Adenoids - removing the

Removing the adenoids
Information booklet on the removal of your child’s adenoids

Your child will be expected in the waiting area of the Outpatients’ Operating Theatre (POK) on the 3rd floor on ………….day, ……-…….- 20… at …… o’clock.

In consultation with your Ear, Nose and Throat (ENT) specialist, it has been decided to remove your child’s adenoids. From a medical point of view, this is a simple procedure but for children such a procedure is certainly no small matter. It is therefore important that you prepare your child well by explaining clearly what is going to happen. Your child will then probably experience the procedure as less unpleasant and be able to deal with it better.  

In order to be able to prepare your child, it is important that you yourself are well informed about the course of events surrounding the removal of the adenoids. That is what this booklet is all about. If, after having reading it, you still have questions, do not hesitate to contact your ENT specialist.

What are tonsils/adenoids?
Tonsils/adenoids are large bulges that are at the back of the nose (adenoids) and the throat (tonsils). They are part of the immune system. If pathogens enter the body via the nose and mouth, the tonsils and adenoids help to catch them and render them harmless.

If the tonsils/adenoids can no longer handle the amount of pathogens, they themselves become infected and can also become swollen. Children will then have constant colds with a runny nose or will often have ear infections. They can also snore or be listless. It is particularly young children who have active and, therefore, enlarged adenoids.

By the time the child is around eight years old, the tonsils/adenoids start to shrink.  If children have a great many on-going problems with their adenoids, it is often decided to remove them. Once the adenoids have been removed, there is sufficient immunity tissue left to take over the task of the adenoids.



1: end of the Eustachian tube;
2: Adenoid;
3: uvula;
4: lower nasal concha;
5: middle nasal concha;
6: middle nasal passage with the drainage channels from the paranasal sinuses.





Preparation by the anaesthesiologist During the walk-in clinic at the Preoperative Outpatients’ Clinic, the anaesthesiologist will give you information about the anaesthesia and pain control (for more information about this, see below in this booklet). Your child’s lungs and heart will also be checked. If you wish, your child can also try out the anaesthesia mask and the balloon in a play situation.

Preparation at home
The best way to prepare your child at home depends on the character and age of your child. It is better not to inform toddlers and preschoolers too long beforehand. They often have no idea of time. One or two days before the procedure is a reasonable timeframe. If your child is already somewhat older, you know yourself when the most suitable time would be. While one child likes to know what is going to happen, another may start to fantasise and becomes unnecessarily agitated if he or she is told too long beforehand what is going to happen. Your child must, however, be given the opportunity to absorb everything and, if necessary, to ask questions. Preparing your child will be easier because you can promise him/her that you will stay there until he/she falls asleep and that you will be there as soon as he/she wakes up.

In order to ensure that the procedure goes as well as possible, you must adhere to a number of rules:

No food and limited fluids
It is exceedingly important that, in connection with the anaesthesia, your child’s stomach is empty when coming to the hospital. Therefore, starting at midnight the evening before the procedure, the child must not eat anything. The morning of the procedure, your child may also not brush his teeth.

Up until two hours before the agreed time, your child may drink clear fluids, such as:

• water
• tea without milk and sugar
• fruit drink made with water and a small amount of syrup
• apple juice

No aspirin
For two weeks before the procedure, your child may not take any medications containing aspirin. (Aspro, Dolviran, APC, Chefarine, etc.) Aspirin increases the chance of haemorrhaging during and after the procedure. Paracetamol is allowed. You can read more about pain control further on in this booklet.

Medication
If your child uses medication, discuss this beforehand with the ENT specialist so that he can assess whether or not this must be taken into account.

Illness
If your child is ill, the procedure cannot be done. This is also the case if, in the immediate vicinity of your child, there are infectious diseases such as: measles, whooping cough, German measles (Rubella), mumps or scarlet fever.

If you have any doubts about this, please contact us at:
tel. 070 - 312 44 08 / 312 44 20.

Transportation home
Make sure beforehand that you have a ride home by car but do not drive yourself. During the drive, your child can become nauseated and vomit some blood. It is, therefore, advisable to bring a towel with you.

What should you take with you?

• A hospital registration card;
• If necessary, any medication that your child must take;
• A cuddly toy, doll, a book to read aloud, some toys for the waiting room. 

Pain control
For children whose adenoids are going to be removed, we advise the parents to give the children a paracetamol (suppository) at 07.00 hours on the day of the procedure. If necessary, you may give another one 6 hours later, thus, at 13.00 hours and repeat the dosage according to the schedule below:

• Children weighing 5 - 10 kg: 120 mg paracetamol, 2 - 3 times/day;
• Children weighing 10 - 20 kg: 240 mg paracetamol, 2 - 3 times/day;
• Children weighing 20 - 30 kg: 500 mg paracetamol, 2 - 3 times/day.

