For a mum, they were the the words that set every alarm bell ringing: “Your two-year-old is waking up during nap time literally gasping for air.'”
Although I had noticed Addi was snoring when she slept at home, I hadn’t realised the severity of it or that it wasn’t normal, until the childcare worker made the observation.
I quickly got a referral from a GP to Dr Mark Guirguis an Ear, Nose and Throat specialist. He took one look inside Addi’s mouth and said, “They will need to come out.” Dr. Guirguis explained that Addi needed to have her tonsils and adenoids removed because their large size was obstructing her breathing, which presented itself mostly while she was asleep, and is often the case in younger children.
For me the realisation Addi needed surgery was confronting. She had been perfectly healthy, so consenting to a procedure where she would have a general anaesthetic and go under a surgeon's scalpel filled me with anxiety.
I began asking my family and friends if they knew anyone else whose children had to have the same procedure, but all I got were stories from my mother's generation about their experience, and one horror story from a co-worker.
In the days that followed, I drove myself to learn all about tonsils and adenoids, and the affect sleep apnoea can have on the development of children's IQ, as well as the tricks and techniques of preparing Addi for the big day - surgery.
Here are some of the things I found most helpful:
1. Talk about what is happening with your child.
Knowledge is power and even if your child is young, chances are they will know something is happening. So, having a conversation in their language is important to prevent them from becoming anxious and overwhelmed. Before we even visited the specialist, I explained to Addi why we were there and what he would have to check.
Once we knew that she was having her tonsils and adenoids removed we explained (in simple medical terms) enough so that she understood the concept - that she would go into hospital, be given medicine to make her have a sleep and when she woke up her tonsils and adenoids would be gone.
2. Let your kids ask questions and be honest in your responses.
Addi showed a healthy curiosity about her operation. She asked if it would hurt, how long she would sleep for and if I would be there while it was all happening. I answered her questions as honestly as I could. I knew if I didn’t, that it could potentially cause her distress on the day of the surgery.
3. Use child friendly resources.
I went to the bookshop and came across 'Dr Dog', a humorous picture book about a family who kept getting sick, including a girl who had to have her tonsils removed. It was enough to reassure Addi that this operation is common and it would make her better.
4. Visit the hospital.
I went to the ward where Addi would go after the procedure. She saw the beds and some of the machines and gained an understanding of the hospital environment. Taking the unknown out is really important and helpful in putting kids at ease when they go in on the big day.
5. Bribery.
Yep, like all good parents I know a bit of bribery is always a winner. The promise of a Barbie once she came out of the operation worked wonders and was one of the first things she asked about when she woke from the anaesthetic.
But parent advie is one thing - for the full picture, I sat down with Dr. Guirguis who, on average, performs this surgery on around 500 children aged two to eight ever year. Dr. Guirguis shared his tips with me, the common misconceptions, and gave some general information about the procedure.
Fact- It is a common medical problem in children and a common operation.
The removal of tonsils and/or adenoids is the most common procedure for children aged two to eight years old in Australia. Children have “small mouths and often have quite big tonsils,” Dr. Guirguis said, and this is the most common reason for their removal in this age bracket. If too large, they cause obstruction of the airways, which, as seen in my daughter's case, leads to snoring, interrupted sleep and even obstructive sleep apnoea.
This in turn can be detrimental to a child’s long-term cognitive ability because of the impact it has on their sleep and ability to concentrate. Dr. Guirguis said that a recent study indicated that those children who suffered obstructive sleep apnoea caused by their large tonsils and adenoids actually had lower IQs than those who had them taken out. “Issues resolve after tonsils and adenoids are removed- snoring stops, sleep becomes much better quality, ”Dr. Guirguis said.
Myth- Having your tonsils removed can reduce your immunity and your ability to fight infection.
Dr. Guirguis said there is “no evidence to support that tonsils removed will impact immunity.” The function of the lymph nodes to do this job means that having your tonsils and adenoids removed really has no significance because there is another part of your body that can step in and do the job in their place.
Myth- You can only eat soft food in the days after the operation.
If you listened to my mum and her generation you’d be convinced that a diet of jelly and ice-cream were on the menu. But Dr. Guirguis says rough food is now encouraged, including: toast, cereal, bread, nuggets and chips. “Rough foods get rid of the sluff (the dead skin left behind which is what can dry and then lead to infection and bleeding) which tends to mean the tissue heals quicker and children tend to get over the operation quicker.” He also said soft drink is helpful in recovery as “the carbonation helps break up the sluff.”
Myth- Tonsils can grow back.
Apparently, a frequent belief is that tonsils can grow back. Not so long ago - 30 years or so - only part of the tonsil was removed and often that part would grow slightly. But now all of a person’s tonsils are removed so this is no longer possible.
Dr Guirguis' main advice:
- Keep up with the pain medication - specifically Panadol. “The biggest issue post op is pain," Dr. Guirguis said. Ensuring you give the required dosage around the clock (including night time) and around 15 minutes prior to eating is important.
- "Keep a regular routine of eating and drinking. The more they eat and drink the more they get rid of this sluff… (and) not eating or drinking can exacerbate the pain.”
- Plan your Carers Leave for three to eight days after the operation. “The most difficult period for post-operative recovery is actually day three to day eight,” Dr. Guirguis said. Often people will plan their leave around the actual operation, but in reality, it is this later stage when your little patient needs the most support.
- “Every parent is going to be nervous to subjecting their child to surgery. The calmer the parent is, the calmer the child.” So, keep calm or pretend to be calm, whichever works for you.
- Use ‘Diflam’ oral spray if pain is an issue or if your child is refusing to eat and drink.
- Ask questions - don’t be afraid to “seem silly” he said. Ask as many questions as you want because knowledge is power (and, for me at least, a cure for anxiety).
Has your child ever had their tonsils or adenoids removed? What was your experience like? Tell us in the comments section below.