When you are told that your child needs their tonsils or adenoids removed, it can be a scary thing to hear, and you may have many questions and concerns.

Tonsil and adenoid surgeries are actually the most common outpatient surgical procedures performed on children in the United States according to a recent study.

In this Q&A, Aldo V. Londino, MD, and Stephanie Wong, MD, ear, nose and throat (ENT) experts at Mount Sinai, explain why tonsil and adenoid surgery is important, the signs your child might need the surgery, what parents need to know about the procedures, and what to expect from the surgery.

Aldo V. Londino, MD

What is a tonsillectomy and/or adenoidectomy, and why are they important?

Tonsils and adenoids are a type of tissue that supports the immune system and helps fight bacteria and viruses in the body. The tonsils are located in the back of the throat. Sometimes in children they get enlarged due to an infection. They appear as two large balls, and block air from flowing through the throat. The adenoids are located at the top of the mouth and behind the nose, and they may enlarge due to allergies, a cold, or another cause. Sometimes the tonsils and adenoids cause obstructive symptoms or turn into sources of infection. A tonsillectomy and adenoidectomy is a surgical procedure that removes the tonsils and adenoids to improve the size of the airway and relieve obstruction in the throat and nose so children can breathe better.

What are the key signs that my child may need their tonsils or adenoids removed?

Here are six common reasons for tonsil and adenoid surgery are:

• Recurrent throat Infections, most commonly strep throat
• Recurring sinus or nasal infections
• Recurrent earaches and ear infections
• Upper airway obstruction
• Chronic sleep-disordered breathing, including mouth breathing, snoring, and obstructive sleep apnea
• Blocked, runny, or stuffy nose

Removing the tonsils and adenoids will result in fewer throat infections and sore throats, as well as  improved breathing and sleeping patterns. Your child may also be happier.

Stephanie Wong, MD

What is involved with surgery?

Both tonsillectomies and adenoidectomies are simple procedures that require a small amount general anesthesia.  Even when both procedures are done together, it usually takes under an hour. Afterwards, parents can stay with their child in the recovery area as they wake up.

What happens afterwards?

Some children feel better in just a few days, while some take up to two weeks to recover. It’s normal for your child to have a sore throat and ear pain after surgery. They may also experience bad breath and white patches that appear in the back of the throat. These symptoms are all normal after surgery and will slowly dissipate. It’s important to check on your child when they first come home to make sure they don’t have any bleeding or difficulty breathing, and to regularly provide pain medications, such as  acetaminophen (Tylenol®) and ibuprofen (Advil®).

If the adenoids were removed, avoid letting your child blow their nose for up to two weeks.

Throughout the recovery time, make sure your child drinks plenty of fluids, and it’s best to avoid carbonated, sugary, or acidic drinks. They should follow a soft diet that is provided by your medical team.

Typically, children who undergo these surgeries can return to school within a week or so, or when they feel comfortable.

If you think your child might need to have a tonsillectomy or adenoidectomy, or if you have concerns or questions, please call 833-4ENTKID (833-436-8543) to schedule an appointment.

Nosebleeds can seemingly come out of nowhere when your child is playing outside or waking up in the morning. While nosebleeds are very common and usually nothing to worry about, they can be frustrating to deal with. In rare cases, they may indicate a larger problem.

In this Q&A, Pediatrician Stephen Turner, MD, from Mount Sinai Doctors-Brooklyn Heights, discusses some of the common causes of nosebleeds, some tips to avoid nosebleeds, and how to treat them.

Why do some kids get nosebleeds?

The number one cause is dry air. As the seasons change and the weather gets warmer or colder, nosebleeds occur more often. Nosebleeds are also heritable—your child is likely to have them if you or their other parent did.

Stephen Turner, MD

What happens when you have a nosebleed?

A nosebleed involves the loss of blood from the tissue lining the nose. The lining is called mucosa, which has an abundant blood supply. However, the front of the nose can dry out easily because of regular airflow, causing blood vessels to crack. Bleeding typically occurs in one nostril, but it can also occur in the mouth. Our mouths are also lined with mucosa, but rarely bleed because they are moist.

How can I prevent my child from having nosebleeds?

Keep their nose moist, especially during a change in season, and minimize future nosebleeds. Ways to prevent nose bleeds include:

• Add more moisture to the air with a humidifier.
• Use saline salt-water sprays and lubricating gels to keep the lining of the nose moist.
• Apply ointment like petroleum jelly in your child’s nostrils before bedtime and early in the morning.
• Help your child avoid blowing their nose by treating their colds or allergies.
• Teach your child not to pick or scratch their nose, which can re-open the nosebleed and create an ongoing cycle.
• Put gloves or socks over their hands at bedtime to keep them from picking their nose when they are sleeping.
• If your child needs to blow their nose, do not to rub or irritate the nose too much.
• Make sure they stay hydrated and drink a lot of water.
• Help their nose heal with antibiotic creams like mupirocin.

 How can I treat my child’s nosebleed?

• With your child sitting up, tilt their head forward and pinch the nostrils together for 5 to 10 minutes and apply steady pressure so the blood coagulates.
• Do not insert tissues in the nose as this can cause further bleeding.
• Do not tilt your child’s head back—this can cause choking or the blood to go down the throat.
• Apply an icepack or a frozen pack of vegetables to the nose to shrink down the blood vessels.

How do I know if my child’s nosebleed needs medical treatment?

If the nosebleed keeps recurring, or lasts more than 15 minutes, or there is excessive blood (up to eight ounces), go to the emergency room or visit your pediatrician.

