The nurse provides discharge instructions to the parents of a child who has undergone tonsillectomy

Your child is scheduled for a T&A (Picture 1) at Nationwide Children’s Hospital. A nurse from Outpatient Surgery will call you the afternoon of the day before surgery to give you the following information:

• The time to stop giving food and liquids before surgery

• The time to arrive at the hospital

• The time of surgery

The nurse will also ask you questions about your child's health including:

• Recent exposures to contagious diseases

• Any medicines your child is taking

• Anything about your child's health that the doctors and nurses need to know to care for your child

If it is more convenient, you may call the Surgery Center at (614) 722-2920 after 2 pm. 

If no one has contacted you by 5 pm, please call the Main OR at (614) 722-5200.

Preparing for Surgery

• If possible, attend a Welcome Walk Orientation Program at Nationwide Children’s Hospital before your child's surgery. The children and their parents will tour the hospital unit, pre-operative area, and Recovery Room. There is also a "medical playtime" for the children while a nurse talks with the parents. The tours are mostly for children ages 2 to 12 and their parents. Brothers and sisters are also welcome. Please call (614) 722-4595 to make reservations.

• Starting 2 weeks before surgery, do not give aspirin or ibuprofen (such as Advil®). These medicines can cause bleeding problems after a T&A.

• Explain to your child that he or she will be asleep while the doctor takes out the tonsils and adenoids. He or she will wake up in the Recovery Room after surgery. A special doctor or nurse will be there to make sure that your child does not wake up until the operation is over. 

• Explain to your child that he will have a very sore throat and will need to drink a lot of liquids to feel better.  Your child will be given pain medicine to help his or her sore throat.

• Please check with your child's school, day care, friends, and relatives to see if your child may have been exposed to any contagious diseases including chickenpox or the flu in the last month.  If he or she has been exposed, call the ENT Clinic at (614) 722-6547 or your doctor’s office.

• Give your child a bath or shower at home the night before surgery.

• Your child may bring a few favorite toys. Please label all items with his or her name.

Food and Drink Before Surgery - It is Very Important to Follow These Instructions Exactly

• Your child may have CLEAR LIQUIDS up to 2 hours before surgery. After that, he may have nothing else to drink. Clear liquids are those you can see through that have no pulp or food bits in them. Examples of clear liquids are water, apple juice, white grape juice and Pedialyte®.

• Your child may have breast milk up to 4 hours and formula up to 6 hours before surgery and water or Pedialyte® up to 2 hours before surgery. All other liquids, semi-liquids and solid foods MUST BE STOPPED 8 hours before surgery.

• Gum, cough drops and hard candy are not allowed. If your child has been chewing gum, surgery will be delayed 2 hours from the time the gum is spit out. If the gum has been swallowed, surgery will be delayed 8 hours from the time it was swallowed.

The Day of Surgery

• Bring your child to the Surgery Unit or Surgery Center entrance (see map on page 6).

• If you have a health card or insurance forms, bring them with you. You also need to know if your child's immunizations are up to date.

• Please bring your child’s social security number and the social security number of a parent or legal guardian.

• Your child will be weighed, measured, and have his blood pressure and temperature checked.

• Your child will be given a physical examination.

• You will fill out a form and talk to an anesthesiologist before surgery.

• Your child will be given a toy to keep.

• A nurse will be assigned to you for all the time your child is in the hospital. The nurse will give nursing care and explain routines, procedures, and home care to you.

• Children under 12 are not allowed to visit the patient units. This helps reduce the risk of infection to our patients.

• Parents must wear their pink/yellow badges at all times. Visitors must go to the information desk and get a blue visitor's pass.

What to Expect After Surgery – Recovery Room

• Your child's throat will be very sore. Pain medication may be given by the nurse every 3 to 4 hours the evening and night after surgery. The more your child drinks, the better he or she will feel. Your doctor may also give you a prescription for pain medicine.

• Your child will have an IV (intravenous line) until he can drink on his own. The IV is put in after the child is asleep in the Operating Room.

• Your child may need to throw up after surgery, and this is normal. Call your child's nurse if this happens.

• It is normal to have a slight fever for several days after surgery.

• For the first 1 to 2 hours after surgery your child will have only water. After that, clear liquids such as 7-Up®, popsicles, and apple juice will be given. Solid foods are given later when the child is ready.

