My four-and-a-half-year-old son has a problem with his tonsils. When he has a cold, he chokes especially when he is sleeping at night. Sometimes he has been know to gag on his saliva even when he is not ill. He is currently on amoxacillan and I am humidifying the air. Can anything be done to alleviate the problem? When do you know that removal of the tonsils is advisable?


Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Removing the tonsils used to be a quite common procedure about 20 years ago or so. Today, we as pediatricians try to avoid sending children to the ear, nose, and throat doctor to have these removed unless the child is having significant problems associated with them:

  1. Some children are born with or develop "kissing tonsils". These are tonsils so large that they meet in the middle of the back of the mouth. When they get sick, children with kissing tonsils often get a muffled voice, have problems swallowing, or may have trouble breathing. If you look into your child's mouth, and the tonsils are kissing, notify your doctor. Your doctor may need to give a course of medication to decrease the swelling of these tonsils.
  2. Sleep apnea - This is a condition in which a child seems to stop breathing (for more than 15 seconds) while asleep and then suddenly takes a large breath. The child may also have a big problem with snoring. These children are generally tired during the day because of poor sleep at night. This condition is more associated with large adenoids (same tissue as tonsils but in a different place), but the tonsils may need to come out as well.
  3. Frequent documented strep infections - The key word here is documented. Many physicians will look into throats, diagnose strep throat, and begin antibiotics without ever doing a test. There are many reasons why we get sore throats the most common of which is viral illnesses. Thus, before undergoing surgery for "frequent infections of the tonsils" it is important to know if these infections are from big tonsils or just bad luck from getting a lot of viral infections.

The problems your son is having with his tonsils when he is sick sound significant but may or may not need intervention depending upon his examination. I suggest you discuss this with your doctor. You can expect him/her to take a careful history focusing on the number of throat infections he has had, any signs of sleep apnea, other respiratory problems (e.g. asthma), and the choking episodes you describe.

Unfortunately, there is not much you can do to alleviate the problem other than avoid getting the illnesses which cause his tonsils to swell. These include careful hand washing.

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