Category Archives: Child Tonsillectomy

A guide for parents of children planning or recovering from tonsillectomy surgery

Child Tonsillectomy Pain Medication

Children have a unique set of advantages and challenges when it comes to tonsillectomy . Their bodies are not the same as adults’. Resilience and ability to heal more quickly usually means a shorty recovery time, but special consideration should be given when giving pain medicine to children recovering from tonsillectomy and adenoidectomy surgery.
This article is written by Brian Stehula PharmD, RPh. Brian is a pediatric pharmacist working in a regional hospital. I’m very pleased to share with you his insights into the latest trends in pain medication for children, particularly those recovering from tonsillectomy surgery. -Greg Tooke 

Post Tonsillectomy Pain Medication for Children

pediatric pain medication
Brian Stehula, PharmD, RPh



The recommendations for the best and safest pain control for pediatric patients after a tonsillectomy are changing. Concerns are now known when children receive a pain medication containing codeine after surgery. Although pain medication with codeine has worked well for some pediatric patients it also has been proven be quite dangerous for some children. Not all children’s bodies break down (metabolize) codeine at the same rate and therefore some children can get high amounts of pain medication in their body quickly. There have been some reports where the pain medication had built up so quickly that some children died from high amounts of medication in their system. These overdoses have happened even when normally recommended doses of codeine were given.

Instead of giving codeine we now have safer choices that work just as well.. There is growing information that the after surgery, tonsil pain can be treated very well with over- the-counter (OTC) medications such as acetaminophen (TYLENOL) and ibuprofen (MOTRIN /ADVIL).
Doctors often have not used ibuprofen (MOTRIN/ADVIL brand names) because they believed it increased the chance of bleeding after tonsillectomy surgery. Children who are given ibuprofen starting the day after surgery very rarely have throat bleeding after tonsillectomy.

The current advice is to give acetaminophen (TYLENOL) in the recommended dose starting right after surgery and to repeat every four hours. Children who have no bleeding can also begin ibuprofen on the day after surgery. Surgeons are able to keep the stronger narcotic (examples include codeine, hydrocodone, and oxycodone) medications for those patients above 3 years of age who do not have good pain control with the acetaminophen (TYLENOL) and ibuprofen (MOTRIN/ADVIL) combination.
Some Tips for Child Tonsillectomy Pain Medication.

  • Talk about options for pain control with your Pediatrician, Family Medicine, or Surgeon before surgery.
  • Your Physician may include an anti-inflammatory steroid like dexamethasone for one to three daily doses after surgery.
  • Throat pain is greater the first few days following surgery and may last up to two weeks.
  • Talk to your child about their throat pain, if they are having pain the earlier you treat it the better the medication will work.
  • Make sure that your child drinks plenty of fluids after surgery. Staying well hydrated is associated with less pain.
  • Ibuprofen can generally be used safely for pain control starting the day after surgery.
  • Pain medicine should be given in the dosage and timing as directed by your child’s Ear, Nose, and Throat Surgeon, Pediatrician, Ped’s Nurse or Pharmacist.
  • For the first few days following surgery, medications should be given on a regular schedule to keep pain better controlled.
  • Children may complain of pain in the morning more than other times of the day.
  • Acetaminophen and Ibuprofen come in liquid form, chewable tablets, and regular tablets and capsules. Choose the form your child can most easily swallow.
  • Rectal administration can be an option for young children refusing to take pain medication orally.
  • Call your health care provider if you are unable to adequately control your child’s pain.
  • Post-Tonsillectomy Pain Control

All ages

  • •Acetaminophen (TYLENOL) on day of surgery give every four hour doses. Have your health care providers help you calculate the appropriate dose and when to give medicine.
  • Ibuprofen (ADVIL/MOTRIN) 10 mg/kg/dose, maximum of three doses in 24 hours, beginning the day after surgery.
  • When ibuprofen is started on day after surgery you can alternate it with acetaminophen.
  • By giving acetaminophen every 8 hours and ibuprofen every eight hours you can alternate which medication is given every four hours.

Ages less than 3 years no narcotics.


Narcotics for pain include medications with hydrocodone, codeine, oxycodone and others. Some of these medications exist in forms that are combined with acetaminophen (Tylenol #3, Tylenol with Codeine liquid, Lortab, Vicodin, Percocet, and others)

Child Tonsillectomy | Sleep Apnea in Children


Child Tonsillectomy

Child Tonsillectomy | Sleep Apnea in Children
Child Tonsillectomy | Sleep Apnea in Children

One Mother’s Experience With Snoring, Sleep Apnea, and Tonsillectomy

Child Tonsillectomy is not simple-but a must for our kid who snored

Adenoid removal surgery on a child seems to be a 3 day recovery, while adding tonsil removal to the surgery day adds 11 more days of recovery. As a scared parent of a child with diagnosed childhood sleep apnea, I still had to talk to many people, take my son to 2 different ENT doctors AND an allergist to be convinced to do tonsillectomy surgery in our child.

