During a postoperative assessment after tonsillectomy, which observation would be of most concern?

• A. The child is swallowing excessively.
• B. The child reports sore throat.
• C. The child is refusing to eat solid foods.
• D. The child's heart rate and blood pressure are elevated.

Answer: (A)

Frequent swallowing after tonsillectomy is the most worrisome observation because it often signals bleeding from the surgical site. When blood collects in the throat, a child will swallow repeatedly to try to clear it, and this can quickly indicate postoperative hemorrhage with the risk of airway compromise. This is why it stands out as the top concern.

Sore throat is expected after the procedure and tends to improve with time, so it doesn’t point to an immediate complication. Refusing to eat solid foods fits with throat pain and temporarily reduced intake, which is common but not as urgent. Elevated heart rate and blood pressure can occur with pain, anxiety, or dehydration and are nonspecific; they warrant monitoring but don’t alone indicate a bleeding event.

If frequent swallowing is observed, escalate promptly by assessing for active bleeding and notifying the supervising clinician to intervene as needed.