Adenotonsillectomy

[ThreeBecameFour]

DD 2.8 will be having an Adenotonsillectomy surgery on the 14 Feb mainly due to issues arising from tonsils and adenoids affecting her sleep - not to the point of sleep apnea but waking a number of times in the night and the tonsils are grade 3 so taking up 50-75% of the airway. Could anyone else whose child has had this done talk me through what happened and what the recovery was like. I know it is a routine operation but I am still nervous and also have a 5 mo ds to look after. I am having irrational fears that something dreadful will happen (which is highly unlikely I know). Tell me your stories & outcomes please!

You'll have lots of replies, I should think - I know I did, when dd2 had her op at 26 months

Main points: take spare tops for both of you, wet wipes etc in case of post anaesthetic sickness (we had none) or hot hospital sweatiness (plenty). Take snacks and drinks and straws. I sent dh out for ice lollies straight after dd woke up, as she wouldn't drink - ice lollies saved us for the next week.

After the op, they like them to have 'rough' foods like toast and crisps - amazingly, dd found them easier than 'sticky' foods like mash or pasta. But don't worry if she doesn't eat for a week or so: if it hurts, she won't want to but she will bounce back as soon as she starts to feel better.

Some kids have a lot of pain (mine did), some almost none, most are inbetween. But in any case, my biggest tip is to keep on top of pain meds after the op and back home for at least a week. Don't wait for the 4 hours to be up, give meds 5 minutes early - we alternated paracetamol and voltarol suppositores, as dd wouldn't swallow the nurofen or calpol. If swallowing is a problem (easier to explain with older kids, mine was very teeny), ask for suppositories - added advantage was I could (sorry, but it was very easy!) slip one in in the middle of the night without waking dd, to keep the pain control going.
I did set my alarm to give pain meds in middle of the night, in dd's case, but probably wouldn't have done if she'd been in less pain.

In terms of hospital itself: going under anaesthesia was easy for us, because dd fell asleep (having had a tantrum because she was thirsty and I couldn't give her milk) and I carried her in to theatre, where they waved gas under her nose till she was properly under then took her off me. That part is hard - the waiting - so if you can, have someone with you to distract you with coffee for the short time it takes!

dd cried hysterically on waking, which upset me but she didn't remember at all half an hour later - the docs said it was a reaction to the anaesthetic, but I think it was also waking up with strange people around her and in pain. Either way, she calmed quickly once cuddled and was totally unaware of it later. Some kids feel a bit sick when they wake up, but dd didn't at all - and ate an hour later.

One thing they didn't tell me was that small kids can react to surgery with a slightly raised temperature the next day - dd stayed overnight in hospital, then was feverish the following evening. If it goes over 38 or she seems unwell, get back to hospital in case of infection (or call the ward). But if its very slightly up, could be nothing as in our case

The other thing to know is that the pain gets better over the first few days, then gets worse again around days 5-7 (approx). This is because of scabs forming and falling off, so don't stop the pain meds until you're past that stage.

That's it, really - except the best bit: dd's life changed hugely thanks to her op, and so did ours. She lost the starved spider look and the dark rings under her eyes, slept well (she had apnoea before), and within a month was growing and thriving like never before. I have never, ever regretted the operation.

Sorry for the essay - hope it goes smoothly and don't hesitate to post for hand holding if needed!

Thanks so much! I forgot to say her surgery is booked for 11amish and they have said she should be able to go home in the evening. As we have a baby and no-one local to help look after 5mo ds and anyone else we had in mind e.g. my mum etc is unavailable, he will be coming with us which they have suggested. Has anyone else done this? DH will be with us. He wants to be at the hospital with her and will help with ds. Will this be an issue do you think?

My advice is to get lots of pain relief immediately after the surgery.

I was told that the kids cry when they wake as a reaction to the anaesthetic and because they are disorientated but not to worry as they're not in pain.

My dd was very articulate as a toddler and woke up very distressed shouting and crying 'you said I was going to have my throat mended but it KILLS more than ever' at which point they gave her IV morphine.

But after that we had an easy time. She needed strong meds at night from day 5-8 and she slept in bed with me as I was scared of her bleeding and choking, but in the daytime she rarely had even paracetamol.

I think most kids go home the same day (dd stayed overnight in HDU because she had a floppy larynx, and was therefore considered a high risk for anaesthesia, but all was fine).

