What are tonsils and why do they need removing? (What is a tonsillectomy or adenotonsillectomy?)

How inflamed tonsils compare with normal tonsils

How inflamed tonsils compare with normal tonsils

What are tonsils?

Tonsils are soft tissue located at the back of your throat; they are part of the body’s lymphatic system (so are adenoids). When they are working properly, they help to recognise bacteria and viruses entering through the mouth and produce white blood cells to fight off infection.

Tonsils are particularly useful during childhood while the body is still encountering new bacteria and viruses for the first time and building up the immune system. Doctors seem to be of differing opinion as to how useful they are as adults; I’ve some that have called them redundant and unnecessary, I’ve also met other doctors who view removing them as an absolute last resort.

Why do tonsils need removing?

Tonsils may temporarily swell while fighting infection, sometimes they become so swollen that they result in a very sore throat and fever (tonsilitis), they may also partially obstruct the airways and not respond to non-invasive treatmeants.

Surgery may be recommended to help treat:

  • Multiple case of tonsillitis (seven cases of tonsillitis or strep in the last year, or five cases or more over each of the last two years).
  • Breathing problems related to swollen tonsils
  • Frequent and loud snoring
  • Periods in which you stop breathing during sleep (sleep apnea)
  • Bleeding of the tonsils
  • Trouble swallowing chewy foods, especially meats
  • Cancer of the tonsils

Back in the 1980s, having your tonsils out was kind of a childhood rite of passage. It was a very common procedure and often parents had already experienced a tonsillectomy in their own childhood. Medical opinion has now swung in a different direction and there is a more stringent list of criteria that often needs to be met (as well as requiring parent consent / advocacy). For a balanced medical opinion, try this post by Christopher Johnson (a pediatric intensive care physician) .

What is tonsil grading?

Surgery is most likely to be recommended if tonsils are consistently swollen at Grade 3 or Grade 4 coupled with other complications (such as snoring and/or sleep apnea).

What are the 4 grades of swollen tonsils

What are the 4 grades of swollen tonsils?

Basically tonsils are graded based on how much of the airway they block.

  • Grade 0 = tonsils are within the the tonsillar fossa
  • Grade 1 = tonsils obstruct 0-25% of oropharyngeal airway
  • Grade 2 = tonsils obstruct 26-50%
  • Grade 3 = tonsils obstruct 51-75%
  • Grade 4 = tonsils obstruct 75%

What are the possible side effects of swollen tonsils?

  • Fever / temperature. Keep in mind that children can react in their own individual ways – they may keep getting low grade temperatures instead of a fever.
  • Runny nose and congestion (as well as the sore throat).
  • Difficult or painful swallowing.
  • Swollen and tender glands (lymph nodes) on the sides of the neck.
  • Bad breath.
  • Fever and chills.
  • Tiredness and headache.
  • Stomach upset or pain.
  • Mouth breathing, noisy breathing, and/or snoring (due to enlarged tonsils blocking the airways). Obstructive sleep apnea. The swollen tonsils and/or adenoids can intermittently block airflow. It sounds like your child is silent and then there’s a big noisy sucking in of air.
    • In Miss 2 it can be so loud that I can hear it through her closed bedroom door and can sound like something’s fallen off a shelf and hit the floor! It’s a crappy and frightening thing as a parent that can result in just sitting with them in the dark either to check that they are breathing or to give them a gentle nudge to help them breathe again. If you’ve spent time with them hooked up to an oxygen saturation monitor then you’ll be familiar with what a stark difference there is between their oxygen levels when alert and upright versus lying prone to sleep.

  • Fatigue. They might seem like they’re getting enough hours of sleep but in reality the quality of sleep is poor because their body is struggling to get enough oxygen through the night. It’s a bit like starting each day on a half tank of gas.
  • Developmental delays. Sleep is critical for young children. During those early years, they are rapidly growing and learning. They need sleep to focus during the day; to have time for their brain to make connections between all the things they have learned or experienced; and their brain releases a growth hormone while they sleep. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can make it harder for them to stay on track.
  • Behavioural difficulties. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can result in daily misery that they don’t know how to express.

Keep in mind that young children (i.e. toddlers) may not be able to describe their symptoms to you and it may not even occur to them to do so (especially if they chronic health issues). They may also be confused by referred pain; the ears and throat share nerves (as well as being linked by eustachian tubes) so they may say their ear is sore when the infection is actually in their throat. Another possibility is if they keep exhibiting teething type behaviour well after all their teeth are in (i.e. chewing on fingers or a dummy constantly, lots of drool) combined with a temperature and bad breath – the cause may actually be their tonsils!

