Adenoids and tonsils

Having your tonsils and adenoids out
Information leaflet about taking out your child’s tonsils and adenoids.

Please bring your child to the waiting room of the Outpatient Operating Room (POK) on the 3rd floor on …………….day, ………-………- 20….. at ……. hrs.

As discussed with your Ear, Nose and Throat (ENT, ‘KNO’ in Dutch) specialist, it has been decided that your child must have its tonsils and adenoids taken out. Although this is a very minor procedure in medical terms, it may have a considerable impact on your child. It is therefore important to prepare your child by telling him/her exactly what is going to happen.

This will make the event seem less intimidating and help your child come to terms with it. To prepare your child properly, it is important that you know exactly what this procedure entails. That is the point of this leaflet. Should you have any further questions after reading the information it contains, please do not hesitate to get in touch with your ENT specialist.

Preparations by the anaesthetist
The anaesthetist will tell you about the anaesthetic and pain relief during a consultation at the Pre-operative Outpatient Clinic (more information later on in the leaflet). Your child’s heart and lungs will also be examined. If you wish, you can let your child play with the anaesthetic mask and balloon to help him/her get used to them.

Preparations at home
The best way to prepare your child for having its tonsils and adenoids out depends on the age and disposition of the child. It is often better not to tell toddlers and very young children too far in advance. Few of them have any real perception of time, and so one or two days beforehand is reasonable. In the case of older children, you should choose the moment that seems best to you. Some children react better if they know exactly what to expect. On the other hand, some children have a vivid imagination and may find a long wait nerve-wracking. It is important that your child is given the chance to think about the forthcoming procedure and ask any questions that may occur to him/her. It may make things easier if your child knows that you will be there right up until he/she falls asleep, and again as soon as he/she wakes up. It is important that you tell your child that when he/she wakes up after the operation, his/her throat will be sore, his/her nose may bleed slightly and it may be difficult to swallow.  

Things to be aware of 

Please read the following instructions carefully as it is important to the procedure itself:

No food and restricted drinks before the operation
It is very important for the anaesthetic that your child fasts before the procedure. He/she may not eat anything after midnight on the day beforehand. Your child must not clean his/her teeth on the morning of the operation. 

He/she may drink clear fluids up to two hours before the agreed admission time. These include:

• water
• tea without milk
• very diluted squash
• clear apple juice

No aspirin
Your child must not take any drugs containing aspirin (Aspro, Dolviran, APC, Chefarine etc.) during the two weeks preceding the operation, as aspirin increases the chances of haemorrhaging during and after the procedure. Paracetamol is allowed.

Regular medication
If your child is on any regular medication, please discuss this with the ENT specialist beforehand, so that he/she can decide whether and how the medication will affect the operation.

Illness
The operation will not go ahead if your child is ill. It will also be cancelled if your child is likely to have come into contact with people with infectious diseases such as measles, whooping cough, German measles, mumps or scarlet fever. If in doubt, contact us on: tel: 070 - 312 44 08 / 070 - 312 44 20.

Transport home
You should arrange transport to take you home after the procedure, but do not drive the car yourself. Your child may feel sick or throw up blood and may need your help during the journey.

What should you bring?

• your registration card
• any medication your child might need
• a soft toy, doll, (picture) book, toys for in the waiting room

Pain relief with paracetamol and diclofenac suppositories
At your pre-operative appointment with the anaesthetist, you will be given three boxes of suppositories (paracetamol and diclofenac) to be used for pain relief during the first three days. The dosage will be prescribed according to your child’s weight.

You may not use any other forms of pain relief while using these painkillers, particularly not aspirin as this increases the risk of haemorrhaging.

At 07.00 hrs. on the day of the operation, give your child a paracetamol suppository and a diclofenac suppository. After the operation, you should administer suppositories depending on the child’s pain and in line with the instructions on the packaging.

Days 2 and 3
Administer suppositories at intervals during the day, according to the child’s pain and in line with the instructions on the packaging. If your child has a sore throat, try to persuade him/her to drink sips of water and eat ice lollies.

