Phone - (02) 9982 3439

Post Operative Care for Children

Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon, specialist registration in Otorhinolaryngology, Head & Neck Surgery.

Post-Operative Care for Children — Tonsillectomy / Adenoidectomy

This information is provided to guide parents and carers through the recovery period following their child’s tonsillectomy and/or adenoidectomy. Please read it carefully before the operation day and keep it accessible at home.


What to Expect

Pain
All children experience throat pain after tonsillectomy. Referred earache is common and does not indicate an ear infection — it arises from the shared nerve supply between the tonsil area and the ear. Pain is often deceptively mild on day one while local anaesthetic is still working, and worsens over days two to five. Give pain relief regularly and around the clock for the first five days — do not wait until your child is distressed. Keeping pain controlled makes drinking much easier and reduces the risk of dehydration. Adenoidectomy without tonsillectomy causes very little pain.

Wound appearance
A white or yellowish-grey coating forms over the healing areas where the tonsils were removed within 24–48 hours. This is normal healing tissue — not infection — and does not require antibiotic treatment. It begins to detach around ten to fourteen days after surgery, which is when the risk of secondary bleeding is highest. Antibiotics are not required after tonsil and adenoid surgery.

Snoring and sleep changes
Snoring may temporarily worsen in the first one to two weeks after surgery because of post-operative swelling. This settles as the swelling resolves. Most children show a clear improvement in sleep by three to four weeks post-operatively.

Nausea and vomiting
Some nausea after the general anaesthetic is common. Anti-nausea medication can be given on the ward if needed. If vomiting is distressing and sustained, please contact the hospital or Dr Roth’s rooms.


Pain Relief

Your child will be prescribed oxycodone syrup and regular paracetamol. Both can be given every six hours. Start giving both medications around the clock from the evening of surgery and continue regularly for the first five days, then reduce as tolerated.

  • Give pain relief 30 minutes before meals and drinks so that swallowing is as comfortable as possible
  • If your child refuses the oxycodone syrup, it may be mixed into a small amount of fruit juice
  • Do not give ibuprofen, Nurofen, aspirin, or any other NSAID — these increase bleeding risk from the healing wound
  • Do not exceed the recommended paracetamol dose — check the bottle carefully for weight-based dosing

Hydration — the Most Important Task

Keeping your child well hydrated is the most important thing you can do during recovery. Dehydration makes the throat wound more painful, which makes drinking even harder — a cycle that frequently leads to hospital readmission. Encourage frequent small sips throughout the day, even if your child is reluctant.

Signs of dehydration requiring urgent medical attention:

  • Dry lips and mouth
  • No wet nappies or very little urine output for six or more hours
  • Increasing lethargy and unwillingness to drink anything
  • Looking unwell or unusually pale

If your child cannot drink at all for more than 12 hours, contact Dr Roth’s rooms or attend hospital.


Activity and Return to School

  • Rest at home for the first week following tonsillectomy. Limit screen time if your child is visibly fatigued.
  • Return to school: Most children return to school at 10–14 days following tonsillectomy, and at approximately five to seven days following adenoidectomy alone.
  • Avoid all vigorous exercise for three weeks after tonsillectomy — including sport, swimming, gymnastics, running, and rough play. Physical activity increases blood pressure and haemorrhage risk.
  • Gentle walking and quiet activities at home in the second week are appropriate.

Bleeding — Recognising and Responding

If your child develops bleeding from the mouth that does not stop within one to two minutes — go immediately to your nearest emergency department.

Secondary haemorrhage is the most serious risk after tonsillectomy and can occur at any time up to 14 days post-operatively — most commonly between days five and twelve. It may appear suddenly even when your child has otherwise been recovering well. Do not wait and see if bleeding settles at home. Blood-streaked saliva in small amounts is normal; frank bleeding from the mouth requires immediate emergency attendance. Some children swallow blood and then vomit dark material — this also requires urgent assessment.


Follow-Up

A post-operative appointment is scheduled for approximately three to four weeks after surgery. Please contact Dr Roth’s rooms at any time if you are concerned.

Contact details:
Dr Roth’s rooms: (02) 9982 3439 — Monday to Thursday during business hours
Outside business hours: attend your nearest emergency department or GP.
Please note: Castlecrag Private and North Shore Private Hospitals have no emergency department and no on-site medical staff overnight — if your surgery was performed there and you require urgent after-hours assistance, please go directly to a public emergency department.

Dr Jason Roth | MBBS, FRACS (ORL-HNS) | MED0001185485
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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