pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Tonsillectomy – criteria for performing

[Two grandmothers are at odds over their grandsons tonsillitis and possible tonsilectomy.]

I just read your article re: tonsillectomy. My three year old grandson was diagnosed with bacterial tonsillitis about 10 days ago. The Dr. put him on amoxicillin, but it did not cure it. Today they gave him another antibiotic, Vantin, and said it is now “acute” tonsillitis. To my knowledge, this is the first time he has ever had tonsillitis, however he does have a history of re current ear infections. His “other” grandmother is insisting that he needs to have a tonsillectomy and apparently has a family practice Dr. who agrees with her. Should his father (who is a single parent) take him to another Dr. for a second opinion or does this make sense to you? The “other” grandmother is pretty controlling and pretty pushy when it comes to this child. She is a hypochondriac herself and takes him to the doctor every time he sneezes. I know this time it is an actual illness, but it is amazing how when he is home with his dad he is well most of the time. The only time he gets sick is when he is visiting her. He is only three years old and the thought of surgery upsets me. Thanks for your opinion… Martha B.

From what you tell me the child does NOT yet meet the criteria for tonsillectomy set up by specialty boards. It doesn’t surprise me that someone could find a physician who takes tonsils out with less stringent criteria especially if there are financial remuneration issues. Additionally a “controlling” person might not have difficulty talking until a physician agrees with them.

I would demand of a physician that the child’s entire medical history be reviewed and insist on documentation in the record of “sore throats”- their cultures and treatments- of a trusted pediatrician (trained specifically for children) before making the decision on tonsillectomy.

By the way: “acute tonsillitis” just means that the child is in the initial onset phase. “Acute” is what everyone gets first and if it lingers on and on it becomes “chronic.” The term “acute” is not used to describe the severity (or importance) of tonsillitis. Throat cultures should usually have been taken before both instituting antibiotics and switching to another one.

If there are any smokers around the child – don’t! Hope this helps you work with your trusted physician.

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