Enlarged Tonsils and Adenoids in Children: Symptoms & Causes

What are enlarged tonsils and adenoids?

“As a parent, it is concerning if your child suddenly has trouble sleeping, and especially scary if they stop breathing for a moment during the night,” said Jennifer Kalansky, DO, Catholic Health Pediatrician. “There could be many causes, but enlarged tonsils or adenoids are a common reason, and easily treatable.”

Tonsils are lumps of tissue in the back of the throat. Adenoids are a patch of tissue located between the nose and throat. Both are part of the immune system and protect the body from disease. Tonsils help filter out bacteria and viruses to fight infection. Adenoids trap harmful bacteria when you breathe in or swallow.

Tonsils and adenoids may become enlarged after an infection, such as a cold or the flu. Tonsils may also become swollen because of mononucleosis (mono), strep throat, pneumonia or tonsillitis.

Who gets enlarged tonsils and adenoids?

Dr. Kalansky explained that children and adolescents are most at risk for enlarged tonsils and adenoids.

Since children have smaller throats than adults, there is less space for tonsils and adenoids. They may also have more exposure to germs and bacteria that cause infections. Adults can get enlarged tonsils and adenoids, but it happens less often. If they become enlarged, it is usually due to allergies, infection or irritants like cigarette smoke.

What are the symptoms of tonsillitis?

Enlarged tonsils and adenoids do not always cause symptoms. However, the most common problems are snoring or sleep issues. Other possible symptoms of enlarged tonsils or adenoids include:

• Bad breath due to bacteria buildup
• Breathing through the mouth due to nasal obstruction
• Ear infection
• Pauses in breathing during sleep (sleep apnea)
• Restless sleep
• Runny nose
• Sore throat
• Strained breathing
• Trouble swallowing
• Waking up frequently

When should I call my child’s pediatrician?

If your child has enlarged tonsils or adenoids and shows the following symptoms, call their pediatrician or take them to urgent care:

• Difficulty breathing
• Excessive drooling
• Fever (101°F or higher)
• Inability to drink or swallow
• Sore throat that lasts more than four days

Can I prevent enlarged tonsils and adenoids?

“There is no way to prevent enlarged tonsils or adenoids,” said Dr. Kalansky. “However, there are steps you can help your child take to keep their immune system strong to prevent infections.”

• Avoid sharing food and drinks, especially with someone who is sick
• Eat a healthy diet
• Get enough sleep
• Practice good dental hygiene (brush and floss daily, regular dentist appointments)
• Stay hydrated

Can enlarged tonsils and adenoids happen more than once?

It is possible to get enlarged tonsils or adenoids more than once. The tissue can swell again due to allergies, irritants or a recurring infection. However, they are unlikely to grow back to their original size after surgery.

How are enlarged tonsils and adenoids treated?

“If your child has enlarged tonsils or adenoids but no symptoms, they may not need treatment,” said Dr. Kalansky. “As your child grows and gets older, tonsils and adenoids become smaller.”

She noted that a pediatrician may recommend your child see an Ear, Nose & Throat (ENT) physician if your child’s symptoms are severe. An ENT may recommend surgery and a sleep study.

A tonsillectomy removes the tonsils. An adenoidectomy removes the adenoids. Both surgeries improve the airway size to help your child breathe easier. The procedures remove any obstruction in the throat that may cause them to snore or have disordered breathing.

Some children have their tonsils and adenoids removed simultaneously, a procedure known as tonsillectomy and adenoidectomy (T&A). It is the most common surgery for children in the U.S. However, the body can still fight infection if both are removed.

Your child may need to take an antibiotic for enlarged tonsils caused by bacterial infections. They may also need a nasal steroid to help ease swelling.

“Your child’s pediatrician will review the best course of treatment and follow-up to make sure your child is feeling better,” said Dr. Kalansky.