5.28.2008

Recovery for Toddler Tonsillectomy

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We were really taken by surprise by how difficult this has been and how much pain our little guy has been dealing with, so I thought I'd post about our experience in case any information here helps someone else preparing for a tonsillectomy for a 3-yr old. A tonsillectomy is considered major surgery. It may just take 20 or 30 minutes (depending on whether you're also taking the adenoids, adding tubes), but it is major surgery. In an adult, it takes a month for full recovery. In a young child, it's a little over 2 weeks.

I think because most people don't remember how much pain they were in when they were this young (they usually just remember the ice cream) and because the doctors forget that we have no idea what we're really in for, we weren't adequately prepared for this. Because it turns out that what we're in the midst of is ten days of round-the-clock pain management. Actually, I'm hoping it's just ten days. Today is day 7. We'll see.

So, Griffin did great during the procedure itself. In the recovery room, he drank some water and ate a popsicle. He stayed overnight in the hospital, as that's their protocol to make sure the pain can be controlled just by the prescription meds that we'd be using at home. After the surgery, as we sat in the family consultation room to hear from his doctor how the procedure went, his ENT told us that Griffin's were the second-largest tonsils and adenoids he had ever removed. The only ones he'd seen larger had been so big that they crossed over each other.

Upstairs in his hospital room, Griffin ate 4 cups of ice cream in a row. Still doing fine. Then the drugs from the procedure very suddenly wore off before he got his first dose of hydrocodone and it all fell apart. I ran to get a nurse and then tightly held him and rocked him in the bed as he sobbed and choked and watched his heartrate race to 189. We gave him the hydrocodone orally using a syringe, but he spat a lot of it out and cried and yelled more. Turns out the hydrocodone can sting a little. I managed to get the rest into him by feeding it to him bit by bit with spoonfuls of ice cream. It took about 20 minutes for it to start to soothe him, but then an hour later he just went to pieces again. This time the nurse called the doctor and got permission to give him morphine. Finally he relaxed and was woozy but comfortable. Once we were finally "ahead of the pain" again, we were able to maintain with the hydrocodone, and we went home the next day.

It was a good thing that I hadn't pressed to have his IV removed early, as is my usual preference. While he was doing a good job of staying hydrated, the morphine was administered via the IV. So if you're anti-IV like I am, this might be one occasion to leave it in as long as your child is tolerating it well.

This is what we have learned since then:

Toddlers are all-or-nothing when it comes to pain management. While they're on painkillers, your child will act completely comfortable and care free. Don't be fooled. As soon as it's time to give them the next dose, do it, or you'll be dealing with 3o minutes of sobbing and clinging while you wait for the next dose to kick in.

If your prescription says to give the painkillers every 4 hours, but you need to give it to them every 3 hours to adequately control the pain, check with the doctor, but ultimately, do whatever you need to do to keep your child comfortable. I told our ENT yesterday that I was dosing Griffin every 3 to 3 1/2 hours to keep his pain under control and his doctor didn't even blink.

Have a humidifier going full-blast in your child's room whenever they're in there sleeping.

Make your child fill up on fluids before they take a nap and before they go to sleep at night.

Your two big objectives for your child will be pain management and hydration. The less your child drinks, the harder the pain is to manage. Keep them very well hydrated. While they're sleeping, they lose fluids into their bladders and into the copious amounts of sweat that will pour out of them while they're healing, and they aren't drinking any more while they snooze, so their throats dry out. As much as Griffin drinks, he still sometimes wakes up coughing and choking and crying just 2 1/2 hours after his last dose. I've heard the dry throat when waking described by an adult as feeling like you have a bunch of glass in your throat. Ooooowwwww. And then the hydrocodone stings. You'll be doing a lot of rocking and soothing and hugging and holding.

Speaking of stinging hydrocodone, if your child is old enough that you can get them to hold their mouth open so you can spray some chlorasceptic numbing throat spray before they take their hydrocodone, that will help numb the sting a little.

What Griffin could or couldn't eat varied day to day, rather than generally improving over time. Food that he was able to eat one day hurt him the next. I read somewhere that the scabs slough off somewhere between day 5 and day 7, and this is the most painful period post-op. We were at a consistently high level of pain until the 9th day, so I couldn't say for sure if this was the case with us, but I suspect it may be part of the reason for the variability in what he was able to eat.

Your child will have the breath of a dog that's dead in Texas in August, from about day 3 to about ... he still has it at day 9.

Dairy products were on the list of foods to avoid - I have no idea why. Griffin really wants a cold glass of milk in his hands at all times. He doesn't like popsicles, is not interested in jello or pudding. But he drinks milk all day, and it really seems to help him. I keep it in an insulated sippy cup so he can roam around the house with it, and he still comes back for a refresh when the chill has gone away.

Your child may be in constant pain for over a week. We've pulled a matress onto the floor in his room and his dad sleeps in there every night with a watch alarm to wake him up every 3 1/2 hours to give Griffin his painkillers, and then I handle the day shift. Usually Griffin wakes him up in pain before the alarm goes off. Just be prepared for this. It's a bit of a long haul, you're sleep-deprived, your child is miserable. This isn't a good time to be trying to accomplish anything else major in your life.

Getting work done right now is impossible, particularly given how out of sorts he is generally, which is understandable. If you normally work from home, plan to take the next 10 days off.

This isn't the time to be stingy with the DVDs. If your child will sit quietly while they watch tv, this is a good way to distract them from their discomfort and keep them still.

Let your child eat whatever they can. Even if it's just Krispy Kreme donuts for two days. They'll lose a ton of weight while they're recovering, and they can eat broccoli when they're better. Griffin can't even manage cold rice yet, and his ribs are really starting to show now. So, Krispy Kreme it is until he's healed.

They say you can take your child back to daycare 5-7 days post-op. This is nuts. Your child has to receive their pain meds at specific times, and someone needs to keep a close eye on making sure he stays hydrated and doesn't suddenly have the pain meds wear off prior to the time to dose. Also, the daycare can only give the dose according to the times on the prescription, so if your child needs their medicines more frequently, daycare isn't an option. Again - be prepared for this with alternate arrangements if necessary.

Another blogger said that the feeling in their throat while they were recovering from a tonsillectomy like "swallowing a box of tacks." Adults take longer to heal, but I think the pain is about the same for kids and adults, from what I can tell.

Good luck with your own kids' tonsillectomies. Hopefully they won't take as long to heal or be so painful an ordeal as what we're dealing with here, but in case it is, hopefully something I've said here helps.