Pediatric Tonsillectomy Recovery: What to Expect Day by Day

Pediatric Tonsillectomy Recovery: What to Expect Day by Day

Tuesday, July 9, 2019

Our 4.5 year old, Phillip, just underwent a Tonsillectomy & Adenoidectomy (T&A) to cure his sleep apnea. You can read about our journey to a sleep apnea diagnosis here or about the details of our surgery experience here.

In general, recovery for a pediatric tonsillectomy is 14 days. While all children will recover at different paces and will have different recovery challenges based on personality, etc, here's a breakdown of what those days/nights looked like for us.

Day 1 (Surgery Day): Surgery was at 8:30am and we were home by 9:45am. At first, Phillip seemed sleepy and laid on the couch but within a few minutes he was wanting to play his new Xbox game (bought specifically for the recovery period). He played it most of the day and ended up not napping at all, which surprised me. Since he didn't get any pain medication at the hospital before being discharged, we made sure to give him some Ibuprofen as soon as we got home. Just a couple hours after surgery he was asking for breakfast. He hadn't eaten since the night before so he was pretty hungry. He wanted French toast sticks and the doctor had told us that he could start on solid foods as soon as he wanted (as long as we avoided anything hard or with sharp edges like crackers, cereals, etc) so we made some up and he ate them all! A friend whose daughter had had a tonsillectomy a year previous told me they had her take a sip of a drink at least every 15 minutes for the first couple days and, as the surgeon had told us hydration was the most important part of recovery, we thought this was a great idea and had Phillip doing the same. At dinnertime, he ate the regular dinner we served and things seemed to be going great so far! We made sure to keep up on Ibuprofen every 6 hours and he really wasn't complaining at all of pain. Enter night 1...

Night 1: Phillip was crying almost all night, waking up every 10-20 minutes saying his throat hurt. He did a lot of grabbing at his neck, sticking his fingers in his mouth, and guttural sounds like he was trying to cough up a hairball. We encouraged lots of little sips of gatorade and implemented a Tylenol dose alternating with the Ibuprofen dose. We realized in retrospect that we should have been doing this all day to stay ahead of the pain curve. Even though he seemed to be handling the pain well during the day on the Ibuprofen alone, we really should have been giving the Tylenol as well so he didn't get to the point of misery he was in come night-time. Around 4am, it seemed that we had gotten the pain under control and he finally slept for 4 hours straight (with one forced wake up for a medicine dose).

Day 2: A little worse than Day 1, but not bad. A little complaining of throat pain but we stayed with our every 3 hour medicine dosing, alternating with Tylenol & Ibuprofen and that seemed to help stay on top of the pain. Still taking sips of gatorade every 15 minutes, ate some popsicles and ice cream and had part of a peanut butter & jelly sandwich.

Night 2: Better than Night 1 but still rough. He was up crying, complaining of throat pain, multiple times although it wasn't nearly as often as Night 1. We almost gave the prescribed hydrocodone at this point but then decided we'd rather give the first dose of it during the day when we could keep a better eye on him to make sure he tolerated it well.

Day 3: Worst day so far! I had actually been warned that it gets worse before it gets better so I was kind of prepared for this although it seemed like Day 2 to Day 3 was a huge change. Phillip complained of his throat hurting almost all day long and took several naps or spent a lot of time just laying down with his eyes closed instead of playing Xbox or watching movies. We did try to administer the Hydrocodone this day but he took one small taste and decided he was NOT doing that. So we stuck to Tylenol/Ibuprofen. It was harder to get him to drink on Day 3 but still encouraged lots of little sips. He ate almost nothing all day, not even popsicles or ice cream. Noticeable bad breath started on this day. Warning: it is the weirdest/grossest bad breath EVER. It's not just bad breath. It's like SOUR bad breath and it's absolutely horrible. It's from the scabs that form in the tonsillectomy bed and unless your child is old enough to gargle salt water, there's really not much you can do about it.

Night 3: Our best night so far. He still woke up crying occasionally but it was almost always right before he was due for his next dose of medicine. Giving medication at night is always a huge fight as he's tired AND uncomfortable and we have to be pretty firm to get him to put it in his mouth, chew & swallow. He always ends up doing it voluntarily so luckily we don't have to force it.

Day 4: Definitely better than Day 3. Usually complains of throat pain about one hour before his next medicine dose is due. That last hour is always rough so we try to get him to drink/eat during the two hours immediately after taking medication.

Night 4: I had read (from adults who have had tonsillectomies) that sleep is your worst enemy as your throat gets dry (especially with the mouth breathing they tend to do post-surgery!) and the pain is immense after a few hours of no drinking. Supposedly, waking up every 1-2 hours to take a sip of something is very helpful but we couldn't get Phillip to wake up that often and be coherent enough to sit up and take a drink. Instead, we started using a cool-air humidifier in the room (which I really wish the post-operative instructions had suggested!) and it did seem to help. He didn't throw any giant fits this night about awful throat pain. We also had some lavender oil diffusing which I had read helps tonsillectomy patients. Anytime I noticed him stirring, I did try to get him to sit up and have a small sip of gatorade to keep his throat from drying out too much. I think it's super helpful to have your child share your bed (or at least your room) these first several nights post-surgery as they need a lot of attention throughout the night.

