if possible, I recommend a Pediatric facility, so all staff, especially anasthetists are accustomed to small children. And give lots of time to heal.
She put on some weight and grew quite a bit in the year immediately following.
posted by readery at 7:33 AM on January 15, 2007

I'll second(?) the ear, nose and throat specialist, although I still shudder when I think of mine as a kid (she was an evil, evil woman). I had my tonsils out at 6 because I was loosing my hearing (I still don't understand the connection) but the only thing I remember about the procedure was that my dad snuck me in McDonalds milkshakes. Oh yeah, and that I could hear again.

Random tidbit that may or may not be true for you - in about 20 years, a growing kid's tonsils will have grown back. Image my surprise at 26 or so when the dentist says to me "you have healthy looking tonsils!". I shot up, "Whaaaaa? I had them removed!" But sure enough, 20 years later I was sporting a pair of healthy tonsils.
posted by cgg at 7:48 AM on January 15, 2007

I just wanted to chime in again. I'm only in my 20s, so my experience with surgery is quite a bit more recent than most of the folks here. I had my first at three years, and barely remember it. Anyway, the horror stories you're hearing are largely obsolete - parents are allowed to spend the night with the child in most cases (and I strongly recommend it), and the nurses and doctors and so on are far 'nicer' than they used to be. Minor surgery is far less frightening for children than it used to be.
posted by spaceman_spiff at 7:53 AM on January 15, 2007

wow! thanks for all the thoughtful, speedy responses. mefi never disappoints (cause when it does, there are always plenty of wise-asses to make the disappointment interesting!)

our pedi (and she's really good) put her hand on my shoulder and said "sometimes bad things happen to nice people. dont do it if you dont have to." she further related that her son had his out at 9 for the same issue. so she waited. i dont think we will. we want our boy to breathe. the hemmoraging thing is all that gives us pause....

i'll be calling for the sleep study now....
posted by oigocosas at 9:03 AM on January 15, 2007

I was scared shitless to take out my daughter's tonsils. Irrationally so. But I knew it was the right thing, due to her frequent sore throats, etc. Here's what I've seen:

She's much less irritable and moody - something I had no idea was even connected, but makes perfect sense.

She sleeps better.

No more strep (well, one last year, instead of four or five episodes)

She doesn't miss school.

BTW, she sounded like a pixie for about three months, which was weird, and we weren't warned about that, but it was nothing bad.

Good luck.
posted by docpops at 10:20 AM on January 15, 2007

I had my tonsils (& adenoids) out when I was 12, and I don't remember it as being all that bad. My tonsils were so big that they would rest on the back of my tongue. I remember some teacher looking at my tonsils and then calling in the principal to look at my tonsils because they were so freakishly huge. I'm pretty sure I was taken to see an ENT. Mine were so bad that they went ahead with the surgery even though I had a cold, because they were afraid that if I had one more bout of tonsillitis, they might swell up so much as to close off my throat entirely. I wasn't scared to be by myself in the hospital overnight (being 12), but nowadays I think they will let at least one parent stay the whole time, so that shouldn't be a problem-- if kids even have to stay overnight for tonsillectomies anymore.

Having had giant tonsils myself, I'd say he'd probably be happier without them. However, IANAD, and you should see one, yadda yadda yadda.
posted by Shoeburyness at 10:47 AM on January 15, 2007

I didn't read any of the comments so maybe I'm repeting someone but:

My 4 year old has had obstructed breathing all her life. Her tonsils almost touch in the back of her throat. She snores most nights and breathes through her mouth most of the time. My partner said she heard her having episodes of apnea. I finally took her to a series of specialists culminating in a trip to our local sleep lab.

The results of the sleep study showed that despite her obviously loud and occasionally labored breathing, she does not actually have apnea. Or at least, she had no incidents of apnea that night. She was getting plenty of oxygen, and adequetly getting rid of carbon dioxide. She got enough REM sleep too. In other words, her breathing sounds bad, but she's sleeping fine.

I also had an interesting conversation with the pulminologist who was very much pushing for tonsilectamy (before we had the sleep study). I asked him for some data on the effectiveness of tonsillectomy to treat apnea, and he said there was NO study he could point to. When pressed, he said tonsilectomy was effective about 50% of the time. I became convinced that this surgery is a common practice, but not an evidence-based practice. And even if it is actually effective 50% of the time, I'm not convinced that surgery would have been a good idea for a condition that tends to resolve itself at puberty.

In any case, I didn't end up having to decide (because of the results of her sleep study).

Good luck.
posted by serazin at 11:45 AM on January 15, 2007

As a nursing student, I have one bit of advice I learned from working on a post-surgical floor (at the #1 pediatric hospital in the United States): keep a journal of intake(liquids and foods) and medication doses/times in case you do go back to the hospital for any reason. It's good for the doctors to know if there is dehydration which is rather common with young children after oral surgery. Make sure your child's pain is medicated properly and completely! (follow your doctors orders, and call your doctor if it doesn't seem effective).
posted by nursegracer at 12:48 PM on January 15, 2007 [1 favorite]

I had big ass tonsils. I got sick a couple times a yr and they'd swell up and nearly touch. Dr's said no, no we won't take them out. In college with the added stress I was getting sick nearly weekly. My mom and I had to tag team the ENT dr and I had them out when I was 23. It was absolute hell for a week. Absolutely awful. Here's another vote for getting them out while you're young.
posted by CwgrlUp at 2:39 PM on January 15, 2007

P.S.: Having further contemplated Pracowity's final suggestion, I have to say the phrase 'I have a frog in my throat' is never gonna be the same.
posted by eritain at 4:04 PM on January 15, 2007

Thanks for that, CwgrlUp. Now I can't stop thinking about "ass tonsils".
posted by flabdablet at 4:35 PM on January 15, 2007

I had my tonsils out when I was four. Please learn from my experience: do not eat green jelly (jello) and strawberry ice cream together. Truly horendous flavour combination.

ie. I don't remember pain or fear.
posted by kjs4 at 5:00 PM on January 15, 2007

I had mine ripped out when I was about four.

All I remember from before hand was killer sore throats and ear aches (I had grommets put in at the same time).

All I remember from afterwards is that I got bored of scrambled egg very quickly and that ice cream hurt for 24 hours. I was more hurt by the fact I couldn't eat the ice cream I was promised than I was by the actual operative pain.

Connected or not - whenever people around me get sore throats, I get ear ache instead. I'm fine with that since I don't swallow with my ears...
posted by twine42 at 12:42 AM on January 16, 2007

Yeah, I wish I had this done when I was a kid. In fact, my doctors almost gave me a tonsillectomy when I was five, but that was about the time that opinion was swinging away from frequent tonsillectomies, and they decided not to go through with it. But I'm delighted to have finally done it now at 34.
posted by Pater Aletheias at 5:06 PM on January 27, 2007

thanks pater, et al.

lil jed will be having em out "after flu season" on the rec of his pulmonologist.

thanks for envisioning him nosocomial-infection-free everyone.
posted by oigocosas at 9:18 PM on January 29, 2007