When Should Tonsils be Removed?

Tonsils are oval-shaped tissue located on both sides of the throat. They are made up of lymphatic tissue, which is responsible for helping the body to fight infection. The size of tonsils can vary from person to person. However, they can become enlarged during an infection.

Your child’s pediatrician checks your child’s tonsils by having your child open his or her mouth wide and shining a light inside. An infant or young child may require the help of a tongue depressor to get a good look all the way in the back of the throat.

While tonsils are present in the body to help fight infections, they can often cause problems, especially when they become infected themselves. Symptoms of infected tonsils include a sore throat, red and swollen tonsils, pus or ulcers on the tonsils, fever, and swollen glands on the side of the neck.

Infections are not the only problems that can develop with tonsils. Enlarged tonsils can also lead to sleep problems, such as snoring and obstructive sleep apnea.

Years ago, many children underwent surgery to remove tonsils after just a few episodes of infection. However, in 2011, the guidelines regarding who needs tonsillectomies (tonsil removal) became much more conservative. Physicians realized that although the surgery was once routine and widely performed, there were very real and potentially serious risks associated with surgery, including infections and bleeding.

The current recommendations say children should only be considered for tonsillectomy if:

– They have had more than 7 infections in the past year

– They have had more than 5 infections each year for the past 2 years

– They have had more than 3 infections each year for the past 3 years

Each of these infections need to be documented by a physician, not just reported by the parent.

Even if a child meets all requirements, this does not automatically guarantee that the child will be taken to surgery. An ear, nose, and throat specialist will decide which patients would benefit most. Tonsillectomy can be a painful procedure with a difficult post-operative course, so the benefits must be weighed against the risks of the surgery.


  • American Academy of Pediatrics
  • Tonsilitis. Pediatrics in Review
  • Tonsils and Adenoids.

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