When should tonsils be removed?
Tonsils are oval-shaped tissue located on both sides of the throat. They are made up of lymphatic tissue, which is responsible for helping the body to fight infection. The size of tonsils can vary from person to person. However, they can become enlarged during an infection.
Your child’s pediatrician checks your child’s tonsils by having your child open his or her mouth wide and shining a light inside. An infant or young child may require the help of a tongue depressor to get a good look all the way in the back of the throat.
While tonsils are present in the body to help fight infections, they can often cause problems, especially when they become infected themselves. Symptoms of infected tonsils include a sore throat, red and swollen tonsils, pus or ulcers on the tonsils, fever, and swollen glands on the side of the neck.
Infections are not the only problems that can develop with tonsils. Enlarged tonsils can also lead to sleep problems, such as snoring and obstructive sleep apnea.
Years ago, many children underwent surgery to remove tonsils after just a few episodes of infection. However, in 2011, the guidelines regarding who needs tonsillectomies (tonsil removal) became much more conservative. Physicians realized that although the surgery was once routine and widely performed, there were very real and potentially serious risks associated with surgery, including infections and bleeding.
The current recommendations say children should only be considered for tonsillectomy if:
- They have had more than 7 infections in the past year
- They have had more than 5 infections each year for the past 2 years
- They have had more than 3 infections each year for the past 3 years
Each of these infections need to be documented by a physician, not just reported by the parent.
Even if a child meets all requirements, this does not automatically guarantee that the child will be taken to surgery. An ear, nose, and throat specialist will decide which patients would benefit most. Tonsillectomy can be a painful procedure with a difficult post-operative course, so the benefits must be weighed against the risks of the surgery.
Reviewed by Dr. Sara Connolly, May 2020
Takeaways
- Tonsils are located in the throat and help fight infection.
- Tonsils can become infected.
- Symptoms include sore throat and swollen tonsils.
- Surgery is not recommended as often as it used to be.
I think it’s important to remember that strep throat is typically a condition of preschool and school-aged children, not babies (and usually not toddlers). The tonsil tissue is not well-developed for infants. Even if someone has a positive rapid strep test, is it truly an infection worth treating? Probably not. The reason why we treat strep throat at all is to prevent rheumatic fever (plus it makes the patient feel better, resolves fever, helps a child to drink, etc.). The Infectious Disease Society of America (IDSA), which pediatric infectious disease doctors trust and use for guidance, recommends not performing diagnostic studies (such as rapid strep screen or throat culture) for children less than 3 years old because acute rheumatic fever is rare in children less than 3 years old and the incidence of strep throat and the classic presentation of strep throat (fever, sore throat, abdominal pain, etc. in the absence of viral symptoms like cough, congestion, runny nose, etc.) are uncommon in this age group. Selected children less than 3 years old who have other risk factors, such as an older sibling with strep throat infection, may be considered for testing.