• No more tonsillitis.

• Improve sleep apnoea.

• Improve nasal airway (adenoids).

• Bleeding either whilst in hospital or 3-7 days after the operation when at home.

• Infection of the wound site.

These will be discussed with you by the doctor prior to consenting for the surgery. All children are different and not all are treated exactly the same. This leaflet and the care described are a general overview of needs – some of it may not apply to your child or they may have some additional needs.

Your child will be admitted on the morning / afternoon of the surgery and should arrive at the Day Surgery Unit. You will have been sent a letter telling you where and what time to arrive, i.e. if he / she is booked for a morning list you must arrive no later than 07:30am and if they are is booked for an afternoon list you must arrive no later than 12pm.

They must not have any food to eat for 6 hours prior to surgery and must only drink clear fluids i.e. water or cordial until you arrive at hospital. Milk is classed as a food substance.

If your child is booked for the afternoon list, please wake them up and give them a light breakfast before 7:30am.

One of the nurses will look after you and tell you and your child what to expect. The surgeon and anaesthetist will speak to you about the operation and will go through the consent form with you. A member of staff from the Play Team will also speak to you and your child and offer distraction up to and including going into the Anaesthetic Room, and later during recovery on the ward. You will be able to stay with your child until they are taken into the operating theatre and you will be reunited as soon as they wake up.

Your child will usually be in theatre for approximately 30-45 minutes. Occasionally it can take a little longer.

Your child will be nursed in the recovery ward until ready to be discharged home. Following adenoidectomy some oozing of blood at the entrance of the nostrils may occur, and / or dribbling from the mouth. Some blood is often swallowed, and this along with the anaesthesia, may result in vomiting in the early post-operative period.

The nurse will check your child’s pulse, temperature, general condition and will look into their throat and nose to check for bleeding. When the nurse is happy that your child is making good progress they will be offered a drink usually about one hour after the procedure.

If able to tolerate fluids your child will be encouraged to try some light diet to eat as this helps reduce debris in the throat. The nurses will ensure that your child is prescribed analgesia (pain killers) for pain control whilst in hospital.

They will be required to remain on the ward for a minimum of 3 hours post operatively. They will be discharged home once tolerating diet / fluids, does not have high temperature (pyrexial), has not vomited or had any bleeding and can get up and about without feeling sick or dizzy. If bleeding or vomiting occurs it may be necessary to keep your child overnight for observation.

It is advisable to take your child home in a car or taxi (not public transport). The effects of general anaesthetic can remain in the system for up to 72 hours.

• Your child should be kept at home in a warm environment for the first 5-7 days, smoky / dusty environments should be avoided.

• Your child may experience some discomfort / pain. Earache may also occur following surgery. This is referred pain (discomfort caused by the operation but felt away from the site of surgery) and this is quite normal. Continue to give regular pain relief medication as advised by the staff and follow the instructions on the bottle. The pain should ease within 10-14 days following surgery.

• Avoid contact with other children (except family) and especially those with coughs / colds.

• No school / parties / clubs for 10-14 days.

• It is important that they eat and drink normally as this aids the healing process.

• Be sensible in the recovery period (2 weeks) and don’t travel abroad or take holidays within 2 weeks.

• Stay within easy distance to hospital access.

Give Ibuprofen 3-4 times daily with food, following the dosage instructions on the bottle. Paracetamol can be given 4 times a day, following the dosage instructions on the bottle – staggering the Paracetamol doses between the Ibuprofen doses will give more constant pain relief.

While your child may be comfortable for a day or so, many children find the pain then worsens for a few days before resolving by the end of the week.

Some children will find the combination of Paracetamol and Ibuprofen effective during this period, but for others it is not enough to relieve their pain, so you will be provided with a small quantity of dilute morphine solution for you to administer if you feel your child requires more pain relief.

Carry on with the Paracetamol / Ibuprofen and give them the lowest dose of morphine that is advised on the bottle for the first dose. If your child does not become excessively drowsy or nauseous and the pain is still uncontrolled, the higher dose of morphine advised on the bottle can be given as the next dose. Doses can be given every 4-6 hours as required up to a maximum of 4 doses in 24 hours.

As soon as your child is comfortable again stop the Morphine and Notes continue with the Paracetamol and Ibuprofen for a few more days.

You may also find that benzydamine spray, sprayed directly into the back of the throat, is effective as pain relief in some children as it is a local anaesthetic. However, research has shown that Difflam is not as effective in children under five years of age but it may be of some use in children aged 5 and over. If your child is aged 5 or over, they will be prescribed a benzydamine spray.

• Infection. The care you are asked to give is an attempt to reduce the risk of infection. However, there are a small percentage of children who do get an infection. An infection can cause the partially healed adenoid tissue or tonsillar bed to breakdown and bleeding can occur (seen approximately 5-8 days after surgery).

• Other signs of infection can be distinguished by excessive bad breath and / or yellow discolouration to the back of the throat (white discolouration around the tonsillar bed is normal).

• If your child complains of pain becoming worse over a period of days, recurrent nose bleeds that are difficult to control, are prolonged or return throughout the day or he / she keeps spitting out or has a high temperature, please contact the nursing staff on the Children’s Ward for advice or alternatively attend your GP or walk-in Centre. In the case of spitting / vomiting fresh blood please attend A & E.

If you have any worries or concerns regarding your child’s stay on the ward or their recovery, please do not hesitate to contact Children’s Clinic on 01253 953651 Monday to Friday 9-4:30 or the Children’s Ward on 01253 953437 outside these hours. You could also consult your GP or attend the Emergency Department for assessment.