How Enlarged Tonsils Affect Children’s Sleep, Behavior, and Health

Table of Contents
View All
Table of Contents

Tonsillar hypertrophy, a condition in which the tonsils are enlarged, is more common in children than adults. Large tonsils usually don't cause symptoms, or only cause minimal symptoms. But they can cause health problems, including snoring and sleep apnea—which can affect daytime behavior and long-term growth in children.

If you have any concerns about your child's tonsils, their healthcare provider can assess whether enlarged tonsils could be causing adverse health effects and whether your child needs treatment.

young girl snoring while she sleeps
quintanilla / iStock / Getty Images


Children can have large tonsils for a number of reasons. The back of the mouth and throat are proportionately smaller in children. The lymphoid tissue of the tonsils and adenoids grows in most children between the ages of two and six years.

For children who do not have room to spare, tonsil growth may cause a narrowing that prevents adequate passage of air. Additionally, muscle tone is firmer in children than adults, potentially shrinking the airway opening in the back of the throat.

The tonsils can become swollen and inflamed when tonsillitis results from allergies or infections, and sometimes these issues can become chronic.


The vast majority of children who have large tonsils never develop symptoms. When effects do occur, they tend to be more common during sleep, when the muscles are more relaxed.

Children who have enlarged tonsils might snore during sleep, and some can develop sleep apnea, which could be noticed if someone else is in the room.

The most common symptoms of enlarged tonsils include:

  • Loud breathing
  • Snoring
  • Trouble swallowing
  • Daytime sleepiness

If your child has enlarged tonsils due to an acute and short-lived infection, the symptoms may also include a fever, sore throat, and cough. Prolonged symptoms indicate a chronic issue.

Tonsillar hypertrophy is more common in children, but adults can have swollen tonsils and associated complications as well.


Sometimes enlarged tonsils can cause problems. Many of these complications can contribute to and worsen each other. For example, large tonsils can predispose your child to recurrent infections, which in turn can lead to chronically inflamed tonsils.

Obstructed Breathing

Enlarged tonsils can interfere with breathing. This is more common during sleep, but it can occur while awake.

Children who have tonsillar hypertrophy might develop mouth breathing, which can lead to dental issues such as periodontal disease, halitosis (bad breath), and tooth decay.

Sleep Problems

Sleep problems due to enlarged tonsils include waking up frequently at night, usually falling back asleep right away. Interrupted sleep and oxygen deficiency can prevent a child from getting enough restorative sleep.

Untreated snoring and sleep apnea can have a significant impact on a child's health. Inadequate sleep may disturb the release of growth hormones and interfere with adequate growth.

Eating Difficulty

Children who have tonsillar hypertrophy can have trouble swallowing food. Additionally, oral health and dental issues can interfere with eating.

Behavior Changes

A lack of restorative sleep and oxygen deprivation can cause symptoms of daytime fatigue, but it can also manifest with irritability, trouble concentrating, hyperactivity, and behavioral changes.

Treatment of enlarged tonsils can improve symptoms of attention-deficit/hyperactivity disorder (ADHD), and may reduce some children's need for ADHD medication.

Heart and Pulmonary Disorders

Children who have enlarged tonsils can develop heart and lung complications. This can be caused by low oxygen, as the heart and lungs attempt to compensate for the effects of enlarged tonsils. In the long term, there can be a resulting change in the structure and function of the heart and lungs.


Enlarged tonsils can be diagnosed with a physical examination. Anatomic variations that may be associated with a narrowed airway, such as large adenoids, a short neck, or a small jaw, may worsen the effects.

  • The degree of enlargement is assessed with the Brodsky scale, which grades the size of the palatine tonsils from 1+ to 4+. At the largest classification, the tonsils are touching in the midline of the throat.

Additional tests that your child might have include pulse oximetry, pulmonary function tests (PFTs), and arterial blood gas. These tests will assess your child's oxygen level and breathing ability.

Your child might also need a thorough dental examination, and in some cases, a sleep study to determine whether they are experiencing sleep apnea.


If you are concerned about the effects of tonsillar hypertrophy, or if your child has been snoring or having recurrent infections, your child's healthcare provider will discuss treatment options with you.

Treatments can depend on the cause of the enlargement:

  • Treatment for inflammation and swelling due to allergies will often involve medications to reduce the allergic reaction.
  • Tonsillitis caused by a viral infection usually involves supportive care, such as fluids and fever reduction.
  • Bacterial infections generally require treatment with antibiotics.
  • Sometimes tonsils are removed with tonsillectomy surgery. This procedure has a low degree of risk and may resolve the effects of tonsillar hypertrophy or chronic tonsillitis.

Frequently Asked Questions (FAQs)

Can I make large tonsils smaller?

You cannot shrink your tonsils, but your healthcare provider can prescribe medicine to reduce swelling, such as anti-inflammatories or antibiotics.

Can only one tonsil be enlarged?

Yes, tonsil swelling can affect only one side, or it may be more prominent on one side than the other. This can happen with hypertrophy or tonsillitis, but sometimes uneven tonsils can be a sign of tonsil cancer, which is rare in children.

A Word From Verywell

If your child is having problems that seem to be related to enlarged tonsils, talk to their healthcare provider to get a diagnosis and to see what treatment options would be best for your child.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Pediatrics. Sleep apnea detection.

  2. Shah UK. Enlarged tonsils and adenoids in children. Merck Manual.

  3. İnönü-Sakallı N, Sakallı C, Tosun Ö, Akşit-Bıçak D. Comparative evaluation of the effects of adenotonsillar hypertrophy on oral health in children. Biomed Res Int. 2021 Apr 2;2021:5550267. doi:10.1155/2021/5550267

  4. Perez A, Hunter K. Adenotonsillectomy as a treatment for sleep-disordered breathing in children with ADHD. JAAPA. 2020 Oct;33(10):34-39. doi:10.1097/01.JAA.0000697248.35685.c6

  5. Kocabaş A, Salman N, Ekici F, Cetin I, Akcan FA. Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy. Pediatr Cardiol. 2014 Jun;35(5):785-92. doi:10.1007/s00246-013-0853-7

  6. Kumar DS, Valenzuela D, Kozak FK, et al. The reliability of clinical tonsil size grading in children. JAMA Otolaryngol Head Neck Surg. 2014;140(11):1034-7. doi:10.1001/jamaoto.2014.2338

  7. Huang Q, Hua H, Li W, Chen X, Cheng L. Simple hypertrophic tonsils have more active innate immune and inflammatory responses than hypertrophic tonsils with recurrent inflammation in children. J Otolaryngol Head Neck Surg. 2020 Jun 1;49(1):35. doi:10.1186/s40463-020-00428-3

  8. Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: Tonsillectomy in children (update)-executive summary. Otolaryngol Head Neck Surg. 2019;160(2):187-205. doi:10.1177/0194599818807917

  9. Jones GH, Burnside G, McPartland J, Markey A, Fallon M, De S. Is tonsillectomy mandatory for asymmetric tonsils in children? A review of our diagnostic tonsillectomy practice and the literature. Int J Pediatr Otorhinolaryngol. 2018 Jul;110:57-60. doi:10.1016/j.ijporl.2018.04.027

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.