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Children undergoing tonsillectomy remain at risk for postoperative pain, respiratory depression, and postoperative nausea and vomiting (PONV), presenting unique challenges for the postanesthesia nurse. This prospective, observational study examined the relationships between and factors contributing to these outcomes in 102 children after tonsillectomy. All children received an intraoperative opioid and one or more antiemetics. The majority (67%) experienced moderate to severe pain, 27% experienced a respiratory event, and 7% had PONV. