Insights from Dr. Kevin Huoh, pediatric otolaryngologist at Rady Children’s Hospital Orange County (Rady Children’s)
Key takeaways
- Sleep issues are now the main reason for tonsil removal: Enlarged tonsils most often cause obstructive sleep apnea in children, signaled by loud snoring, gasping, restless sleep, or daytime hyperactivity, making tonsillectomy a common solution.
- Tonsillectomy is safe and minimally invasive: Surgeons perform tonsillectomy entirely through the mouth, often alongside adenoid removal, using modern surgical techniques tailored to each child’s needs.
- Recovery is easier with newer techniques: Intracapsular tonsillectomy, now widely used, reduces pain and bleeding risks, allowing most kids to return to normal eating and activities much faster than with traditional surgery.
Helping parents understand when and why tonsils need to come out
When a child’s nighttime snores start sounding like a freight train or sore throats become as routine as homework, enlarged or chronically infected tonsils are often the quiet culprits. A pediatric tonsillectomy, one of the most common surgeries performed on children, can feel daunting to parents, yet it remains a time-tested solution for improving sleep, reducing recurrent infections, and boosting overall quality of life.
In this article, we turn to the expertise of Dr. Kevin Huoh. He demystifies the procedure, explains when it’s recommended, and walks through what families can expect—so you can make confident, well-informed decisions for your little one’s health.
Why are tonsils removed?
Tonsils sit at the back of the throat and help the immune system fight germs that enter through the mouth. In the past, doctors often removed them because of frequent infections or chronic enlargement. Tonsil removal dates back to ancient times, with records as early as the Roman Empire.
Thanks to modern antibiotics and earlier treatment, infection-related removals are now uncommon. Today, the leading reason for taking out children’s tonsils is obstructive sleep issues—large, infection-inflamed tonsils can enlarge enough to cause snoring or sleep apnea by blocking the airway at night.
“I would say over ninety percent of the tonsillectomies I perform at Children’s Hospital of Orange County are for sleep apnea or airway obstruction,” states Dr. Huoh.
The mechanics behind sleep apnea
During sleep, throat muscles naturally relax, narrowing the airway and often causing snoring—even in adults. In children, this effect is more pronounced because their tonsils tend to enlarge from frequent infections, and their airways are smaller due to their still-developing anatomy.
When tonsils become too large, they can further restrict airflow, making breathing during sleep more difficult. “Those big tonsils pose more of an issue while kids are sleeping than if they were in an adult,” notes Dr. Huoh.
Sleep apnea symptoms to look out for
Parents are usually the first to notice signs of a problem, often during co-sleeping or while sharing a room on vacation. They may hear their child snoring loudly, sometimes even louder than an adult, and observe pauses or gasps for air during sleep, which can indicate a potential airway obstruction.
“I noticed this in my own son. A few years ago, he would crawl into our bed at night and I would hear him struggling to breathe and snore,” shares Dr. Huoh. “Those are the cardinal hallmarks of what parents should be aware of as symptoms of sleep apnea.”
Children with sleep apnea may show signs of fatigue during the day, such as difficulty waking up or, paradoxically, hyperactivity. Sleep apnea often causes ADHD-like behaviors in children. Instead of appearing sleepy, some overtired kids may seem overly energetic. Another possible sign is trouble with nighttime potty training, as sleep apnea can contribute to bedwetting.
What happens during the surgery?
Tonsil removal is typically first considered when a child has symptoms of sleep apnea, along with visibly enlarged tonsils. In some cases, a sleep study may be done to confirm the diagnosis.
Dr. Huoh explains that the surgery, often including adenoid removal, is performed entirely through the mouth, with no external incisions. There are several surgical methods available, including traditional tools like scissors or newer technologies like electricity or radiofrequency ablation, and the choice depends on the specific case and surgeon’s preference.
The recovery process: What to expect
Recovery from a tonsillectomy can vary, but at CHOC, the most common approach is the intracapsular tonsillectomy—a newer technique that removes 90–95% of the tonsil while leaving a small portion behind. This method, widely used in Europe and growing in popularity in the U.S., offers key benefits: it significantly reduces the risk of post-operative bleeding—less than 1%, compared to 3–5% with traditional methods—and is generally less painful, leading to a smoother recovery for children.
“Our patients return to a regular diet almost immediately after surgery. My son was eating macaroni and cheese that night after surgery. We do tell parents to avoid any sharp food for a week or so,” advises Dr. Huoh. “Now, if you have the traditional operation, there’s quite a bit more discomfort involved. We usually tell parents to stick with ice cream and yogurt for a week or so. Kids will also take pain medication, usually Tylenol and Motrin, for a few days after surgery.”
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Learn more about CHOC’s otolaryngology program
At CHOC, our pediatric otolaryngologists provide comprehensive care for children of all ages – from newborns to teens – with conditions of the ears, nose, throat (ENT).