If the pain has not eased within 5 days, please contact your GP.

The day of the operation
On arrival, you should take a seat in the POK waiting room, which is on the 3rd floor of the hospital. You and your child will be collected and taken to the waiting area of the treatment room. Your child will be given something to drink in preparation for the operation. The drink will make him/her feel calm and relaxed. You can stay with your child during this time. 

Your child will be given a wrist band showing his/her name. After about 30 minutes, you (one parent) and your child will be collected and taken to the treatment room. The medical team will be waiting for you, dressed in operation clothing. Your child will lie down on the operation table beside which you may stand. The anaesthetist will place a mask over his/her face and ask him/her to blow into it. Your child will fall asleep within a minute or two. Some children roll their eyes or wave their arms or legs at this point.

Once your child is asleep, you will be asked to leave the room. Your child will be given a drip once under anaesthetic and this will be removed in the recovery room before you go home. After the operation, your child will be brought back to where you are waiting.
A nurse will be in constant attendance in the recovery room. Most children cry as they wake up from the anaesthetic and you may see a little blood seeping from his/her mouth and nose. It is best if your child stays lying down for a while so do not try to pick him/her up.
The specialist treating your child will come to the recovery room to tell you how the operation went. He/she will also check that your child is recovering as expected. You and your child will then be taken to the Willem-Alexander ward (a children’s ward), where you will remain for about three hours. You will not be seen by a doctor but the children’s nurse will keep a close eye on your child for these three hours and say when he/she is fit enough to return home. If everything goes well, your child will be discharged after these three hours. 

At home
It is advisable that your child gets plenty of rest. Give him/her lots of regular, cold drinks as soon as you get home, such as water and squash. Ice lollies are allowed too. Cold drinks will soothe his/her sore throat. Do not be alarmed if your child brings up (old) blood after the first sip.

The second day:
Encourage your child to drink in the same way as on the first day. You can also give him/her some smooth porridge or cold custard. The nurse from the Willem-Alexander nursing ward will telephone you to ask how your child is doing.

The third day:
Your child can get up on the third day. He/she could also try eating other smooth puddings and tepid soup.

The fourth day:
Offer your child mashed potato, pureed vegetables and meat, bread without the crusts and a soft boiled egg.

The fifth day:
Your child can go outside.

The eighth day:
Your child can go back to school.

The schedule shown above is just a rough guideline. In theory, your child can eat and drink anything he/she wants and can cope with. This will not interfere with the healing process of the wound.  

Once you are home, pay particular attention to the following:

High temperature and earache
It is quite normal for your child to have a slight temperature during the first two days. Earache is also a common side-effect. However, if his/her temperature is still high after a couple of days, get in touch with the hospital.

No aspirin
If your child is in pain, you must not give him/her any drugs that contain aspirin, as aspirin increases the risk of haemorrhaging.

Letting off steam
Your child may need to let off steam after the stress of the operation. He/she may even be a little hard to handle during the first couple of days. This will soon pass if you are kind and patient. A bit of extra attention will do no harm for a while, and he/she will certainly appreciate some tender loving care. So do not be afraid to spoil him/her.

When to call the doctor
Your child may spit mucous streaked with blood the day after the operation. He/she will probably have a sore throat and possibly earache. Some children even throw up black vomit. This is blood they have swallowed. If your child repeatedly vomits fresh blood or vomits excessively, you should get in touch with the hospital.
During office hours, call the ENT Outpatient Clinic: 070 - 312 44 08. Outside office hours and at the weekend, you should call the Accident & Emergency Department (SHE): 312 44 45. If your child’s temperature is still above 38.5°C after two days, contact your GP.

Check-up
You will be given a card with an appointment for a check-up at the ENT Outpatient Clinic six weeks after the operation.

The picture on the left shows a throat with tonsils, the picture on the right is after they have been taken out.

Finally
If you have any questions after reading this leaflet, please contact the ENT Outpatient Clinic, which is open on weekdays and can be reached via telephone number 070 - 312 44 08. We would be interested to hear your opinion.

If you have any comments or suggestions relating to this leaflet 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: February 2010/35