When should you consider having your child's tonsils removed?

Historically, children had their tonsils removed to reduce the frequency and severity of colds and strep throat. (The tonsils and nearby adenoids, both part of the immune system, catch and harbor germs, so removing them can reduce infections.)

Doctors still do take out children's tonsils for recurrent throat infections, but most of the country's nearly 600,000 tonsillectomies in children are done to correct breathing problems that can disrupt sleep and even lead to trouble paying attention and concentrating in school, said Dr. Dwight Jones , a pediatric otolaryngologist at Children's Hospital in Boston.

"What happens in many children is that the tonsils get to be large -- disproportionate to the mouth and throat -- so when the child goes to sleep and the tongue falls back in the mouth, you get obstructive sleep apnea," the cessation of breathing during sleep.

The result is often loud snoring, restless sleep, and both hyperactivity and sleepiness the next day. Some research even links sleep-disordered breathing with ADHD, attention deficit hyperactivity disorder. Bedwetting, for unclear reasons, has also been linked to sleep apnea.

When tonsils are removed, 83 percent of children with sleep apnea get better, meaning there is no more snoring, labored breathing, or pauses between breaths, said Dr. Stacey Ishman , an assistant professor of pediatric otolaryngology at Johns Hopkins Children's Center. School performance can also improve.

Removing tonsils is also getting easier than it used to be. In the old days, doctors used scalpels to remove tissue, which led to considerable bleeding. The latest approach is coblation, which uses high-frequency radio waves to sculpt away tonsils from the underlying muscles. With this technique, bleeding is minimal and so is post-op pain.

JUDY FOREMAN

E-mail health questions to Foreman@globe.com.