Care at Home

• Some patients have less of an appetite after surgery, but it is very important to continue to drink fluids to stay hydrated and to lessen the discomfort. Follow your doctor’s instructions about what diet your child should have after surgery. Eating food will not hurt the throat. Make sure your child drinks plenty of clear liquids often (Picture 2).

• Sore throat is the most common complaint after surgery. This may last for 7 to 10 days. For some children, the sore throat gets worse 5 to 8 days after surgery. Gray or white film will appear where the tonsils used to be. About a week after surgery, this film will come off and your child may have a sore throat again for a day. Drinking plenty of fluids will help to decrease the discomfort.

• Your child may have bad breath, “stuffy nose” and drainage for 7 to 10 days after surgery. This is normal and will go away as he or she heals.

• Your child may have ear pain up to a week after surgery and it may be worse at night. This is normal and is coming from the tonsil area. Giving pain medicine usually helps.

• Get your child up and about, and do not keep him from playing. He may play outdoors, but should avoid swimming, contact sports, strenuous activity and travel for 2 weeks after surgery.

• Your child may go back to school 1 week after surgery.

Pain Medicine After Surgery

Doctor's Order

• Your child's doctor has recommended acetaminophen. Tylenol®, Feverall®, Panadol® and Tempra® are some of the brand names of this medicine. Use this as directed. It is helpful to give your child pain medicine every 4 to 6 hours for the first 48 hours after surgery and then as needed to keep pain controlled. Do not give Tylenol® at the same time as Lortab or other pain medicines containing acetaminophen. Follow the instructions on the label to find the number of tablets or amount of liquid to give your child.

• For children over 3 years of age, your doctor may prescribe a narcotic pain medicine called Lortab (hydrocodone and acetaminophen) for postoperative pain control. This medicine should be given as directed. Check on your child regularly after giving this medicine. Do not give this medicine within 4 hours of giving Tylenol® or other acetaminophen-containing medicines.

• Your physician may recommend ibuprofen (Motrin®, Advil®) for pain control. These medicines can be alternated with either acetaminophen or Lortab because they do not contain acetaminophen. Please discuss with your physician whether ibuprofen is appropriate for your child after surgery.

• If your child has severe pain that is not relieved by pain medicines given as directed, call the doctor.

• Side effects are rare, but if your child has nausea or vomiting, skin rash or bruises, stop giving this medicine and call your doctor.

Safety Tips and Other Advice

• Read the label each time before you give your child this medicine.

• Give the exact amount of medicine as ordered by your doctor.

• If the medicine is a liquid, use a pediatric measuring device (available at the pharmacy) to measure the exact dose.  Do not measure liquid medicines in kitchen spoons.

• Stay with your child until he or she has swallowed the dose of medicine.

• Do not give more than 5 doses of this medicine in a 24-hour period unless ordered by your doctor.

• Store all medicine out of the reach of children.

• If your child or someone else takes too much of this medicine, first call the Central Ohio Poison Center at 1-800-222-1222 (TDD 614-228-2272). They will tell you what to do.

When to Call the Doctor

Call your child’s doctor if any of the following occurs:

• Your child may have a slight fever for a few days after surgery. If the temperature goes over 101 F, and it does not stay down with Tylenol or Motrin as prescribed, contact our office at (614) 722-6547. After hours, call the main hospital operator at (614) 722-2000 and ask for the ENT resident doctor on call.

• Call the ENT Clinic Nurse at (614) 722-6547 if drainage from the nose continues after 14 days.

• Sometimes children will bleed from the nose or mouth as late as two weeks after the operation.  In most cases it is not serious but contact your child’s doctor immediately if this occurs.

Follow-Up Appointments

Generally, most children do well after tonsillectomy and adenoidectomy surgery. The ENT nurses will follow up with you by phone within 3 to 4 weeks after surgery. 

If you have any concerns, you may notify us and an office visit will be scheduled. Please call the ENT nurse at (614) 722-6547 with any questions.

Tonsillectomy and Adenoidectomy (PDF)

HH-I-64 12/76, Revised 1/17 Copyright 1976, Nationwide Children’s Hospital

Which action would the nurse do first when planning to provide a back massage to a client quizlet?

Which preventative measure will the nurse include in education regarding the prevention of acute otitis media in children?

Which method of medication administration is commonly used in toddlers when the child has poor intravenous IV access during an emergency situation?

Which is a complication that may develop in the child with hypospadias?