• 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.
  • Day 1 (Return home)
    • 1st dose, 12:00 p.m., Acetaminophen
    • 2nd dose, 3:00 pm (3 hours after), Ibuprofen
    • 3rd dose, 6:00 pm (3 hours after), Acetaminophen
    • 4th dose, 9:00 p.m. (3 hours later), Ibuprofen
    • etc.  (You may need more doses as prescribed)
  • Day 2 (Return home)
    • 1st dose, 6:00 pm, Ibuprofen
    • 2nd dose, 9:00 am (3 hours after), Acetaminophen
    • 3rd dose, 12:00 pm (3 hours after, Ibuprofen
    • Continue alternating every 3 hours

• 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.
  • Proxim Group Pharmacy
    • 6900 Decarie Blvd., Côte Saint-Luc, Montreal (in Decarie Square)514-370-8885(closed on Saturdays)
  • Uniprix Pharmacy
    • 5025 Sherbrooke Street West, Suite 102, Montreal (Westmount)

• 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.

• Ibuprofen should be given before night because it lasts longer than acetaminophen.
• Be sure to give one of the pain medications before your child goes to bed.  Wake the child up to give acetaminophen or ibuprofen for the first 3 days after surgery.
• If you are using morphine, do not stop acetaminophen and ibuprofen.

• It may take 2 to 3 weeks before returning to a normal state.
• If you are using a humidifier, use a cool mist.
• Night terrors have been reported.  Your child may have night terrors that can last for three to four weeks after surgery.

• Yes. This probably originated in the nasopharynx where the adenoids were removed.
• Observe and if it happens again, take your child to The Montreal Children’s Hospital immediately for an ENT examination.

• Bright red blood in your child’s throat and/or vomiting from coffee beans are signs of bleeding. There is a possibility of bleeding after the operation, and it is more common between the fourth and eighth day after the operation.
• Blood may come from the nose or mouth, or be visible in sputum or vomiting. Proper hydration reduces the risk of bleeding.
• If bleeding occurs, bring your child to The Montreal Children’s Hospital immediately.

• A mild fever of up to 38.5°C or 101°F is normal after surgery.
• Acetaminophen given for pain, cloth baths, and increased fluid intake can help lower your child’s temperature. If the fever persists for more than two days, call the ENT doctor on call. Fever can be a sign of an infection. If you have been prescribed an antibiotic, continue to take it.
• 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.

• An adequate intake of fluids is necessary for:
  • Ensure proper hydration
  • Decrease pain
  • Prevent stiffness of the throat muscles
  • Prevent crusting
  • Facilitate swallowing

• The amount a child should drink per day is usually based on their weight after tonsillectomy and/or adenoidectomy

Adapted from the Children’s Hospital of Eastern Ontario (CHEO)

(kg:Kiligrams; lbs:pounds; mL: milliliters)

• An adequate intake of fluids is necessary for:
• This is common because he eats and drinks less than normal.
• Your child may lose a few pounds after the operation. Your child may also have stomach aches if they don’t eat or drink enough.

• After surgery, start giving your child clear liquids. These can include water, apple juice, flat ginger ale or 7Up, popsicles, ice cream, and jelly. Your child may prefer cool liquids. If your child vomits, wait half an hour before starting to give them fluids again.
• After tonsillectomy: The day after the operation, a soft diet can be started and given as tolerated.
• A soft diet consists of: Soggy cereals, oatmeal, porridge, pancakes, a sandwich, fish, eggs, cheese, pasta, rice, a milkshake, well-cooked vegetables, soft fruit, ice cream, pudding, soup, etc.
• If necessary, blending solid foods will help your child swallow.
• Soft, cold foods can be soothing.

• There are no strict restrictions on food avoidance.
• However, some dry and/or acidic foods could irritate the throat, including toast, crackers, tomatoes, orange juice, and lemonade.
• It is also recommended to avoid any red food, as it can look like blood when the child vomits.

• Constipation can be seen after any surgery, due to opioids given during anesthesia or a side effect of morphine medications. It is common for the child not to have a bowel movement after the operation. Try to give them soft foods that contain fibre, such as fruit (prune juice) and vegetables, which can often help.

• This is normal. It appears almost immediately after surgery and can take up to 3 weeks to go away.
• After a tonsillectomy, the back of the throat and tongue may be covered with a white membrane. This usually disappears within two weeks. Your child may also have a larger-than-normal discharge from their mouth and nose for a while.
• Example:

• Earaches are common after tonsillectomy and/or adenoidectomy. They can be due to throat pain. Earaches can go from mild to very painful. They most often begin between the third and ninth day after the operation. Ear infections can last from three to eight days.

• Your child’s voice may change after tonsillectomy and/or adenoidectomy. This change of voice will be temporary and may last from one to three months.
• Do not hesitate to report this during your follow-up visit to your ENT doctor.

• Mucus from the operation can cause a cough. If your child has a fever or is otherwise unwell, seek medical advice

• Cough syrup is generally not recommended after surgery.

• Your child may have a high fever (> 39.0°C), increased pain, swelling, warmth or redness, and restricted neck movement.
• These symptoms usually appear 6 to 9 days after the operation. If the pain has worsened significantly after this time, it may be a sign of infection.

• Yes, this is normal, and it will go away after a few weeks.
• Your child’s breath may be unpleasant after tonsillectomy and/or adenoidectomy. This will improve as the throat heals.

• It is normal and can last up to 2 weeks, you can use a saline nasal rinse to improve comfort in the meantime.

• 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.

• Bleeding – bright red blood from the nose or mouth
• Vomiting resembling ground coffee material