When many of us were growing up, the cure-all for throat infections and breathing problems was removal of the tonsils and adenoid. Today, these operations are rarely recommended. Find out when your child's tonsils or adenoids should be taken out and -- perhaps more importantly -- when they shouldn't.

Remember how terrified you were as a child when you had to go to the hospital to have your tonsils removed? The operation to end recurrent sore throats was a childhood rite of passage, and after surgery we were rewarded with heaping plates of ice-cream. Kids who breathed through their mouths had their own war stories about having their adenoid taken out. Today, most children are spared such operations because doctors know more about these tissues and how to deal with infections.

What Are Tonsils and the Adenoid?

The tonsils are a pair of small almond-shaped masses on either side of the throat. These structures act as a defense against infections that invade the body through the nose and mouth. Tonsils are part of the body's protective lymphatic system, which dispatches cells that literally devour bacteria. The Adenoid is a grape-like mass of tissue located above the tonsils, behind the nose. Its role is to help fend off respiratory-tract infections.

What Are Symptoms of Tonsillitis and Enlarged Adenoid?

Occasionally, the tonsils become overwhelmed by a bacterial infection. This infection, known as tonsillitis, usually strikes children between the ages of three and six. The symptoms of tonsillitis are similar to those of the flu, so it may be tricky to distinguish between the two. Signs of infection include difficulty swallowing; red and swollen tonsils; white or yellow spots on the tonsils; sore throat; swollen glands in the neck, and fever.

The adenoid may swell temporarily when a child has a cold or other infection, but constant swelling can cause ear and sinus infections. Signs of an enlarged adenoid include breathing through the mouth instead of the nose; a nasal quality to the voice; noisy breathing; and snoring. If in addition to having above symptoms, your child stops breathing for short periods during the night and always seems to have a "throaty" voice, both the adenoid and tonsils may be swollen.

How Is Tonsillitis Treated?

Sometimes tonsil and adenoid tissue swell and then return to normal without treatment. But if your child has symptoms more than 48 hours or has a history of tonsillitis, see your pediatrician. An untreated infection can lead to a painful abscess in or around the tonsils. The doctor will examine your child's throat and take a throat culture. If tonsillitis is diagnosed, a 10-day supply of an antibiotic will probably be prescribed. Symptoms should disappear within a few days, but it is important to finish all of the medication to keep the infection from making a come back.

When Is Surgery Called For?

Tonsils or the adenoid may have to be removed (usually when a child is six or seven) under certain conditions. These include:

• Swelling makes breathing or swallowing difficult.
• An enlarged adenoid distorts speech.
• A swollen adenoid causes repeated ear or sinus infections.
• An excessive number of sore throats or stubborn tonsillitis that doesn't clear up.
• Lymph nodes beneath the jaw remain swollen even with antibiotic treatment.

What Exactly Does the Surgery Involve?

Tonsillectomy and Adenoidectomy are surgical procedures that require general anesthesia. Help make surgery less frightening for children by explaining what will happen, answering their questions and assuring them that you'll be nearby throughout the operation.

During surgery, the tonsil or adenoid tissue is removed and the cut area is left to heal naturally. These are simple operations but like all surgery, a small amount of risk is involved. The procedure can be done either in a hospital, which requires a stay of a day or two, or it can be done on an outpatient basis so that the child can recuperate at home.

Your child's throat will be sore for several days after the operation. Soft foods, including ice cream, custards, and soups, can help soothe the pain. Children can look forward to returning to their normal activities within a week after the operation.

Common Myths About Tonsils and the Adenoid

Don't be tempted to have your child's tonsils or the adenoid removed because of any of these common tall tales:

"Tonsils are useless."

Not true. Researchers continue to report new evidence that shows tonsils are a valuable part of the body's defense mechanism against invading germs and viruses.

"Tonsils are making my child sick."

Chances are your child is going through a normal stage of growth, irrespective of the condition of the tonsils. Before children can build up antibodies to fight off `bugs,' they must be exposed to them. So a certain number of mild respiratory diseases are expected during a child's early years.

"Children are healthier without them."

It's not true that a tonsillectomy or adenoidectomy makes a child less susceptible to colds, sore throats and other respiratory ailments. Nor do the operations relieve an allergy or a chronic problem such as asthma.

"They're swollen."

There is no standard size for tonsils; they can be large or small. What you perceive as swelling may be the tonsils' normal size. Tonsils are very small at birth, enlarge gradually, and reach maximum size at age six or seven. After that, they usually shrink to walnut size. An adenoid grows between the ages of three and five and then shrinks, eventually disappearing altogether during puberty. Unless a medical problem is diagnosed, enlargement alone is no basis for surgery.