Discharge Instructions: Tonsillectomy and Adenoidectomy

Important information following surgery:

We believe all children have a right to the best pain management that can be safely provided. The goal is to recognize pain and treat it successfully with medicines and comfort measures. Your child will likely have pain after surgery. Your child may not be pain free, but we will help each child to be as comfortable as possible.

Patient instructions following surgery: 

Pain and discomfort

• Many children have pain for up to 10 to 14 days after surgery.

• Encourage frequent chewing to decrease throat, jaw and ear pain. An ice collar may make your child more comfortable.

• Ear, jaw and neck pain can occur. The pain may get more severe 3 to 7 days after surgery. 

• Signs of pain after tonsillectomy include crying, touching the head, throat, ears or neck, drooling, refusing to drink.

• Your child should take acetaminophen and ibuprofen (Motrin®), or acetaminophen (Tylenol®) and celecoxib (Celebrex®) for post-op pain.

• Give your child dexamethasone 48-72 hours (2-3 days) after surgery if the other pain treatments of celecoxib and acetaminophen or ibuprofen and acetaminophen does not relieve your child’s pain and is showing signs of severe pain. 

• Signs of severe pain include:

  • Child rating pain score as 8 or above

  • Crying more than normal or excessive crying

  • Refusing to open mouth or talk

  • Less active, sleeping excessive amount or curled up in bed

  • Not drinking or drinking only sips

• Give the pain medicine that is ordered by your surgeon.

• Give the pain medicine with milk or food to prevent stomach upset.

• Do not give aspirin products for 2 weeks after surgery.

• Please read your Tonsillectomy and Adenoidectomy Diary every day.

• It is normal for the uvula in the back of the throat to swell or be very large.

Bleeding

When the tonsil or adenoid scabs fall off, your child may bleed from the mouth or nose. If you see blood, call ENT immediately.

Diet, poor appetite, weight loss

• Many children do not want to eat their normal diet for 2 weeks. Their appetite will be decreased. Encourage your child to eat and drink often. 

• The Tonsillectomy and Adenoidectomy Diary tells you how many ounces your child should drink every day. 

• Encourage your child to drink often, starting the day of surgery. Jell-O, pudding, ice cream and popsicles count as drinks. 

• If your child does not want to drink, offer small amounts of fluid often. 

• Offer Carnation Breakfast Essentials® or Pediasure® if you are concerned with your child’s nutrition, or they have weight loss. 

• Your child may drink or eat anything that they would like. 

Constipation

• Your child may not have a bowel movement for several days after surgery. 

• Encourage your child to drink often, especially high-fiber drinks. Examples are pear, apple, or apricot juice. 

• Encourage high-fiber foods. Examples are fresh fruit, vegetables, raisins, prunes, and oatmeal. 

Activity 

• Closely supervise your child for 24 hours after receiving anesthesia. 

• Many children do not return to their normal activity level for 7 to 14 days after surgery. 

• Plan to stay within the tristate area for 14 days after surgery. Flying in an airplane is not recommended until 21 days after surgery. Discuss travel plans with your surgeon. 

• Your child may shower or bathe. 

• Your child may return to school or daycare and all gym/play activities when they:

• feel ready 

• are eating and drinking well 

• only need an occasional dose of acetaminophen, ibuprofen or celecoxib pain medicine for mild discomfort or pain 

Nasal congestion and cough

• Encourage your child to drink a lot, including water, juice or milk. 

• Use normal saline nasal spray in the nose every 2 to 3 hours as needed while awake. 

• A cool mist humidifier can be used while sleeping. 

• Keep their head propped up on 2 pillows. 

Bad breath

• Your child will have bad breath until the tonsil and adenoids scabs fall off, in 10 to 14 days. 

• Encourage your child to brush their teeth and tongue at least 2 times a day. 

• Use normal saline spray in the nose every 2 to 3 hours while awake.

Voice changes

• Your child’s voice may change after surgery. It may have a “nasal” sound. The voice usually returns to normal within 12 weeks after surgery. 

• Liquid may come from your child’s nose after they drink. Encourage small sips or drinking through a straw. This problem usually goes away within 12 weeks after surgery. 

Follow-up appointment: 

• The ENT department will contact you by letter 4 to 8 weeks after surgery to check on your child’s progress. 

• A follow-up appointment is not required unless you or your surgeon request one.

Suggested shopping list: 

• Drinks including juices, milk, Pedialyte® (for children under 2 years)

• Soft chewing gum or chewy candy, crunchy food including pretzels, chips, crackers

• Ice cream, yogurt, pudding, popsicles, Jell-O

• Acetaminophen liquid or tablets (suppositories for children under 4 years of age)

• Ibuprofen (if your surgeon recommends this medicine after surgery)

• Normal saline nasal spray (any brand)

Call 911 immediately, if your child has difficulty breathing. 

Call you CHOP ENT team with questions, concerns or if your child: 

• Has bleeding from the nose or mouth or has bright red blood in vomit. Call immediately. 

• Does not feel any better 45 minutes after taking pain medicine. 

• Drinks very little or refuses to drink. 

• Urinates less than twice a day. 

• Has no tears with crying. 

• Vomits 2 times in one day.

• Is constipated.

• Has a temperature of 102ºF (38.8 C°) or higher by mouth or rectum. 

• Has severe bad breath. 

• Has severe neck pain or a stiff neck or their head is tilted to the side. 

What to Expect After the Operation:

Watch the video

https://info.chop.edu/4btD9Ww

Division of Otolaryngology (Ear, Nose and Throat)

215-590-3440 

7 days per week/24 hours

Reviewed February 2024 by Christie Alminde R.N. CPN