The course of events on the day of the procedure
On the day of the procedure, you will go to the waiting area of the Outpatients’ Operating Theatre (POK) on the third floor. You and your child will then be fetched and brought to the waiting room of the surgery. There, your child will be given a substance to drink in preparation for the procedure. This substance will make your child calm and relaxed. You will stay with your child during this time.

Your child will be given a wristband with his/her name on it. After about 30 minutes, you (only one parent) and your child will be fetched and brought to the operating theatre. The medical team will be waiting in surgical scrubs. Your child will be laid on the operating table and you may stand next to him/her. The anaesthesiologist will place a mask on your child’s face and will ask him to blow into it. After 1 á 2 minutes, your child will fall asleep. Sometimes, children roll their eyes a bit or wave their arms and legs. As soon as your child is asleep, you will be asked to leave the operating theatre.  

After the procedure, your child will be brought back to you. There is always a nurse present in the recovery room. Most children cry as they wake up. And, often, there is some blood coming out of the nose and mouth. It is a good idea to leave your child in bed for awhile and not to pick him/her up.
The consulting specialist will come to the recovery room to tell you how the procedure went. At the same time, he will check to make sure that your child is alright. Once your child is wide awake, you make take him/her home.

Home again
The day of the procedure:
Once you are at home, it is possible that your child will be sleepy for the first few hours. Have your child drink something as soon as you get home, and regularly after that. Immediately afterwards, you child may, in principle, eat or drink anything he/she wants. If the weather is good, your child may go outside on the second day and go to school on the third day. 

Letting off steam
It is possible that your child will need to vent his/her bottled up tension. For this reason, the first few days may be a bit difficult. If, however, your child is well taken care of at home, this will generally end by itself. It may help to give your child a great deal of attention during the initial period. The child simply needs a bit of extra affection and patience. Therefore, a bit of spoiling cannot hurt. 

When should you call the doctor?
After the procedure, there is often a mild fever. If your child is in pain, you may not give any medication containing aspirin, because aspirin increases the chance of haemorrhaging. Sometimes your child may vomit a black-coloured substance. This is blood that has been swallowed. If your child repeatedly vomits fresh blood or vomits large amounts, you must then contact the hospital.
During the day, you may call the ENT Outpatients’ Department: 070 - 312 44 08. In the evening, at night and in the week-ends, you may call the Accident and Emergency Department (Spoedeisende Hulp): tel. 070 - 312 44 45. 

Check-up
Six weeks after the procedure, you and your child will be expected at the ENT Outpatients’ Department. You will be given an appointment card for this when you leave the hospital.

In conclusion
If, after reading this booklet, you still have questions, you can contact the ENT Outpatients’ Department. The Outpatients’ Department can be reached on working days via telephone number 070 - 312 44 08.  We value your opinion. If you have any comments or suggestions concerning this booklet or your treatment, please let us know. 

Additional information
Right to information and consent Every child has the right to be fully informed about a course of treatment or medical procedure. This has been laid down in the Dutch Medical Treatment Contracts Act [Wet op de Geneeskunde Behandelingsovereenkomst]. In this respect, a child’s rights are no different from those of an adult. However, the aspect of granting consent is different. In very general terms, the statutory regulations on giving consent to treat a child are as follows. 

Children up to twelve years of age
In the case of children below twelve years of age, consent must be given by the child’s legal representative (usually the parents).

Children between twelve and sixteen years of age
The decision about treating a child of between twelve and sixteen years old is made jointly by the parents and the child. This means that both the child and the parents must give consent.

Children of sixteen years of age and older
The Dutch Medical Treatment Contracts Act considers children over the age of sixteen to be adults, and capable of making their own decisions about treatment. All information is aimed directly at the young person concerned, and the parents or guardians will only be involved in decisions if he/she agrees.

Treatment may not be given without the express consent of a patient or his/her legal representative. Exceptions to this rule include: acute situations or situations in which failure to treat could endanger the child.

National Child and Hospital Association
In April 2008, the National Child and Hospital Association (Landelijke Vereniging Kind en Ziekenhuis) awarded Bronovo a Smiley for its children’s department. This national association is responsible for awarding Smiley quality marks to hospitals with outstanding facilities for children and parents.

The National Child and Hospital Association aims to help parents by: boosting children’s wellbeing before, during and after being admitted to hospital. The Association publishes various leaflets and runs a useful website.

National Child and Hospital Association
Korte Kalkhaven 9
3311 JM Dordrecht

Tel +31 (0)78-614 63 61
www.kindenziekenhuis.nl (only in Dutch)  

Edition: May 2010/110