Tonsillectomy is removal of the tonsils. Adenoidectomy is removal of the adenoids. If they are done together, the surgery is often called a "T and A." Because children with bleeding disorders have an increased risk for bleeding after this surgery, it is generally recommended that they stay overnight in the hospital for close observation. It is common to have an upset stomach and vomiting (throwing up) during the first 24 hours after surgery.

After surgery, DDAVP and Amicar® may be given intravenously (in the vein) to help control bleeding. These medicines are important to the healing process, so your child will stay in the hospital until able to take them by mouth. Your child will be given pain medicines after surgery. Children with bleeding disorders must not take aspirin or nonsteroidal anti-inflammatory medicines, such as ibuprofen, which increase the chance of bleeding.

Children with bleeding disorders may take acetaminophen for pain and inflammation (swelling). Talk with your doctor, nurse practitioner or nurse if you have questions about the medicines.

Your child’s throat may be sore for two weeks, especially when eating. The soreness may get better after a few days and then get worse again. Your child’s voice may change a little after surgery. Call the hematology clinic if the soreness prevents taking the medicines.

Ear pain is common, often when swallowing, because the ear and throat have a common sensory nerve. Jaw spasms (sudden twitching) may also occur and cause pain. Neck soreness is common after an adenoidectomy and usually lasts about one week. You can expect your child to have bad breath for a few weeks. Because of swelling in the throat, snoring is common after surgery but should go away after about two weeks.

Caring for your child after a tonsillectomy

Give him or her liquids to drink. Keeping the throat moist eases discomfort and prevents dehydration (a dangerous condition in which the body dries out). Older children can chew gum to increase the flow of saliva and the rate of gentle swallowing. This decreases throat soreness and jaw spasms; it does not take the place of liquids.

Your child may need to continue the DDAVP and Amicar after going home, to help prevent bleeding. DDAVP may be given intravenously (IV) in the clinic, or by using the nasal spray Stimate® at home. With DDAVP or Stimate, follow the fluid restriction guidelines given to you, and refer to the education sheets "DDAVP (desmopressin acetate) for bleeding disorders" or "Stimate (desmopressin acetate)."

Amicar is often given by mouth using pills or liquid. Children may not like the taste, but Amicar must be taken as often and as long as prescribed to prevent bleeding. Give pain medicine regularly within the limits set by your doctor. Give it before bedtime and right after waking in the morning. Try to time other doses 30 minutes before meals to help make swallowing easier. Pain medicine suppositories are available for younger children who often refuse to swallow medicines.

To prevent bleeding, avoid coughing, nose blowing, clearing the throat and spitting. Wipe the nose gently if needed. When sneezing, encourage your child to open the mouth and make a sound, to prevent pressure buildup.

Avoid coming in contact with people who have colds, flu or infections.

Eating

For the first day, give only cool, clear liquids such as apple juice, water, Popsicles®, Jell-O® and pop that has lost its fizz. If your child has an upset stomach, give small amounts often. Avoid red liquids, because if your child vomits, the vomit will be red, which may look like blood.

The second day, when your child wants them, start dairy and soft foods such as ice cream, milk shakes, smooth yogurt and pudding. Liquids are more important than food. Be sure your child drinks enough to urinate every eight hours. But if your child is using DDAVP or Stimate, follow the fluid guidelines for those medicines. Avoid citrus fruits and juices such as orange juice, as they may sting your child’s throat.

When your child wants them, add other soft foods such as applesauce, cooked cereal, canned fruits, cottage cheese, mashed potatoes, scrambled eggs and warm or cold soups. Continue the soft diet for one to two weeks after surgery. Avoid foods with rough edges such as chips, crackers, hard candy, pretzels, popcorn and pizza crusts for two weeks after surgery. Also avoid foods that are hot in temperature or spicy hot until after your child sees the surgeon again.

Other things you need to know:

• Bleeding risk is greatest at two times: right after surgery and seven to 10 days afterwards, when the scab may fall off.
• Be sure to return to the hematology clinic as instructed, about six days after surgery.
• Do not travel out of reach of your doctor until after your child has seen the surgeon again (about 14 days).
• Healing takes about two to three weeks.
• Encourage quiet activities indoors for the first three to five days.
• Children can usually return to school or day care after one week.
• No active play, gym or running for two or three weeks after surgery. Avoid any activity that lowers the head below the heart (such as gymnastics or hanging from monkey bars) for three weeks after surgery, because this greatly increases the risk of bleeding.

Who and when to call for help

Call the hematology clinic if you notice:

• Bleeding
• Vomiting of blood or pink-tinged fluid
• Nosebleed
• Soreness prevents taking medicines
• Problems giving Amicar, DDAVP, or Stimate

Call the surgeon if:

• Pain is not relieved with medicines
• Upset stomach and vomiting continues more than 24 hours after surgery
• Temperature higher than 101 degrees F

Signs of dehydration:

• Sunken eyes
• Dry, sticky lips
• No urine for more than 8 hours
• No tears