What does surgery (a tonsillectomy) involve?

Surgery will normally take place at a hospital (probably as an outpatient). The doctor will review medical history in advance and make recommendations about pausing medications. You will normally be advised not to take anti-inflammatory medications within 7 days of surgery. They will also discuss post-operative pain medication.

The day of the surgery will involve a period of fasting; food or water won’t be permitted because they can impact the anesthetic. It’s a good idea to have family support and a game plan of how to distract your child; an older child may understand why they can’t eat but a toddler is likely to just focus on the fact that they are off routine and they are HUNGRY!

During surgery, your child will be under a general anesthetic. The surgeon will enter through the mouth and the tonsils will be removed with an electrical cauterizing unit.  You can watch videos of surgery on YouTube but they can be a bit difficult to stomach; I preferred this video of a digital tonsillectomy surgery.

adenotonsillectomy

Adenoids and tonsils

Often the adenoids will be removed at the same time as the tonsils (if they are also swollen); this is termed an adenotonsillectomy. Click here for information about the adenoids.

What happens after surgery?

Depending on the age of your child, they may keep them in the hospital overnight for monitoring or they may go to a recovery room and then go home the same day. You should be given a pamphlet with information about post-op care (i.e. like this tonsillectomy guide).

Your child may feel quite groggy and tired for the next few days and also have some nausea; vomiting once or twice is normal but contact your doctor if vomiting persists.

A light, cool diet for the next few days is generally recommended (avoid hot liquids or spicy food) but doctors will often recommend that children eat whatever they want – the abrasion from bread or crackers will actually help to clean the area. (That’s not to say there won’t sometimes be screaming pain because a sharp cracker edge has just struck the surgical site).

Some doctors will prescribe antibiotics. They will normally be prescribed painkillers (like Pammol and Tramadol) and anti-inflammatories (like Nurofen); if your child won’t take the fully funded options consider buying over-the-counter replacements (for kids) that have been flavoured.  It is important to keep on top of their medication (including waking them up around the clock for a few nights) as the pain is severe; it will often peak somewhere around around Days 5-9 due to the way the membranes heal and can be excruciating.

It’s important to keep them rested and hydrated – even if this means just getting small regular sips of water, lemonade ice-blocks, or melty ice=cream into them; overall, the fluids are more important than food.

Common side effects will include:

  • Swollen tongue
  • Bad breath (like a hyena!)
  • White coating on the tongue
  • White scabs over the tonsils

Your doctor will talk you through potential complications and when to seek immediate medical care – i.e. if bleeding occurs (it can be life threatening); they may be able to resolve with medication or surgery may be required.

They need lots of rest for two weeks to promote healing and will be off school during this time due to the risk of infection.  They will also generally have several weeks off sports, exercise, and swimming.

Keep in mind that removing tonsils may only be one part of a wider treatment plan. If the chronic inflammation was linked to allergies then you will still need to work with a doctor to create an ongoing allergy treatment plan.

Gluten Free Berry Muffins

Gluten Free Berry Muffins

Gluten Free Berry Muffins

I love experimenting with gluten free flours. This is a different recipe again from the gluten free Vanilla Cupcakes and moist Chocolate Cupcakes. I was really stoked as Miss 2 kept asking for more of the mini ones and her playdate didn’t notice they were gluten free!

Like most gluten free baking, these are best served same (or next day); I free flow the rest in the freezer and pull them out as needed.

Ingredients

Group 1

  • 1 cup hot water
  • 1/2 cup neutral vegetable oil (like Rice Bran oil)
  • 1 egg
  • 1 tsp vanilla
  • Generous pinch ground cinnamon

Group 2

  • 3/4 cup sugar
  • 1 cup superfine white rice flour
  • 1/2 cup garbanzo flour (also called chickpea flour)
  • 1/4 cup oat flour
  • 1T sweet (glutinous) rice flour
  • 1/4 cup cornstarch (cornflour)
  • 1/2 tsp guar gum
  • 1/2 tsp Baking Soda
  • 1/2T Baking Powder
  • 1/2 tsp salt

Other ingredients

  • 1/3 – 1/2 cup frozen berries
    • I recommend raspberries and blueberries.
  • Raw unrefined coconut sugar

Allergies: dairy free, soy free, gluten free, nut free.

