What are tonsils and why would a child need them removed?

This is a great question that comes up a lot. Everyone has heard of tonsils, but very few people actually know what they are or what they do.

The tonsils are small balls of tissue on either side of the back of the throat. They are made of lymphatic tissue and their primary role is fighting infection. There are other areas in the body that also make cells to fight infection, such as the bone marrow and thymus gland in the chest. 

When do the tonsils cause problems? With exposure to colds and infections the tonsils may get bigger. If they become too large, they may block breathing at night and cause snoring. Another reason is frequent infections. 

Large tonsils and snoring

The most common reason for tonsil removal is snoring due to large tonsil. If they grow too large, they can narrow the back of the throat and may cause snoring or difficulty swallowing. Nighttime symptoms of concern include pausing in breathing, gasping, choking, bedwetting and teeth grinding. Daytime symptoms may include excessive sleepiness, poor attention span and hyperactivity. Your doctor may recommend a sleep study — an overnight test to measure breathing — if more information about your child’s sleep is needed.

Infected tonsils (tonsillitis)

The primary symptoms of tonsillitis include a sore throat, swollen tonsils and fever. If you look in your child’s mouth, you may see tonsils that appear red, larger than normal and with a yellow or white coating.

Tonsillitis may be caused by viruses and bacteria, and as many as 30 percent of tonsillitis cases are caused by streptococci bacteria. Strep throat is highly contagious. If you suspect strep throat, contact your primary doctor’s office to be checked and treated; on rare occasions infection may result in damage to the heart or joints. If your child is diagnosed with strep throat, keep him or her home from school or daycare until cleared by your doctor. As with any illness, in addition to practicing good hygiene, be sure everyone in the family washes their hands regularly.

Removing tonsils (tonsillectomy)

Your doctor may recommend removal of the tonsils (a tonsillectomy) if the tonsils are large and causing breathing problems or repeated sore throats are impacting school attendance and quality of life. If your child experiences more than seven infections in one year, five infections a year for two consecutive years, or three infections a year for three years or more, a tonsillectomy might be necessary.

About the surgery

Approximately half a million surgeries to remove the tonsils are performed per year in the United States. At Children’s Wisconsin, we never refer to any surgery as “routine,” especially when general anesthesia is involved. Because of children’s growing bodies, they react differently to anesthesia than adults. That’s why anesthesiologists at Children’s Wisconsin are specially trained in pediatric medicine and have the expertise and experience to know how to administer anesthesia safely and effectively to children at any age.

A tonsillectomy takes approximately 30 minutes from start to finish and you can expect to spend several hours afterward in the hospital — in some cases the child will stay overnight. Recovery is painful, and may last one to two weeks. Encouraging eating and drinking helps speed up the recovery process. Although tonsils are lymph tissue, studies have shown that children do not have an increase in infections and are healthier after removal.

Talk to a pediatric ear, nose and throat specialist

If you are concerned about tonsil enlargement and breathing, or repeated tonsil infections, I recommend you speak with your child’s primary doctor. Your doctor will refer you to an ear, nose and throat specialist (otolaryngologist) who can talk to you if surgery is helpful for your child.

Ear, nose and throat specialists from Children’s Wisconsin care for children at our Milwaukee, Delafield, Mequon, Greenfield, Kenosha, and New Berlin clinic locations.

Cecille Sulman, MD Medical Director Ear, Nose and Throat Program

The Ear, Nose and Throat Program at Children’s Wisconsin provides specialized medical and surgical care to children, infancy through adolescence, who have problems with their ears, noses or throats. We have 18 board certified specialists and advanced practice providers who provide comprehensive ENT care at multiple locations.