And having your baby there should be fine - childrens' wards are used to babies

Hi, I had a tonsillectomy when I was 6.
Not as young as your DD and it was just my tonsils but I was absolutely fine - I went from having frequent bouts of intensely painful tonsillitis to never having it ever again.
I remember my throat being very sore after the operation but I had lots of painkillers and ate a lot of ice cream and I was back at school within 2 weeks. Have never had any throat problems since (touch wood).
Everything will be fine - it's a really common operation and it's quick and simple to carry out. Good luck, your DD will be just fine. :)

Most children go home the same day unless for some reason you don't fit the day case criteria in which case it's one night. It's best to prepare for that just incase. Your baby can visit during the day but siblings can't stay overnight (just incase you stay, it doesn't happen often if not planned).

We don't tell patients to eat crunchy food these days, it's more a normal diet, as long as they're eating and drinking which is the most important thing as it helps prevent infection and bleeding afterwards.

Most important thing when you are home is regular pain relief (paracetamol and ibuprofen) and food and drink, even if its little and often. Give medicine for at least a week. Any sign of fresh blood from nose or mouth take straight to your local A&E (not saying this will happen), its quite normal for things to get worse at home before they improve, breath will smell and their voice can go a bit higher pitch. If they snore it can take a couple of weeks to settle. Long term the difference can be huge!

pobble are you sure it is just paracetamol and brufen?

Dd was discharged with the biggest bottle of codeine phosphate I have ever seen.

DD had hers done in 2006 and had some sort of stronger painkiller (cant remember name). DS in 2010 just paracetamol and ibuprofen. Agree that you need to give the pain relief regularly - don't let them get sore! Both very different. DD had very little pain after and DS was very sore for about a week. DS was very sick after the operation. Best thing we ever did, though!

Things have changed, codeine isn't given for home anymore as some children metabolise it into morphine too much.

When I say big bottle. I mean BIG. I still have 800ml left. Her OP was 18months ago.

What's the issue with metabolising into morphine?

Some children are at risk of a rare adverse reaction which means they metabolise codiene into morphine in higher than normal amounts. Higher amounts can cause breathing difficulties, which can be fatal. Because of this codiene is no longer given out to take home. It's quite a recent thing.

Oh I see. Though when she had her bad nights I don't think anything less would have helped.

But importantly wtf do I do with this massive bottle now? Sell it on the black market?

Ds1 (4.8) had this just before Christmas. His tonsils were grade 4. He made a v quick recovery from the operation and was eating normally within a couple of hours. He managed fine on ibroprofen/paracetamol and I was able to start stepping down the dosage after about 5 days. I slept in his room for the first few nights as he did wake up a bit when the mediciation wore off.

For the tonsils he had a relatively new procedure where they don't remove the whole tonsil but leave part of the tissue behind to reduce the risk of bleeding and speed up recovery. this link explains it, that's the surgeon who did ds1's op and he was great, if your surgeon offers it then I would recommend it on the basis of ds1's experience.

One thing to add is that ds1 was absolutely fine but I was a nervous wreck, so be prepared for that, especially when they put them under anaesthetic.

Take the bottle back to a pharmacy, they can dispose of it. That's a massive bottle to be going home with!

It was the dispensing bottle I think. They said they had no smaller. Dd had to have her OP in an adult only wing.

No idea if any of that made any difference.

DS had this surgery aged 3.10 (Elibean you gave me lots of support - under a different name - thank you :) )

The surgery was quick and although he was tearful and confused on waking he was sitting up and asking for food almost immediately! He ate loads and his breathing was better immediately. He was kept overnight (we live a long way from hospital and while rare, postoperative bleeding can be quite serious, hence no discharge the same day) and was fine the next day, just bored.

The worst was days three until six I think. He was in terrible pain and swallowing the painkillers was really difficult for him which causes a horrible catch 22. DH moved into his bed and I slept with him setting myself alarms for pain relief doses. I will be honest and say it was really tough.

On the flip side his breathing was instantly better, even the first night in hospital. His foul breath was gone too!

We had an 8 month old and the hospital were fine with us having her there. I took her home overnight and DH stayed with DS.

DD is now being considered for the surgery. I saw the ENT consultant last week and we decided to put it off for another few months but I'm now regretting it and I think the memory of the difficult recovery period swayed me. The impact of poor quality sleep on a child cannot be underestimated and having her sobbing her exhausted heart out at 4pm today because she's so worn out cemented my decision that we will go ahead. It really helped DS. You are doing the right thing :)

I think I remember the different name, Cashew, glad ds is fine and wishing you all the very best for an easier recovery for dd when the time comes

FWIW, with those who do find swallowing pain meds very tricky - as dd did - paracetamol and voltarol suppositories really are amazing. They work fast as they are absorbed super quickly, and are small and easy and dd (who was tiny at 26 months) didn't even notice them. The hospital gave us some, and the GP readily handed out a prescription for more.