Recovery After Tonsillectomy and Adenoidectomy: A Guide for Parents
As a pediatrician who has guided many families through tonsillectomy and adenoidectomy (T&A) recovery and went through it personally with my younger son, I wanted to share some practical advice to help make this challenging time easier for both you and your child. While the procedure itself is common and generally safe, the recovery process requires attention, patience, and care.
Here are some key items to make sure you have on hand as you prep for the surgery and recovery process. They helped me to feel much better prepared when we went through it.
The First 24 Hours: Anesthesia Recovery
The first hurdle after surgery is often the recovery from anesthesia. This can sometimes be more challenging than parents expect:
Emotional reactions: Children may wake up confused, upset, or agitated. This is normal and temporary. Some children cry inconsolably or seem not to recognize parents initially. Stay calm, speak softly, and provide reassurance.
Physical symptoms: Nausea, vomiting, dizziness, and shivering are common after anesthesia. The medical team will monitor these symptoms before discharge, but they may continue at home.
What helps: Keep the room quiet and dimly lit. Minimize stimulation. Gentle physical contact like holding their hand or stroking their hair can be comforting. Follow the hospital's instructions about when it's safe to offer small sips of clear liquids.
Pain Management: The Key to Recovery
Effective pain management is crucial for your child's comfort and healing. Many children have pain for up to 10 to 14 days after surgery.
Encourage frequent chewing to decrease throat, jaw and ear pain. An ice collar may make your child more comfortable.
Ear, jaw and neck pain can occur. The pain may get more severe 3 to 7 days after surgery.
The First Few Days
Stay ahead of the pain: Give pain medication on a regular schedule as prescribed, even if your child seems comfortable. It's much easier to prevent pain than to treat it once it's severe.
Set alarms: Consider setting alarms for nighttime doses. Waking a sleeping child for medication may seem counterintuitive, but maintaining consistent pain control is important.
Days 5-7: The Critical Period
Prepare for increased pain: Around days 5-7, the surgical scabs begin to come off, often leading to increased pain and potentially some minor bleeding. This is normal but can be frightening if you're not prepared.
Medication tracking chart: Create a simple chart to track when medications were given. This helps prevent missed or double doses, especially when multiple caregivers are involved. I used this one when my son had his surgery.
Tips for medication administration:
For younger children, medicine syringes work better than cups for accurate dosing
Administer medication toward the inside of the cheek, not directly to the back of the throat
If prescribed, alternate between different types of pain relievers as directed
Keep pain medication by your bedside for nighttime doses
Hydration: This is Key
Staying hydrated is absolutely essential after a T&A procedure:
Goal: Aim for at least 4-6 cups of fluid daily (adjust based on your child's age and size).
Best choices: Cool (not cold) liquids like water, diluted juice, popsicles, jello, and sports drinks.
Avoid: Hot liquids, acidic juices (orange, grapefruit), and carbonated beverages as these can irritate the surgical site.
Tracking tip: Keep a fluid log or mark cups/bottles to monitor intake.
Dehydration warning signs: Dry lips, reduced urination (fewer than 3-4 wet diapers or bathroom trips in 24 hours), dark urine, excessive sleepiness, or fewer tears when crying.
Food: Gentle Progression
While hydration takes priority, eating soft foods helps with healing:
First 1-2 days: Focus on cool, soft foods like popsicles, jello, pudding, ice cream, and yogurt.
Days 3-5: Progress to mashed potatoes, scrambled eggs, pasta, oatmeal, and applesauce.
After day 7: Begin introducing more normal foods, but avoid hard, crunchy, or spicy items for at least 2 weeks.
Important note: Some physicians actually recommend gentle chewing of soft foods like goldfish or even gum earlier in recovery, as this can promote blood flow to the healing area and prevent muscle stiffness. We did this and found that it helped a lot. Always follow your surgeon's specific advice.
What to Expect
Constipation
Your child may not have a bowel movement for several days after surgery.
Encourage your child to drink often, especially high-fiber drinks. Examples are pear, apple, or apricot juice.
Encourage high-fiber foods like fruit, vegetables, raisins, prunes, and oatmeal.
Nasal congestion and cough
Encourage your child to drink a lot, including water, juice or milk.
Use normal saline nasal spray in the nose every 2 to 3 hours as needed while awake.
A cool mist humidifier can be used while sleeping.
Keep their head propped up on 2 pillows.
Bad Breath
Your child will have bad breath until the tonsil and adenoids scabs fall off (usually 7-14 days afterward)
Encourage your child to brush their teeth and tongue at least 2 times a day.
Use normal saline spray in the nose every 2 to 3 hours while awake.
Voice changes
Your child’s voice may change after surgery. It may have a “nasal” sound. The voice usually returns to normal a few months after surgery.
Liquid may come from your child’s nose after they drink. Encourage small sips or drinking through a straw. This problem usually goes away within 12 weeks after surgery.
Rest and Activity
Finding the right balance between rest and gentle activity is important:
Sleep: Your child will likely need more sleep than usual. Create a comfortable, quiet sleeping environment.
Position: Elevating the head slightly while sleeping can reduce pain and swelling.
Activity level: Expect your child to be less active than normal for 7-10 days. Avoid rough play, sports, or strenuous activities for 2 weeks.
Kid-Friendly Activities During Recovery
Keeping a young child entertained while restricting activity can be challenging. Here are some age-appropriate ideas:
For Toddlers (1-3 years)
Quiet reading time with favorite books
Gentle sensory play (rice bins, water play with supervision)
Simple puzzles
Watching familiar shows or movies
Coloring with washable crayons
Puppet play
For Preschoolers/Early Elementary (4-7 years)
Craft projects that can be done while sitting
Building with blocks or magnetic tiles
Board games and card games
Drawing and coloring books
Play-doh or modeling clay
Audio stories
when to seek help
Know when to seek medical attention:
Has bleeding from the nose or mouth or has bright red blood in vomit. Call immediately.
Does not feel any better 45 minutes after taking pain medicine.
Drinks very little or refuses to drink.
Urinates less than twice a day.
Has no tears with crying.
Vomits 2 times in one day.
Is constipated.
Has a temperature of 102ºF (38.8 C°) or higher by mouth or rectum.
Has severe bad breath.
Has severe neck pain or a stiff neck or their head is tilted to the side.
and just remember…
As both a pediatrician and a parent who has been through this with my own child, I want to offer some reassurance:
This recovery period, while challenging, is temporary. Most children show significant improvement after the first week, though complete recovery may take up to two weeks. The benefits of the surgery—improved sleep, fewer infections, better breathing, and enhanced quality of life—make this difficult period worthwhile.
Trust your instincts as a parent. You know your child best. Don't hesitate to contact your healthcare provider with concerns, even if they seem minor. It's always better to check than to worry.
Remember that each child's recovery experience is unique. Some bounce back quickly, while others take more time. Be patient with the process and with yourself as you navigate this challenging time.
Sending you a big hug,
Anjuli
Disclaimer: This blog post is for informational purposes only and should not replace the specific instructions provided by your child's surgeon or healthcare provider. Always follow the post-operative care instructions given by your medical team.