Tonsils and adenoids in children

What the tonsils and adenoids do

The tonsils are two pads of tissue at the back of the throat; the adenoids sit higher up, behind the nose, where they can’t be seen directly. Both are part of the body’s immune defences in early childhood, sampling germs that enter through the nose and mouth.

They tend to be largest in young children and shrink naturally with age — the adenoids often almost disappear by the teenage years. Because the rest of the immune system takes over this role, children manage well if the tonsils or adenoids later need to be removed.

Common problems they cause

Two patterns usually bring a child to an ENT clinic. The first is repeated throat infections — frequent episodes of tonsillitis with sore throat, fever and difficulty swallowing. The second is obstruction, where enlarged tonsils or adenoids physically narrow the airway:

• A blocked nose, persistent mouth-breathing and a nasal-sounding voice
• Snoring, restless sleep, or brief pauses in breathing during sleep
• Frequent or lingering ear infections and “glue ear”, when large adenoids block the tube that drains the middle ear
• Repeated sore throats that keep a child off school or nursery

Why watchful waiting often comes first

Most sore throats in children are caused by viruses and settle on their own without antibiotics. Tonsils and adenoids also tend to shrink as a child grows, so a problem that seems significant at four years old may resolve by itself a year or two later.

For these reasons, the first step is usually careful observation rather than surgery — tracking how often infections truly occur, how much sleep and breathing are affected, and whether things are improving on their own. Keeping a simple record of episodes, with any doctor visits or fevers, is genuinely useful at the assessment.

When removal is worth considering

Removing the tonsils (tonsillectomy), the adenoids (adenoidectomy), or both is considered selectively — when problems are frequent or severe enough to affect a child’s wellbeing and simpler measures haven’t been enough. Guideline frameworks weigh the frequency and severity of well-documented episodes rather than any single magic number:

• Frequent, documented throat infections over time that disrupt school and daily life
• Obstructed breathing or disturbed sleep from enlarged tonsils or adenoids (sleep-disordered breathing) — now one of the most common reasons for surgery
• Persistent glue ear or recurrent ear infections linked to enlarged adenoids

What an assessment involves

At the visit, Dr. Marwan asks about the pattern of infections, breathing and sleep, examines the throat, nose and ears, and — where it helps — uses a small endoscope to look at the adenoids, which can’t be seen directly. If sleep is disturbed, questions about snoring and breathing pauses help judge how much the airway is affected. The aim is to match any treatment to the child, explain the options in plain language, and recommend surgery only when it is genuinely the right step.

If surgery is needed: the basics

Removing the tonsils and/or adenoids is a common, well-established operation, usually done under general anaesthetic as a day case or with a short stay. Recovery from tonsillectomy typically takes one to two weeks, during which a sore throat is normal; regular pain relief, plenty of fluids and soft foods help. Adenoid removal on its own is generally easier to recover from. Your surgeon will give specific aftercare advice for your child.

When to seek urgent care

After surgery, or with a severe infection, get medical help straight away if your child has:

• Any bleeding from the mouth or nose after surgery
• Difficulty breathing, or pauses in breathing during sleep
• An inability to drink fluids, or signs of dehydration (very little urine, drowsiness)
• A high fever that won’t settle, or worsening pain despite pain relief

Common questions