What is the typical post-operative care regimen for a toddler with no significant past medical history or allergies undergoing adenoidectomy?

Post-Operative Care for Toddler Adenoidectomy

For a healthy toddler undergoing adenoidectomy, expect a 1-2 day recovery period with pain management using NSAIDs (ibuprofen), careful monitoring for bleeding and dehydration, and return to normal diet as tolerated within 24-48 hours. 1

Immediate Post-Operative Period (First 24 Hours)

Pain Management

• NSAIDs (ibuprofen) are the first-line analgesic and are safe without increased bleeding risk 1
• Avoid opioids in routine cases due to respiratory depression risk, especially in toddlers 1
• If opioids are necessary, use reduced doses with careful titration 1
• Pain is the main cause of morbidity and can lead to decreased oral intake and dehydration 1

Monitoring Requirements

• Most healthy toddlers can be discharged the same day after a few hours of observation 1
• Monitor for respiratory complications during recovery room period with pulse oximetry 1
• Watch for signs of bleeding, which occurs in approximately 2% of cases 2
• Assess hydration status and oral intake before discharge 3

Feeding and Hydration

• Encourage oral fluids immediately as tolerated 3
• No specific dietary restrictions are required - advance diet as tolerated 3
• Monitor for dehydration, which is a common complication along with pain 1, 3
• Dysphagia and decreased oral intake are expected but should improve over 24-48 hours 1

Days 1-7 Post-Operative

Activity and Recovery

• Recovery typically takes 1-2 days for adenoidectomy alone 1
• Normal activities including baths and swimming are permitted 1
• Air travel is generally safe after adenoidectomy 1

Complications to Monitor

• Bleeding (approximately 2% incidence) - most common serious complication requiring immediate medical attention 2, 4
• Dehydration from poor oral intake 1, 3
• Postoperative nausea and vomiting 3
• Referred ear pain (otalgia) 3
• Fever or signs of infection 3

Red Flags Requiring Immediate Evaluation

• Any bleeding from nose or mouth 4
• Signs of dehydration (decreased urine output, lethargy, dry mucous membranes) 3
• Persistent vomiting preventing oral intake 3
• Respiratory distress or difficulty breathing 1
• High fever or signs of severe infection 3

Special Considerations for Toddlers

Age-Specific Risks

• Toddlers aged 0-3 years have higher rates of airway and respiratory complications compared to older children 5
• Younger children (0-9 years) experience higher complication rates overall, though absolute rates remain low in healthy children 5
• Anesthesia mortality risk is approximately 1:50,000 for ambulatory surgery 2

Rare but Serious Complications

• Velopharyngeal insufficiency (abnormal nasal voice quality) - rare but permanent if occurs 1, 6
• Grisel's syndrome (atlantoaxial subluxation) - extremely rare 1, 6
• Nasopharyngeal stenosis - rare 1
• Death - extremely rare with modern anesthesia 1

Follow-Up Care

Routine Follow-Up

• Schedule post-operative check within 2-4 weeks to ensure complete healing 1
• Assess resolution of presenting symptoms (nasal obstruction, chronic adenoiditis) 2, 7
• No routine imaging or testing required for uncomplicated recovery 1

When Surgery Was for Otitis Media

• If adenoidectomy was performed with tympanostomy tubes, follow-up includes monitoring tubes until extrusion 1
• Adenoidectomy reduces need for future ear surgery by approximately 50% in children ≥4 years 1, 2

Common Pitfalls to Avoid

• Do not prescribe routine opioids - NSAIDs provide adequate analgesia without respiratory depression risk 1
• Do not restrict diet unnecessarily - advance as tolerated to prevent dehydration 3
• Do not dismiss minor bleeding as normal - any post-operative bleeding warrants evaluation 4
• Do not assume all post-operative problems will resolve without intervention - dehydration may require IV fluids 3