Your child is in preschool and brings home the dreaded note from her teacher: "Your child has been exposed to tonsillitis." It is 5:30 PM, your doctor's office is closed, and panic sets in. What is tonsillitis? Does it have something to do with her tonsils? Does it have something to do with strep throat? Is some treatment needed tonight, even though my child seems fine? Why didn't we discuss this with our doctor at her last well checkup? These and many other questions will be posed and answered in this article on Tonsils and Adenoids .

What are tonsils and adenoids?

The tonsils can be seen at the back and to the sides of the throat. They are reddish, oval-shaped lumps of tissue, and are located on both sides of the uvula (the little piece of tissue that hangs straight down in the back of the throat in the midline). When the tonsils become inflamed, the condition is called tonsillitis. The adenoids cannot be seen directly, as they sit in the space above the uvula. The tonsils and adenoids have often been felt to be involved in the immune system, but their exact role has not been determined.

It is common for youngsters under age six or so to have "large" tonsils and adenoids, possibly because of their greater number of exposures to germs from other children or from allergies. When the tonsils and adenoids are infected, they become very swollen and red and can cause problems with swallowing and/or breathing.

How can you detect infection of the tonsils and adenoids?

Since the tonsils are visible at the back of the throat, just ask the child to relax the tongue and take a deep breath. This causes the tongue to drop down and the palate to rise which makes the tonsils visible even without the dreaded tongue-blade. Get to know your child's normal, uninfected tonsils, since, as mentioned, they can be rather large in the "normal" state. Infected tonsils will be larger and redder than normal. Also, her voice may change, taking on a thick sound as if she is "talking around" something. Adenoids cannot be seen directly, but require special mirrors or scopes, or even x-rays to detect. When these are enlarged, patients often complain about trouble breathing through the nose (creating the well-known mouth-breathing phenomenon) or difficulty smelling things.

If your child has infections of the tonsils and adenoids infrequently, there is no reason for concern or action, as this is quite common. The symptoms will disappear after the infection or allergy has resolved. Persistent swelling, however, can really affect the quality of your child's life and requires further evaluation. The signs to look for in persistent swelling of the tonsils and adenoids are:

The child's speech is affected, causing the nose to sound like it is always blocked when she talks. This may cause the typical "I hab a code in my dose" quality of speech.
She is a noisy breather most of the time, and at night snores to an abnormal degree. This abnormal snore is characterized by a moment of actual stoppage of breathing, necessitating the child to often "thrash about" to change her position in order to help her start breathing again. This is "sleep apnea" and, though it may not cause the child to fully awaken, it certainly interferes with the soundness of her sleep (and of all of those in the same household!) As this condition worsens, the child is unable to receive adequate oxygen into the bloodstream during sleep, resulting in drowsiness and lack of energy during day, even after the usual number of hours of sleep.

What can be done?

Since this is such a common problem in childhood, your doctor, after a complete examination of the head, neck, chest and abdomen, may feel that the situation can be safely watched for awhile, especially if the symptoms have only recently begun and are not too severe. After age six or so, the tonsils and adenoids usually start to shrink on their own, justifying a greater degree of patience. Your doctor may feel measures to prevent and control allergies may be in order if these seem to be contributing to the problem. Antibiotics may be prescribed to eliminate infection. And of course, there is the surgical approach that was so very common in years past: the "T and A," or surgical removal of the tonsils and adenoids. While this operation may well have been overly performed years ago, a significant number of patients today benefit greatly from this surgery. Because there is always a degree of risk associated with any surgical procedure, the American Academy of Pediatrics has established the following recommendations as to when surgical removal of the tonsils and/or adenoids should be considered:

"Sleep apnea", as discussed above, occurs frequently.
The tonsils are so enlarged that they cause difficulty in swallowing.
The adenoids are so enlarged that they cause extreme difficulty with breathing and cause distortion of the voice (consider removal of adenoids only).
The presence of an infection called peritonsillar abscess, a serious infection with pus collection around or behind the tonsils.
Frequent tonsil and adenoid infections which cause ear infections so severe as to require surgical ear tube placement (often called P.E. tubes).
The recurrence of a significant number of tonsil infections in a short period of time, especially if the cause of the tonsil infections has been the bacteria called Streptococcus, or "Strep throat." For further information, please visit the Strep Throat Center. This last recommendation clearly requires the most communication and agreement between you, your child, and your doctor.

Remember that these are recommendations only. In any specific case, you and your doctor may agree that a different course of action is best. But with this understanding of your child's anatomy and today's recommendations as to courses of action available, you are the well-informed decision-maker your child deserves!

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