Directions

  1. Preheat the oven to 180’C.
  2. Whisk together the ingredients in Group 1. This helps to aerate the mix. You can use a stick blender or I used the food processor (with a plastic mixing attachment, not a metal cutting blade!).
  3. Sift together the ingredients in Group 2.
  4. Mix the combined dry ingredients into the whisked liquid.
  5. Prepare the frozen berries and mix in gently.
    • Raspberries crush really easily into tiny teardrops (which provide a pretty pink speckled effect when baked); blueberries are already a good size; boysenberries are large enough to need cutting in half.
  6. Pour into cupcake / muffin trays.
    • I made 6 large and 12 mini cupcakes.
  7. Preheat the oven to 180’C. The mixture will thicken slightly while the oven heats.
    • The mix will appear very runny compared to a gluten mix – the rice flour and cornstarch will cause it to thicken as it cooks.
  8. Bake at 180’c for approx. 25-35 mins or until cooked.
    • I found the mini muffins took 25 mins and the normal ones took 35 mins.

 

Icing 

I liked these with dusted with coconut sugar. I pulled them out of the oven after approx. 15 minutes (once they had risen), dusted with coconut sugar, and then placed back in the oven to finish baking.

I also have recipes for other icings that don’t use any artificial colours, glycerin, additives etc.

Chocolate Buttercream Icing (allergy friendly)

Chocolate Buttercream Frosting

Chocolate Buttercream Frosting

This is a great frosting to use with Gluten Free Chocolate Cupcakes, the Crazy One Dish Chocolate Cake, or the Chocolate Irish Potato Cake (vegan).

Ingredients

  • 115g softened butter, or allergy friendly spread like Nuttelex
  • 2 cups icing sugar
  • 1/2 cup Dutch Cocoa Powder
  • 1/2 tsp vanilla essence
  • 1 – 3 Tbsp milk (dairy, rice, or coconut)
  • Optional: 1/2 tsp espresso powder

Allergies: gluten free, dairy free*, soy free, egg free, nut free.

Directions

  1. Whip the butter.
  2. Sift in 1 cup icing sugar, cocoa powder, and espresso powder. Add the vanilla and milk.
  3. Beat until smooth.
  4. Slowly beat in the rest of the icing sugar to give a good consistency for frosting.

How to make allergy free Peppermint icing

After Dinner Mint Chocolate Cupcakes (Gluten Free!)

After Dinner Mint Chocolate Cupcakes (Gluten Free!)

It continually amazes me how many products contain hidden sources of soy. I wanted to make a peppermint icing but Natural Peppermint Essence at the supermarket contains: Glycerine, Alcohol, Water, Peppermint Oil. That might not sound so bad but our lengthy food allergy journey had me wondering what Glycerine actually is.  Research shows it’s sometimes made from animal fat but mostly it’s made from vegetable oil..with soybean oil being extremely likely.

I liked this on the Gluten Free Chocolate Cupcakes 🙂

Ingredients

  • 100% Peppermint herbal tea bag
  • Boiling water
  • Icing sugar

Directions

  1. Steep the tea bag in 1/4 cup boiling water.
  2. Make your cupcakes. (This gives the peppermint time to steep and the water time to cool.)
  3. Slowly mix the peppermint water into icing sugar.
  4. Ice your cooled cupcakes. We like them on gluten free Chocolate Cupcakes.

Note: Herbal / fruit teas work to create other flavour icings as well. Check out this naturally pink icing on vanilla Gluten Free cupcakes.

Moist & delicious Chocolate Cupcakes (gluten free!)

I love chocolate. I’ve posted a few chocolate recipes like the Crazy One Dish Chocolate Cake and the Chocolate Irish Potato Cake, and I’ve posted some make-from-scratch gluten free recipes like the Vanilla Cupcakes and the all natural pink berry flavoured icing. I wanted to play around in the kitchen with some different gluten free ingredients and make a wonderfully chocolatey and moist cupcake that also wouldn’t be packed with sugar – I prefer to balance my cakes so there’s more chocolate flavour in the cake and then extra sweetness in the (optional) icing. Miss 2 loved these with all natural peppermint icing or the Chocolate Buttercream icing (dairy free).

Ingredients

Group 1

  • 1 cup hot water
  • 1 tsp instant coffee powder
  • 1/2 cup neutral vegetable oil (like Rice Bran oil)
  • 1 egg
  • 1 tsp vanilla
  • Generous pinch ground cinnamon

Group 2

Allergies: dairy free, soy free, gluten free, nut free.

