Q: My 4 years old daughter has enlarged tonsils. I give her antibiotics very often due to tonsil enlargement, which is accompanied with infection and swelling. Should we get her tonsils removed? I have heard that tonsils can be removed at the age of 5 years and before that, the child mist be administered pneumococcal vaccine in order to avoid an infection. But the vaccine is not available in our city. Should I wait for her to turn 5? She had adenoids removed at the age of two and a half years. Also she has 4 nodules on her head for the last 3 years - two behind the ears and the other two at the backside of the head. She has a very sensitive skin and gets rashes, which cause itching at the night-time and if the itching is severe I give her cetirizine. What should we do?

A:Huge tonsils causing obstructive symptoms especially noisy breathing at night requires adeno-tonsillectomy.

Pneumococcal vaccine is helpful in preventing ear infections.

Allergy treatment by cetirizine can be continued till she grows out of it. Most children where family history of allergy, asthma, urticaria, etc. is not present grow out of it. Long-term use of cetirizine is without side effects.

Lymph nodes are reactive and settle down after surgery. If parents decide against surgery use ampicllin and cetirizine for 3 to 6 months with mometazone spray to shrink adenoid and tonsils. Use of long-term antibiotics with beta-haemolytic Streptococci for prevention of rheumatic fever has been done without harm.