Tonsils in Kids -- Dr. Sanjay

WHAT ARE TONISILS?
• Tonsils are part of immune system of body. There are three sets of tonsils in the back of mouth; adenoids are also one of them.
• The main functions of these tonsils are like an army soldier, whenever anything unhygienic comes into the mouth, they fight with that first. While doing this, i.e. trying to prevent infection, they them self get injured i.e. they get infected and enlarged. So, by suffering them self, they prevent the infection to spread to rest of body.
• These tonsils grow until puberty (10-12 years), than begins to shrink in the following years. These tonsils are very important as a protective mechanism for children, because they are more likely to eat things which are unhygienic. After 12 years, they regress because our other immune mechanisms become more active to prevent infections.

WHEN TONSILLECTOMY IS JUSTIFIED?
You will be surprised to know, if they are so protective, why we need to remove them. Yes, sometimes we need to remove them, mainly because of mechanical problems which occur because of their enlargement. So there are 2 clear cut indications for its removal before 12 years:
I) When tonsils are enlarged so much that they obstruct breathing and swallowing both.
II) When throat infections are sooo much that these enlarged tonsils them self are posing risk for more infections (in such cases removal of these tonsils may be help full).
So, tonsillectomy will be advisable in a child who:
-- have developed at least 7 “significant” episodes of throat infection in 1 year.
-- Or atleast 5 “significant” infections every year from last 2 years.
-- Or atleast 3 “significant” infections every year from last 3 years.
Significant infection means : associated with high grade fever every time, with enlarged lymph nodes in throat, tonsils coved with pus like coating called exudates every time.

Every child who meets these criteria also need not go for surgery. Many children will improve spontaneously without surgery sooner or later. So, the decision about surgery should be individualized.
Recent evidence also suggests, that those children who are not frequently having significant tonsillitis if undergoes surgery, it won’t help in reducing chances of throat infection. So, surgery should be done only in those cases, where things are really worse.
So, prevention of throat infection in this age is more important.

MYTHS AND PREVENTION OF TONSILLITIS ?
3 POINTS TO REMEMBER IN PREVENTING TONSILLITIS:
• AVOID CROWDED PLACES.
(Infection may be contacted from persons, who are infected. If you find someone infected, keep distance from him/her and take precautions to avoid infection. Pollution and crowded places again increases risk of infection)
• GOOD BALANCED DIET.
(Includes two major diets, 2 times milk, one fruit a day)
• DURING INFECTIONS AVOID COLD DRINKS, ICECREAMS, COLD WATER
(Cos these organism multiply very fast when cold temp, so it will worsen the situation)

MYTHS NEED CLARIFICAITON:
1. No scientific evidence to suggest that curd or fruits like mausambi increase risk of tonsillitis (Infect fruits contain good amount of Vit C, which is needed for good immunity)
2. Fruits as such are better than juices, cos they contain lot of fibres, which are good.
3. Chocolates, nuts, cream biscuits can’t cause infection, why we avoid them, cos, when children eat them often they get contaminated, and by contamination risk of infection increases.
Hope many things are clarified.