Directions

  1. Preheat the oven to 180’C.
  2. Whisk together the ingredients in Group 1. This helps to aerate the mix. You can use a stick blender or I used the food processor (with a plastic mixing attachment, not a metal cutting blade!).
  3. Sift together the ingredients in Group 2.
  4. Mix the combined dry ingredients into the whisked liquid.
  5. Pour into cupcake cases (makes about a dozen). Bake at 180’c for approx. 25-30 mins or until cooked.
  6. Allow to cool before icing. (We liked combining these with an all natural peppermint icing!).

 

Icing 

The icings that I use don’t have any artificial colours, glycerin, additives etc.

Gluten Free Pina Colada Cookies

Gluten Free Pina Colada Cookies

Gluten Free Pina Colada Cookies!

These Gluten Free Pina Colada cookies (UK/USA)  are a light fluffy cookie that I don’t think most people realize are gluten free when eating them! They use the Gluten Free Vanilla Cookie recipe as a base but the variations make this a moister cookie (as well as tasting of the sunny tropics). These are very welcome to add a bit of sunshine to a cold winter day and also make a great tropical treat for birthday parties!

Ingredients

  • 1/2 cup superfine white rice flour
  • 1/2 cup Healtheries Gluten Free Bread Mix
  • 2 tsp Baking Powder
  • 1/2 tsp Baking Soda
  • 1/2 cup sugar
  • 3 Tbsp butter or allergy-free spread (i.e. Nuttelex)
  • 1 egg (whisked) or egg replacement.
  • 2 Tbsp greek yoghurt / coconut yoghurt / coconut milk
  • 1/4 cup dessicated coconut
  • 1/4 cup pineapple (crushed and drained)

Allergies: gluten free, dairy free*, egg free*, soy free, nut free.

Directions

  1. Cream the ‘butter’ and sugar. Mix in the egg.
  2. Mix in the rice flour, GF bread mix, baking powder. baking soda, yoghurt, coconut, and pineapple.
  3. Spoon out onto lightly oiled baking tray and flatten slightly.
  4. Bake at 180’C for approx. 15-20 mins (or until golden brown).

Makes approximately 12 cookies.

Note: There are several reasons that I choose to use the Healtheries Gluten Free Bread Mix instead of the Healtheries Gluten Free Baking Mix.

I prefer to use guar gum in my recipes and avoid xanthan gum; the latter is artificially derived and is often grown on an allergenic base (such as corn, soy, or wheat).

I like to control the rising agents in my baking so that I can tailor them to each recipe.

Frugality! The Bread Mix can be used to make both Gluten Free Bread and Gluten Free Baking whereas their Baking Mix can only be used for baking.

Highlights for May (collected recipes & posts)

ALLERGY FRIENDLY COOKING

BAKING & DESSERTS

MEALS

PARENTING

PLAY

HEALTH

Choko Pikelets (apple pie style!)

Choko pikekets (apple pie style!)

Choko pikekets (apple pie style!)

I posted earlier about why choko are awesome and such a versatile vegetable; as well as being nutritious they are also cheap, easy to grow,  and low in natural food chemicals (amines, salicylates, glutamates) which makes it suitable for sensitive guts, and those following a RPAH Failsafe diet (often useful for allergy sufferers).

It easily takes the place of fruits like apple or pear which means it’s a great way of adding a vegetable into your baking! Miss 2 loved these apple pie style Choko Pikelets and kept asking for more!

I’ve kept the spices mild but you can definitely play around with them to suit your palate! Try increasing the cinnamon to 1 tsp, or adding 1/2 tsp ground ginger, a pinch of nutmeg, a pinch of ground cloves, or a combination of these!

Ingredients

  • 1 cup plain flour
  • 1 tsp Baking Powder
  • 1/2 tsp Baking Soda
  • Pinch salt
  • 1/2 tsp ground cinnamon
  • 1/4 tsp allspice
  • 2 Tbsp maple syrup + 1 Tbsp brown sugar, or, 1/4 cup white sugar.
  • 1/2 cup grated fresh choko
    • Just like grating potatoes, a lot of water comes out. Pat the grated choko dry before use.
  • 3/4 cup milk (can use almond or rice milk)

Note: Other names for choko include – chayote, sayote, labu siam, seemai kathrikai, Buddha’s Hand Melon, lóng xü.cài, ishkus, इस्कुस, স্কোয়াশ, Bangalore brinjal, chou chou, pipinola.

Tip: Although the recipe is gluten based, you can easily use Nana’s Yummy Gluten Free Pikelets and just add the choko + spices.

