When a child’s tonsils become inflamed, surgical removal - a tonsillectomy - is often ordered. Picture: Thobile Mathonsi
When a child’s tonsils become inflamed, surgical removal - a tonsillectomy - is often ordered.

New research, however, suggests more caution may be needed in patients aged 3 or younger.

The study of more than 1800 cases involving children under the age of 6 found the rate of complications, such as bleeding or respiratory issues, rose for the youngest patients.

Specifically, children aged 3 or under had a 7% chance of requiring care for these post-tonsillectomy issues, compared with 4.6% of children aged 3 to 6, the findings showed.

Furthermore, “we did not find weight to be a useful predictor of complications,” wrote the researchers, led by Dr Claire Lawlor, a paediatric otolaryngologist at Boston Children’s Hospital.

The study authors said “age rather than weight” is key to gauging the safety of tonsillectomy in very young children.

A paediatrician who wasn’t involved in the study said the findings confirm much of what’s already known on the subject.

“Tonsillectomy may be appropriate for some children because of recurrent tonsil infections or obstruction,” said Dr Michael Grosso, chair of paediatrics at Huntington Hospital in New York.

“However, it is an operation that is not altogether without risks. Be sure it is necessary and get a second opinion if there is any doubt.”

The Boston researchers also noted the complication rate didn’t seem to change whether or not the child had had an overnight stay in hospital after a tonsillectomy.

Grosso said many hospitals mandate overnight stays, and he believes they can help safeguard children to a certain extent.

However, the new research shows inpatient observation and care “protects against some complications, but not those that can take a week or more to happen”, Grosso said.

Specifically, the new study “found dehydration and breathing problems happened more often in younger patients, while bleeding was present in almost the same number of children, regardless of age,” he said.

The study, published online in Jama, Otolaryngology - Head and Neck Surgery, is the largest such review on the subject ever conducted, Lawlor’s team said.

Dr Lee Smith is chief of paediatric otolaryngology at Cohen Children’s Medical Centre in New York.

He believes inpatient admission for children under the age of 3 does help safeguard patients if a complication arises.

“This policy has worked well to maintain a safe environment for these young patients,” Smith said.

“All surgery has inherent risk, and health care providers need to establish guidelines which mitigate those risks and provide the safest environment for our paediatric patients.” 

 The New York Times