• The best way to control pain is not to wait for your child to show signs of pain. You can use acetaminophen (Tylenol) and ibuprofen (Motrin or Advil). These medications are usually sufficient to control pain. We recommend that you alternate medications (by changing places).
• For example, if you start with a dose of acetaminophen, then use ibuprofen, then acetaminophen, then ibuprofen, and so on (see chart below). Give them regularly for the first two days after surgery. After that, only give medication when your child needs it. Follow the instructions for your child’s age and weight. Use the correct dose for each medication. Do not take more tablets than what is allowed per day. Ask your pharmacist or doctor if you are unsure how much medication to give. Opioids such as morphine are rarely prescribed and are often not needed in most cases (note: there are exceptions).
• Below is an example of alternating medications for the first two days for an average 3-year-old. Your child may need different amounts of medication and different times. Ask your doctor or pharmacist to make a schedule so you know when to give your child the medications.

• Ask your pharmacist for another formulation or brand.
• Consider using suppositories for acetaminophen and/or ibuprofen.

• The suppository formulation of ibuprofen is not commonly found in most pharmacies.
• Here are the pharmacies that offer ibuprofen suppository

It is preferable to have a medical prescription and allow a delay of 24-48 hours because suppositories are made at the pharmacy.

• The Canadian Pharmacists Association has created an educational document for parents:
  • https://caringforkids.cps.ca/handouts/health-conditions-and-treatments/shortage-of-childrens-liquid-pain-and-fever-medications

• The dose may be given as prescribed when you leave the hospital.
• You can also follow the recommended dose of acetaminophen or ibuprofen listed on the bottle.
• The dose of oral acetaminophen ranges from 12.5 mg/kg to 15 mg/kg.
• The oral dose of ibuprofen is 10 mg/kg.
• The dose of oral morphine will be calculated for you based on your doctor’s prescription. The dose of oral morphine is usually between 0.05 and 0.1 mg/kg after this procedure.

• Your doctor may have prescribed morphine. You can give it if your child is still in pain despite using acetaminophen and ibuprofen.

• When the child starts to feel comfortable, you can start to decrease the medication. Every child is different.
• We recommend that you first stop morphine (if you were administering it).
• Then, decrease the frequency of acetaminophen and ibuprofen administration. For example, if you were giving 4 doses of each a day, decrease to 3 doses the next day, to 2 doses the next day, and then only if your child needs them for pain.

• There are non-drug pain relief strategies to help your child feel more comfortable and relaxed. Comfort your child in the way that worked best before surgery.
• Distraction will help your child take their attention away from the pain. Examples include playing games or with a favorite toy, reading or telling stories, watching TV or videos.
• For teenagers, relaxation is very useful.
• Using hot or cold ice packs on the child’s neck and/or ear can help.

• Breathing through the mouth can make the mouth and throat dry or painful. Place a humidifier near your bed when you sleep. This can make it easier for your child to breathe. To be on the safe side, it is recommended to use a cool-mist humidifier. Hot water or steam from a hot mist humidifier or steam sprayer can burn a child if they get too close. Don’t forget to follow the instructions for cleaning the machine.

• Your child should try not to cough, clear their throat, or blow their nose for 10 days.

• The teeth and tongue can be cleaned with a toothbrush or washcloth. Use water with a very small amount of toothpaste. Gargles and mouthwashes should not be used.

• Normally, surgeons recommend that the child be able to resume activities 10 to 14 days after the procedure. The reason for this is that the risk of bleeding is during this period.
• In the meantime, your child should only do quiet activities. He must not run, cycle, jump or swim. Ask your surgeon when your child will be able to return to sports, sports competitions, or any other activity that may affect the throat.
• Avoid long-distance travel for 2 weeks due to the risk of bleeding.

• After the operation, your child should stay home for at least seven days after the adenoidectomy and ten days after the tonsillectomy (or for as long as your surgeon tells you). This will help your child recover and stop infections and bleeding. Your child should not be in contact with people who have a fever or cold. If your child is of school age, homework should be arranged with the teacher before the operation.

• Persistent vomiting more than three times a day
• Pain that doesn’t go away even after giving your child the prescribed medications.
• A fever of 38.5°C or 101°F, 48 hours after surgery.
• A sore throat or earache that lasts more than 10 days after surgery.

Note: you can call the ENT doctor on call between 7 a.m. and 11 p.m. for any questions. In the event of a serious problem between 11 p.m. and 7 a.m. (e.g., bleeding), go directly to the emergency room.