Should my toddler’s tonsils be removed?
Your toddler’s tonsils could be making her sick. Look out for these signs.
Tonsils are fleshy pads located at each side of the back of the throat. The main function of tonsils is to trap germs (bacteria and viruses) which you may breathe in. Proteins called antibodies produced by the immune cells in the tonsils help to kill germs and help to prevent throat and lung infections.
“Young children struggle more with tonsils and adenoids because the glands enlarge in the first five to seven years of their life and are crammed into quite a small space in a child’s throat. So if they become infected and swell, that space gets even more constricted,” says Knysna-based ear, nose and throat specialist (ENT), Dr Martin Young. “It’s often the tonsils and/or adenoids that could be causing your child’s ill-health.” The following may be signs that your child’s tonsils are causing problems:
Snoring
“Snoring is a biggie,” says Dr Young. “If your child is snoring, be aware that this isn’t normal, especially if she’s choking as a result. This is called sleep apnoea, and it requires immediate attention because of the significant risks to a child’s health.”
Sleep apnoea
Basically what happens is that the tonsils and adenoids are enlarged to the point that they block the child’s airways when she’s sleeping. Sleep apnoea means that she briefly stops breathing and wakes up repeatedly during the night.
“When this happens, aside from the negative effects on the heart and lungs, children use a significant amount of the body’s energy trying to breathe, instead of using that energy for the growth, learning and processing that takes place during normal sleep,” says Dr Young. “Children don’t get tired when they lose out on sleep; instead, they get fidgety and hyperactive, and parents or teachers may think they have ADHD. If a child who snores is brought to me and she has large adenoids and tonsils, I have no hesitation in suggesting they be removed, even if she’s not getting tonsillitis.”
Notice if your child is a very restless sleeper, or if she snores loudly and then gasps and moves a little. This happens when the muscles around the tonsils and adenoids are relaxing and collapsing the airways. The airways get blocked, and the brain wakes the child up to prevent suffocation.
Once the adenoids and tonsils are removed, the child will sleep better. Even if she’s just snoring a lot, and doesn’t have sleep apnoea, it’s probably because her airways are obstructed, so it’s worth having her tonsils checked. Her tonsils and adenoids will shrink as she gets older, so her snoring may fade, but it’s wisest to have her assessed.
Tummy problems
One of the signs that your child’s tonsils are unhappy may be tummy problems – anything from loss of appetite to a stomach ache. “If a child has large, functional, hard-working tonsils, they may send inflammatory by-products into the intestine,” says Dr Young. “This causes an immune response in the lymph glands of the intestine, which means they enlarge and cause discomfort. When we look in the child’s throat, we see enlarged tonsils. Remove the adenoids and tonsils and the tummy problems should disappear.”
Recurrent sinusitis
If your child gets recurrent sinusitis (confirmed by an ENT), it’s reasonable to remove the adenoids and perhaps the tonsils, as these are the areas where bacteria can re-infect the sinuses. Bacteria hitchhike within the adenoid and tonsil cells, where antibiotics can’t reach them, leading to recurrent sinusitis. While removing these glands, your ENT may also wash out your child’s sinuses, to open the drainage pathways, and help to clear the infection.
Chronic sore throat
If your child is getting a sore throat often, then her tonsils may be the problem, especially if they have yellow spots on them, and if she’s spitting out what look like rice grains that taste and smell bad. “That’s tonsil debris, and it usually means chronic tonsillitis, which can grumble on for some time, and cause bad breath and a sore throat,” says Dr Young. “We see this more in older children and adults, and it can’t really be managed medically. The only way to cure the condition if it’s problematic, is to remove the tonsils and adenoids.”
Breathing through the mouth
This goes hand in hand with snoring and must also receive medical attention. “If the child is habitually breathing through her mouth, then the upper jaw grows larger in order to close the mouth. As a result, you end up with ‘adenoidal facies’, an elongated face with a long upper jaw. And there’s a good chance that she’ll need dental treatment (because the teeth dry out and develop cavities), as well as orthodontic treatment in later years to correct her bite.”
Also look out for dark rings around the eyes, which result from dark, venous blood flowing back under the skin from the congested nose and throat; as well as a permanently snotty nose that doesn’t respond to allergy treatment. The nose makes a lot of mucus every day, so if the adenoids are enlarged, they may block the normal backwards drainage into the throat.