Skin cancer occurs when there is damage to cells that make up the outer layer of your skin, which causes these abnormal cells to grow in an uncontrolled way.

Skin cancer is the most common form of cancer—there are more cases of skin cancer than all other cancers combined. More than 5 million people in the United States are diagnosed with skin cancers each year. One in five people in the United States will develop a skin cancer by the age of 70. Most of these cancers are caught before they spread, and they are treated with surgical removal in the doctor’s office.

About 200,000 people are diagnosed each year with melanoma, a type of skin cancer that develops when melanocytes (the cells that give the skin its tan or brown color) start to grow out of control. Melanoma is a more dangerous form of skin cancer because it can spread to other parts of your body.

In this Q&A, Jesse M. Lewin, MD, FACMS, Associate Professor of Dermatology, Icahn School of Medicine at Mount Sinai, explains how skin cancer is best treated with early detection and treatment, and offers some tips for reducing your risks. Dr. Lewin is also Chief of Mohs Micrographic and Dermatologic Surgery and the Director of the Kimberly and Eric J. Waldman Melanoma and Skin Cancer Center.

“Unlike with many other cancers, patients and doctors have an advantage over skin cancer, in that we can see it with the naked eye,” says Dr. Lewin. “We don’t need imaging tests to look for these types of cancers; we just need to partner with our patients and be on the look-out for new and changing lesions, which are the earliest sign of skin cancer. The other advantage is our ability to reduce the risk of skin cancer by protecting ourselves from the sun and avoiding tanning beds.”

Who can get melanoma?

 Melanoma affects more men than women. People of any skin type can get skin cancer, however those with lighter skin and eyes are at greater overall risk. Those at higher risk for developing melanoma include:

• People with more than 50 moles or with atypical moles, which are often larger and have more irregular borders (dysplastic nevi)

• People who are sensitive to the sun, which includes those who sunburn easily, or have natural blonde or red hair

• People with a personal or family history of melanoma

Is the risk different for people with darker skin tones?

While people with darker skin types have a lower chance of developing a skin cancer, these cancers do occur. In fact, melanoma in patients with darker skin tones is often diagnosed in its later stages, when it’s more difficult to treat. One reason is that people with darker skin types are more prone to developing skin cancer on nonexposed skin with less pigment. Up to 75 percent of tumors occur on the palms, soles, in the mouth, and under the nails.

What are the early signs of melanoma?

Some of the early signs include a new lesion that is irregular or an existing lesion which changes in size, shape, or color. We talk about the ABCDEs of melanoma: Asymetry; Border irregularity; Color variegation; Diameter greater than the size of a pencil eraser; and Evolving (changing). Between 20 and 30 percent of melanomas arise in association with existing moles, while 70 to 80 percent arise as new lesions.

Most melanomas are pigmented (brown or black). But some melanomas do not produce melanin and can appear pink or tan. This variety highlights the importance of seeing your dermatologist for periodic skin cancer screening exams and flagging lesions that are new or changing.

Melanoma can develop anywhere on your skin, but they are more likely to occur on the chest and back in men, and on the legs in women. The neck and face are other common sites. In about half of cases, patients discover these melanomas themselves. The best way to detect melanoma is to look for a change in the size, shape or color of an existing mole.

How can I avoid getting melanoma?

There are some risk factors that you cannot change like your skin type, age, and family history. But there are ways to lower your risk of skin cancer.

The majority of skin cancers are caused by ultraviolet (UV) radiation from the sun and tanning beds, so the most important thing you can do to reduce your risk of developing skin cancer is take steps to protect yourself from these exposures.

Studies show that having five or more sunburns doubles your risk for melanoma. This is why it is particularly important to educate and protect children and adolescents from the sun. People who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent.

Here are some tips:

• Use sunscreen with a Sun Protection Factor (SPF) of 30 or above. A nickel-sized dollop of sunscreen is enough for your face. One ounce of sunscreen can cover your whole body but needs to be reapplied every two hours. One study found that regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing melanoma by 50 percent. Your face is especially vulnerable to sun damage as it is exposed to the sun year-round.

• You are vulnerable to sunlight all year round, not just when at the beach. So, consider using a moisturizer with sunscreen every day all year.

• When outside, wear protective clothing, a wide brimmed hat, and UV-blocking sunglasses. Seek shade. If possible, avoid the sun during peak sun hours (10 am to 4 pm).

• Avoid tanning beds.

What Treatments are Available for Skin Cancer?

Mohs surgery is a precise surgical technique used to remove skin cancers, including those found in areas that cosmetically sensitive and functionally important: such as your eyelids, nose, lips, ears, fingers, and toes, as well as for some more aggressive skin cancers on other areas of your body. This procedure can be used to treat a wide array of skin cancers, including melanoma and nonmelanoma skin cancer.

For this procedure, we give local anesthesia to numb the skin, and then remove the skin cancer with a narrow margin of normal skin. The skin is then processed into slides so we can look under the microscope to check if the skin cancer has been fully removed. If there is still skin cancer left, we remove more skin and make more slides. Once the skin cancer is fully removed, we repair the wound by stitching it in a way to offer the patient an optimal functional and cosmetic outcome.

For early melanomas, removing the skin cancer with a margin of normal skin is all that is required. Mohs surgery with immunohistochemical staining for early melanomas, particularly those located on functionally and cosmetically sensitive areas, is also offered at select academic centers including Mount Sinai. For melanomas that are deeper, lymph node testing and imaging, such as a CT (computerized tomography) or PET (positron emission tomography), may be indicated. Those cancers are treated by medical and surgical oncologists.