Having your child's tonsils and adenoids out may help with snoring, mouth breathing
May 28, 2025
Back in the mid-20th century, physicians didn’t hesitate to remove a child’s tonsils and adenoids to prevent recurring throat and upper respiratory infections. The procedure, which is called an adenotonsillectomy, is a lot less common for preventing infection these days – but it can be a safe, effective treatment for sleep-disordered breathing.
The tonsils, visible on the sides of the back of the throat, connect with the adenoids, which are hidden behind the nasal cavity. Together, these structures form a ring of lymphatic tissue that’s part of the developing immune system in babies and toddlers. The tonsils and adenoids help fight infection, producing antibodies that build a healthy immune system during early childhood.
In some kids, their tonsils and adenoids become enlarged due to infection, allergies, or even acid reflux. Oversized tonsils can obstruct their airway during sleep, which interferes with how well they sleep. Problems may include:
- Snoring
- Mouth breathing
- Irritability
- Hyperactivity
- Bed wetting/enuresis
- Grinding of teeth/bruxism
- Frequent respiratory infections
- Higher rates of antibiotic use and hospital visits
My colleagues and I have published a series of studies based on data collected as part of a clinical trial, The Pediatric Adenotonsillectomy Trial for Snoring (PATS), an NIH-sponsored study of over 400 children who snored and had disrupted nighttime breathing. Some of these patients were treated at Children’s Health. Our most recent study showed that children who had an adenotonsillectomy had one-third fewer visits to health care providers and needed half the prescriptions in the year after surgery compared with those who did not have the surgery. That amounted to about 125 visits and 253 prescriptions avoided for every 100 children.
There are more than half a million adenotonsillectomy procedures in the U.S. each year. It’s one of the most common surgeries done under general anesthesia in children. And while it does require several days of downtime for your child, it can result in lifelong health benefits.
Which kids benefit from adenotonsillectomy?
When we assess children for sleep-disordered breathing, we consider the severity of daytime and nighttime symptoms:
- At night, kids might snore, breathe through their mouths, or toss and turn with restless sleep. Some also have mild obstructive sleep apnea, where the child stops and starts breathing throughout the night.
- During the day, children with sleep-disordered breathing may show signs of unhealthy sleep through irritability, hyperactivity, difficulty with attention or concentration, or behavior issues.
If your child has large tonsils and their symptoms have been going on for three months or longer, your physician may talk with you about surgery.
Removing the tonsils and adenoids has no proven effect on immune function later in life, and most children “grow into” their enlarged tissues. The adenoids actually disappear in the teen years, and the tonsils stay the same size, appearing smaller as the child grows. So, some parents choose to go through a few months of watchful waiting first to see whether the symptoms improve with time.
Children with excess weight are more likely to develop severe and persistent obstructive sleep apnea. It can be difficult to distinguish between primary snoring – the early stages of sleep-disordered breathing – and obstructive sleep apnea. In these cases, we will consider a sleep study/polysomnography. Some children need a referral to our team of specialists in pediatric sleep medicine and weight management. Adenotonsillectomy, along with weight management, can help with obstructive sleep apnea symptoms.
Optimal timing for an adenotonsillectomy for sleep-disordered breathing is between ages 4 and 8. Once the child reaches age 12, recovery can involve more pain and discomfort and a longer time away from school and activities.
“We often meet with older children who are already prepared with questions about the surgery from videos they’ve watched online. It's not unusual for older kids to come in and say they want it done because they want to sleep well and feel better.”
What to expect with surgery and recovery
If you decide to have your child’s tonsils and adenoids removed, you can expect the surgery to last about an hour. Adenotonsillectomy is usually an outpatient procedure performed under general anesthesia.
We remove the tissues with cauterization, which means we use small amounts of electrical energy to “zap” away the tissue. This option results in very little bleeding, and the wounds heal naturally without stitches. Most children can go home the same day.
While the procedure is simple, recovery can be uncomfortable. Your child likely will have a severe sore throat for about a week, so they’ll need close supervision at home. He or she will likely be tired and cranky; eating and drinking will be difficult during the first few days.
Dehydration is a risk after an adenotonsillectomy since it will be difficult for your child to swallow for a few days. Following the dosing schedule for pain relief as directed will keep the discomfort at a minimum so your child can drink plenty of fluids to stay hydrated. After the first day or two, you can offer popsicles and soft foods such as fruit snacks, yogurt, pudding, and (yes, it’s true) ice cream.
After a week at home, we recommend another week away from strenuous activities, such as sports, gym class, and physical chores.
Guidelines for managing pain at home
Follow the guidelines for pain management at home, using only the products listed on the post-surgery care materials. We typically recommend an over-the-counter liquid pain reliever such as children’s ibuprofen or acetaminophen. During recovery, do not give your child any medication containing codeine, as it can cause life-threatening breathing problems after an adenotonsillectomy.
How to make the best choice for your child
Your child will eventually “grow into” their tonsils and adenoids, but this may take years rather than weeks or months. If you’re not sure what to do, there’s usually no harm in waiting three to six months for further observation. Our care team will watch your child’s progress and symptoms and provide alternative treatment options, if needed.
If you choose to go forward with the procedure, you can be confident in knowing that an adenotonsillectomy has been proven to be a safe and effective option, with significant improvement for your child’s health and quality of life.
Talk with your child’s pediatrician about your options. If the child is school age, talk with their teachers and coaches about the best timing. You might also connect with other parents whose child has had the surgery to get their opinion about the recovery and health benefits.
Remember, our door is always open. Feel free to ask questions and request information. We are here to help you make informed choices for your child’s health.
Research highlights
Ron Mitchell, M.D., of UT Southwestern and Children’s Health was among the scientists involved in the Pediatric Adenotonsillectomy Trial for Snoring (PATS), which looked at the effectiveness of the surgery by comparing two groups of children: those who had their tonsils and adenoids removed and those who opted to wait. Here are some of their published studies:
Adenotonsillectomy and Health Care Utilization in Children With Snoring and Mild Sleep Apnea
Symptoms, Quality of Life, and Executive Function in Children Who Snore
Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children, a Randomized Clinical Trial
A randomized trial of adenotonsillectomy for childhood sleep apnea
To talk with an expert about sleep-disordered breathing in children, make an appointment by calling 214-645-8300 or request an appointment online.