Allergies: gluten free*, dairy free*, soy free, nut free.

Directions

  1. Whisk the egg and 1/2 cup milk until frothy.
  2. Combine the dry ingredients.
  3. Stir in the choko. Then mix in the frothy egg + milk mixture.
  4. Slowly mix in the additional 1/4 cup milk until you have a smooth consistency.
  5. Allow mixture to stand for a few minutes.
  6. Heat a non-stick frying pan over medium heat. Wait until it is hot and then brush with butter or allergy-free spread (like Nuttelex).
  7. Drop level tablespoonfuls of the mixture into the pan and cook for half a minute or until bubbles appear on the surface.
  8. Turn over and cook other side for 1 minute until golden.
  9. Allow to cool and serve with butter / spread and honey or jam.

Gluten Free Vanilla Cookies

Gluten Free Vanilla Cookies

Gluten Free Vanilla Cookies are the base recipe for making Pina Colada Cookies!

These Gluten Free vanilla biscuits (UK) / cookies (USA) are a light crunchy cookie that I don’t think most people realize are gluten free when eating them! They’re also the base recipe for variations, like the GF Pina Colada cookie recipe that will be publishing soon!

Ingredients

  • 1/2 cup + 1 Tbsp superfine white rice flour
  • 1/2 cup Healtheries Gluten Free Bread Mix
  • 2 tsp Baking Powder
  • 1/2 cup sugar
  • 3 Tbsp butter or allergy-free spread (i.e. Nuttelex)
  • 1 egg (whisked) or egg replacement.
  • Vanilla Essence

Allergies: gluten free, dairy free*, egg free*, soy free, nut free.

Directions

  1. Cream the ‘butter’ and sugar.
  2. Mix in the egg and several drops of vanilla essence.
  3. Mix in the rice flour, GF bread mix, baking powder.
  4. Spoon out onto lightly oiled baking tray and flatten slightly.
  5. Bake at 180’C for approx. 15-20 mins (or until golden brown).

Makes approximately 12 cookies.

 

Note: There are several reasons that I choose to use the Healtheries Gluten Free Bread Mix instead of the Healtheries Gluten Free Baking Mix.

I prefer to use guar gum in my recipes and avoid xanthan gum; the latter is artificially derived and is often grown on an allergenic base (such as corn, soy, or wheat).

I like to control the rising agents in my baking so that I can tailor them to each recipe.

Frugality! The Bread Mix can be used to make both Gluten Free Bread and Gluten Free Baking whereas their Baking Mix can only be used for baking.

Nana’s Yummy Gluten Free Pikelets

Yummy Gluten Free Pikelets

Yummy Gluten Free Pikelets (light & fluffy)

Ingredients

Dry

  • 1/2 cup superfine white rice flour
  • 1/2 cup  Healtheries Gluten Free Bread Mix
    • Note: this already contains guar gum.
  • 1/4 cup sorghum flour
  • 1T sugar
  • Optional: 1T Maple Syrup
  • 1 1/2 tsp Baking Powder
  • Pinch salt

Liquid

  • 1/2 cup rice milk
  • 1 egg
  • few drops vanilla essence
  • 1 Tbsp rice bran oil

(Have more rice milk available.)

Allergies: dairy free, gluten free, soy free, nut free.

Directions

  1. Whisk the wet ingredients until frothy.
  2. Combine the dry ingredients and then mix in the frothed wet ingredients.
  3. Slowly mix in additional rice milk until you have a smooth consistency.
  4. Allow mixture to stand for a few minutes (it will thicken up).
  5. Heat a non-stick frying pan over medium heat. Wait until it is hot and then brush with butter or allergy-free spread (like Nuttelex).
  6. Drop level tablespoonfuls of the mixture into the pan and cook for half a minute or until bubbles appear on the surface.
  7. Turn over and cook other side for 1 minute until golden.
  8. Allow to cool and serve with butter / spread and honey or jam.

 

Note: There are several reasons that I choose to use the Healtheries Gluten Free Bread Mix instead of the Healtheries Gluten Free Baking Mix.

I prefer to use guar gum in my recipes and avoid xanthan gum; the latter is artificially derived and is often grown on an allergenic base (such as corn, soy, or wheat).

I like to control the rising agents in my baking so that I can tailor them to each recipe.

Frugality! The Bread Mix can be used to make both Gluten Free Bread and Gluten Free Baking whereas their Baking Mix can only be used for baking.