Secondary haemorrhage after tonsillectomy most often occurs between about the fifth and tenth day, as the slough separates. A small 'sentinel' bleed that stops on its own can precede a larger one.
Parents should be told before discharge that any fresh blood from the mouth, or repeated swallowing in a sleeping child, means returning to hospital, and how to get there quickly. Children with a small blood volume can become shocked before the bleeding looks dramatic.
- Give written advice at discharge: any bright red blood means returning to hospital.
- Admit and observe even when a bleed has stopped by the time the child arrives.
- Secure intravenous access and send group and save early for any child with a significant bleed.
- Watch for tachycardia; hypotension is a late sign in children.
Why it matters
A sentinel bleed sent home can be followed by a life-threatening one.
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