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Posted by on Sep 17, 2012 in Children's Health, Sick Kids | 6 comments

Taking Out Tonsils: Does Frequent Strep Throat Matter?

I get this question a lot,

“How many times does my child need to get strep throat before we can take his tonsils out?”

This question undoubtedly comes from parents who are simply sick and tired of watching their child struggle with case after case of strep throat. Kids in pain, decreased eating, missed days of school and work, countless trips to the doctors office, and that DREADED throat swab… I could go on and on. 

A recent study published in Clinical Infections Diseases has reinforced research, however, suggesting that tonsillectomy (removing the tonsils) should not be performed on kids with repeated cases of common strep throat. 

 I can hear the tired parents groaning…

Let me try to explain why kids should keep the tonsils, even with frequent strep throat infections. 

  1. Kids tend to “grow out of” strep throat. Many observational studies have been done in children with frequent throat infections. Interestingly, kids seem to have a natural decrease in infections over time. This natural improvement happens so frequently, it is rarely recommended to perform a tonsillectomy for simple throat infections alone. 
  2. Improvement after a tonsillectomy is short lived. AKA – You can get strep throat even if your tonsils are removed. After tonsils are removed, there is a significant decrease in throat infections for 24 months. This averages about 2 less infections per year versus those who keep their tonsils. Once the 2-year mark has passed, no significant distinction is seen. 
  3. Yes, the tonsils do something. Those pink, squishy tonsils are strategically placed in the back of the mouth to protect kids from infectious particles trying to sneak into the body. Tonsils are lined with “M cells” that help the immune system fight disease. Although there have been no studies showing significant clinical changes of the immune system once removed, tonsils may provide some benefit to a child’s illness-prevention system. 
  4. Tonsillectomy is not without risks. Tonsils are removed surgically, and under general anesthesia (GA). The most common surgical complications are bleeding and pain. Kids after the procedure can also experience severe nausea and vomiting that can lead to hospital re-admission. GA has its own set of complications based on the individual and the drugs used. Full risks of the procedure should be discussed with a qualified surgeon. 

What can I do if my child gets strep throat a lot?

  1. Be sure it is strep throat. Do NOT take antibiotics from someone who says it “looks like” strep throat. A swab MUST be done to diagnose and confirm a true infection before any antibiotics should be prescribed. 
  2. Finish all the medicine. Set the alarm on your phone. Make a simple chart. Do what you need to do to remember to take the medication as instructed. 
  3. Change the toothbrush. Once your child is halfway through the antibiotic course, get your child a new toothbrush or run the current toothbrush through the dishwasher. 
  4. Routine hygiene at school and home. Wash hands frequently, especially before eating. Don’t touch the T-Zone! 
  5. Be patient. 

Still thinking about getting your child’s tonsils removed? Share the decision making process with your child’s pediatrician and ENT surgeon. Review your family’s unique history and experience to make the best decision for your child. 

6 Comments

  1. I discovered your website via a recent NYT article and I love all the useful info! As a family physician in Australia I am also a primary care provider for children (Paediatricians over here only see more complex patients who require referral). I can think of lots of parents who would find your site useful. Thanks for the resource!

    • Thanks for stopping by, and the kind words. It’s so great to connect with other dynamic physicians all over the world. NB

  2. Hi there. I have 6 kids and 4 out of the 6 had swollen tonsils. Only one of them had to go to the doctors because he got a fever, very lethargic,sore back, and even then the doctor said to give him panadol and drink plenty of water. I have a 10 month old who I thought was in pain because of teething but have looked inside his mouth and noticed white bumps at the back of his mouth, near his tonsils. He is a bit whiny, and has gotten over the fever stage of things, but still drooling. It’s been 2 days, today is the 3rd day. Is it ok to just use neurofen and panadol and water?

    • I hope you little one is feeling better. This sounds like a personal health issue best answered by your doctor. Thanks. NB

  3. My 4 year old daughter has had strep 3 times in a month and a half. Although she doesn’t have strep now her tonsils have been swollen for 2 weeks. Any suggestions as to what I should do?

    • Wait! It will take awhile for the tonsils return to normal size after repeated infections. NB

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