Day 5: I had been preparing for this to be the start of some really bad days, as I'd heard that anywhere from days 5-9 are the worst because the scabs begin falling off and expose some nerve endings. Turned out that day 5 was about on par with day 4. Not better, but not worse. He tried to have some cheesy bread but cried because it was too hard (it was actually soft but it turned out he wasn't ready to try solid foods again yet). He had a couple bowls of oatmeal this day and that's about it. His breath is AWFUL by this point. Like you have to turn your head away if you're holding him or else you'll probably gag. We can already tell a change in his voice. His words used to be pretty muffled due to the huge tonsils so he already sounds a lot more clear.

Night 5: Similar to night 4. Up a couple times right before it's time for his next medicine dosing but slept pretty solid most of the night. I actually think he might already be sleeping better than he was pre-surgery when he was struggling with sleep apnea. We did the humidifier again and lavender oil in the diffuser (we actually have a 2-in-1 which makes it even more simple).

Day 6: I would say that this is now been our hardest day yet. Day 3 had been winning out but Day 6 definitely takes the cake. Could be partially due to the fact that I'm more exhausted as a caregiver. We're still on the every 3 hour Tylenol/ibuprofen rotation and we try to be careful not to miss since we notice when we do he has a rough time. We were away from home for his 1pm Tylenol dose and I had forgotten to bring some with me. At 1:45 he was crying about his throat hurting but after getting that dose he was fine again. He doesn't like to drink anything through a straw (even though he is allowed) because the pressure seems to cause him pain in his throat. One thing we've noticed is that he's extremely quiet since having the surgery. He says as little as possible which is understandable since it probably hurts less when he doesn't use his voice. Took naps throughout the day.

Night 6: Another rough night. Up a few times crying from pain, even before his next dose was due. Pretty hysterical at times. The only thing that worked for us to calm him down was turning on a show that he could fall asleep to. We'd also encourage (and by encourage I mean fight until he did it) a sip of gatorade or water, which I just kept at my bedside. He always seems to feel better after taking a drink but it's really a fight to get him to do so when he's already in pain.

Day 7: Better than day 6 which is a relief, since I was expecting it to be worse. Still not an easy day. Took two naps and complained of a sore throat multiple times. Breath doesn't seem to be quite as bad as it's been but still not pleasant. Lots of drooling whenever it's close to medicine time because he doesn't want to swallow his spit. I have a pretty sensitive stomach when it comes to spit/drool so this is the hardest part for me as a caregiver.

Night 7: Probably one of our best nights so far! HALLELUJAH. Still was up a few times crying but bouts didn't last as long as they normally do. He did stay awake for about an hour watching a show at one point whereas he normally falls right back to sleep after taking medicine but he wasn't crying/whining so I'll take it. We still are doing every 3 hours for medicine, even at night. I don't usually have to wake him because he will wake within 30 minutes of dosing time (on either end of the hour).

Day 8: I *think* we might be on the up & up!? We've been using the Hydrocodone since Day 5 because they have been pretty rough days/nights. But after he took his night dose this night I told him I thought it would probably be his last one of it (he HATES the taste so it was a good motivator to get him to take one last dose). He seems to be doing better between medicine doses so tomorrow we'll be back on the regular tylenol/ibuprofen rotation without the hydrocodone and see how it goes. Before we ever had surgery I had heard that days 7-10 were the worst so I was really preparing myself for this. Honestly though, by the time we got to day 6 I was really dreading it and thinking "how are we not even at the worst part?!"

Night 8: Up a few times crying from pain (not as great as night 7 but not as bad as night 6). Still using hydrocodone at least before bed to get him through the night.

Day 9: Today was probably equivalent to Day 2...before things went way downhill. He skipped several doses of medicine but still needed it about every 4-6 hours (instead of every 3). Started eating a little more today than he has been.

Night 9: We're getting there!! He woke up once but wasn't even close to hysterical and didn't even need pain medication - just fell back to sleep after a drink of water.

Day 10: I had heard from friends that their kid suddenly turned a corner on Day 10. I'd say this happened for us sometime between Day 9 & Day 10. Today was really good! He didn't take medicine AT ALL and didn't ever complain of his throat hurting! The bad breath is abating, he's talking a little more & acting quite a bit more like his normal self. He is still careful with what he eats (as he's supposed to be until Day 14) but he has more of an appetite so hopefully he'll start gaining back the 2 pounds he couldn't afford to lose in the first place haha!

Night 10: HALLELUJAH, HE SLEPT ALL NIGHT. We started him in his own bed for the first time since his surgery and he did end up in our bed at some point during the night but I didn't even notice so he must have been quiet and gone right back to sleep. It's so weird to watch him sleep now because he is so quiet and he didn't toss/turn at all whereas before his surgery he was constantly flipping around, kicking his legs, etc. We are so excited to see how it affects his everyday life going forward!!

Day 11: He is doing so great now. Hasn't had any pain medication in over 36 hours, hasn't complained at all about his throat, and is becoming a little more active/talkative. He still has to be careful with his activity level until his hits the two week mark but I think we are luckily past the highest risk days for post-op bleeding (7-10). His breath is so so much better (still a tinge of sour/bad breath) and he talks a little more every day. His throat must still be bothering him at least a tiny bit because he seems to have excess saliva a lot so I wonder if it's still difficult to swallow.

Overall....HOLY COW. I was told soooo many times by the surgeon and so many friends that the recovery is rough. I asked my friends to tell me everything and nobody sugarcoated recovery. I heard over and over that it was the recovery from hell. So I felt like I was pretty prepared for it. Nothing can prepare you. It is literally the worst. So, so exhausting for everybody involved. I spent half my days feeling so bad for Philly-boy and the other half feeling so frustrated because he was SO whiny & clingy & just screaming at us whenever he's in pain (which was often).


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