Please don’t let anyone do tonsillectomy surgery on a child less than 2.5 years unless they need surgery to survive to the next day! The Internet is full of death stories about adenoid and tonsil removal surgeries on children 2 years or younger. If you decide to do tonsillectomy surgery, make sure you are within 20 minutes of a GOOD hospital; if there is major post operative bleeding, young patients can die. I had to do a lot of research to convince me to have tonsils removed from my kid.

My son’s sleep apnea and childhood tonsillectomy story:

Since birth, my son had the following issues. He snored at less than 1 year and did mostly mouth breathing which caused frequent choking while eating. The only sickness he had was a yearly sinus infection; he never had bad ear or throat infections. My son’s biggest problems were trouble sleeping, hyperactivity, and constipation. Otherwise, he seemed to be a healthy kid. Removing the Adenoids was an easy decision after I insisted an ENT look at the adenoids with a scope to verify they blocked off my son’s nose passage almost completely. My husband’s experience with adult sleep apnea also helped our decision to remove my son’s adenoids. My husband’s parents were convinced in the early 1980′s he didn’t need surgery at age 5. After decades of problems, he can’t breathe well enough to live a long life, so he is suppose to use a CPAP machine. It seems surgery after puberty does not help sleep apnea patients much, so we wanted to prevent this future problem for our son.

The first highly recommended ENT surgeon we saw pretended to check our sons adenoids with a simple flashlight looking up my son’s nose and said “oh yes, they need to come out” and “tonsils should be removed because that is standard procedure for sleep apnea” . After we found out you can’t see adenoids without a small scope, we were skeptical and sought a second opinion.

Tonsil removal should not be considered lightly, the recovery process can be long. Some doctors play down the recovery process. My heart goes out to the kids and parents making this decision based on repeated sickness in the ears and throat. After reading a lot of tonsillectomy articles written by doctors, I would wait to remove tonsils to alleviate sickness until a whole year goes by and you or your kid is: older than 2yrs AND has 4 infections IN ONE YEAR. Some ENT surgeons rush surgery and perform it on kids less than 2 yrs. You must consider the risks, pain, and recovery after tonsil removal is worth it or you shouldn’t do it! Don’t assume you will be the lucky one who has a quick recovery and no post operative bleeding. To help you after surgery, I compiled these tips we found necessary!

Good pre and post operative tips can be found on this website. Also, post-op tips for parents can be found at http://www.childrensmn.org/manuals/pfs/surg/018765.pdf. This website is good because they give you good food tips and remind patients that a soft-food diet is necessary for 2 weeks after child tonsillectomy. Did you know major arteries and veins could have been injured in tonsillectomy surgery and surgeons cauterized to stop them from bleeding? The potential for bleeding 10 days after surgery must be taken more seriously than many people want to admit to you! I didn’t get all my info in one place or from my ENT, (ear, nose, and throat)doctor. I’ve tried to help others by posting this long post on the Internet. The Internet has so many scary stories and so many websites that make you think tonsil removal is easy and routine. My husband and I really appreciated helpful tips from a real parent’s and real patient’s experience.

I found only a few websites mentioning how much propping the patient’s head up with pillows can help recovery for the whole 2 weeks (use same height/angle that helps relieve acid reflux). I wish I found this tip on day 1 post-op!! My husband and I found this website really helpful http://tonsillectomyrecovery.com/tonsillectomy-recovery-forum/ For the good photos and patient stories about how long recovery can take. Check the surgery area daily (if you can with a popsicle stick to help hold down the tongue) but look over this website’s photos so you know what to expect! http://tonsillectomyrecovery.com/tonsillectomy-recovery-forum/ .

Homemade ice pops (made with mostly water) will be necessary for weeks 1 AND 2 after tonsil surgery! I can not say enough how helpful those home-made ‘water juice pops’ were! The tonsil removal patient needs round-the-clock care like a newborn so get help or you will never make it to day 10!!

Beware, I found BAD advice posted on the internet by ear, nose, and throat professionals!! Bad advice rushes recovery telling patients they can go back to playing outside or back to work/school before the scabs come off the tonsils; the scabs don’t come off in kids until one week after surgery (at the earliest). Bad websites only mention how recovery can be quick for people so you feel better about your potential recovery. Bad advice promotes post operative bleeding by telling patients they can eat french toast for breakfast! For 2 weeks patients should only eat soft foods. Bread Is only OK IF the crust is removed and ONLY IF THE BREAD IS SUPER SOFT. You can easily find internet stories from parents whose children died due to bad doctors or bad food advice! Be prepared and you will be thankful. Our child had a successful adenoidectomy and child tonsillectomy, but it wasn’t easy. We were thankful for good tips we found on the internet! Article by: Shannon Gordon