A prospective cohort study exploring the impact of tonsillectomy on feeding difficulties in children

Objectives Paediatric feeding difficulties are common, affecting up to 25% of otherwise healthy children, symptoms include food refusal, gagging, choking, and excessive mealtime duration. These symptoms are commonly described in pre‐operative discussions about tonsillectomy. This prospective study explores the impact of tonsillectomy on paediatric feeding difficulties. Design This prospective cohort study invited caregivers of children undergoing tonsillectomy to complete a PediEAT questionnaire about their children's feeding behaviours, pre and post‐operatively. The study was completed in two phases with 9 questions administered in phase 1 and three additional questions added for phase 2. A free text comments box was also provided. Responses were graded from 0 to 5, where 0 is ‘never a problem’ and 5 is ‘always a problem’ with eating behaviours. Setting The study was conducted at our institution, a tertiary paediatric ENT unit. Participants Children aged between 6 months ‐ 7 years undergoing tonsillectomy for any indication were invited to participate. Main outcome measures Changes to the Pedi‐EAT scores pre and post operatively were the main outcome measure. Results 102 participants were recruited between January 2020 and January 2022. The mean age of participants was 4.1 years, 87% had a concurrent adenoidectomy. The mean time to completion of post‐operative questionnaire was 23 weeks after surgery. 9 of the 12 questions showed a statistically significant improvement in post‐operative scores using a paired student t ‐test ( p < 0.05). The most significant improvements related to ‘gets tired from eating and is not able to finish’ (1.49 pre‐op, 0.91 post op, p < 0.01) and ‘eats food that needs to be chewed’ (1.4 pre‐op, 0.72 post‐op, p < 0.01). 13% of participants only underwent tonsillectomy and this group also showed a statistically significant improvement in fatigue during eating ( p < 0.05). Conclusion Symptoms of fatigue during eating and avoidance of food requiring mastication are most likely to improve following tonsillectomy in children.