Not necessarily. The 2019 AAO-HNS guideline sets specific thresholds before surgery is even an option for throat infections: 7 or more episodes in the past year, 5 or more per year for 2 years, or 3 or more per year for 3 years — each documented with fever, swollen lymph nodes, pus on the tonsils, or a positive strep test. If those numbers aren’t met, the guideline strongly recommends watchful waiting. Most children improve on their own over time.

The AAO-HNS guideline uses the Paradise Criteria: 7 documented episodes in the past year, 5 per year for 2 consecutive years, or 3 per year for 3 consecutive years. Each episode must be confirmed with at least one clinical finding — fever above 101°F, swollen neck lymph nodes, pus on the tonsils, or a positive strep test. A child who doesn’t meet these numbers is not a guideline-supported candidate for surgery on the basis of infections alone.

Yes — and this is the second major reason tonsillectomy may be recommended. Enlarged tonsils can partially or fully block the airway during sleep, causing snoring, mouth breathing, and pauses in breathing. Daytime effects are often missed: inattention, hyperactivity, poor school performance, bedwetting, and stunted growth can all result from poor sleep quality. When obstructive sleep apnea is confirmed by a formal overnight sleep study, the guideline recommends tonsillectomy.

The most serious risk is bleeding — occurring in about 1 in 100 children within 24 hours and 2–6 in 100 children in the days 5–10 window when surgical scabs fall off. Any bleeding from the mouth or throat after tonsillectomy is an emergency room visit. Dehydration is the most common reason children are readmitted — staying on top of fluids is critical. Nausea, ear pain, bad breath and a sore throat are expected in the days following surgery.

The 2019 AAO-HNS guideline strongly recommends ibuprofen, acetaminophen, or both on a regular schedule — not just when your child complains of pain. Children often will not volunteer that they hurt. Proactive, scheduled dosing produces better outcomes. Codeine and any medication containing codeine must never be given to children under 12 after tonsillectomy according to the guidelines. The FDA has issued a black box warning: codeine converts to morphine at unpredictable rates and has caused deaths after this surgery.

Pain typically lasts 7 to 10 days and is often worst in the morning. It can last longer in older children and adults. Ear pain is common and normal — it is referred pain from the throat. Staying well hydrated is the single most important thing families can do at home, as dehydration is the leading reason children are readmitted after surgery. No strenuous physical activity for 2 weeks. Most children return to school within 1 to 2 weeks once pain is controlled and they are eating and drinking normally.

Sometimes. Adenoidectomy — removal of the adenoid tissue behind the nose — is often performed at the same time as tonsillectomy, particularly when enlarged adenoids are contributing to sleep-disordered breathing. The 2019 AAO-HNS guideline addresses tonsillectomy with or without adenoidectomy but does not define separate indications for adenoid removal. Your surgeon will determine whether adenoid removal is appropriate based on your child’s specific anatomy and clinical picture.