Originally written in July of 2015 for publication in Midlothian NOW Magazine.

Approximately 500,000 tonsillectomies are performed in the US each year.  And while the number of these procedures has dropped significantly in the last 30 years, it still remains the second most common childhood surgery.  But not for the same reasons you, or perhaps your parents, had the procedure.  Rather, 80% of tonsillectomies are now performed to open a child’s airway, while chronic tonsillitis only makes up 20%.

What do tonsils have to do with a child’s airway, and why do we need to open them up?  When a child has chronically enlarged tonsils, they can partially (or completely) obstruct a child’s airway when the child is asleep.  Just as excess weight or a very large tongue can cause obstructive sleep apnea in an adult, large tonsils can cause sleep apnea in a child.  Sleep apnea can cause a host of medical complications in a child’s developing body, including ADD/ADHD, poor performance in school, and bedwetting well past potty training.

Whether or not a child with enlarged tonsils has true sleep apnea, they will very likely develop into mouth-breathers at night, and sometimes during the day as well.  Mouth-breathers are likely still not getting adequate oxygen to their brains, preventing them from performing their best at school.  Also, because their air is not properly filtered through their noses, they are more likely to have seasonal allergies and frequent colds.

In addition, when a child’s mouth is chronically open, it can drastically affect the development of their mouth, face and jaw.   The most visible changes could be dark circles under the eyes, as well as a recessive chin and an elongated lower face, as the jaw will grown downward more than outward.   The roof of their mouth will develop more narrowly, furthering their likelihood of sleep apnea.  It may become difficult for them to close their lips when their teeth are together.

When their mouths are open at night, saliva flow will decrease, and bacteria have longer to flourish.  These children will often build up heavy plaque on their front teeth, and they are more likely to develop cavities.

If you see some of these signs and symptoms in your child, or notice that they have very large tonsils for a long period of time, talk to your child’s dentist or pediatrician to determine if they should see an otolaryngologist.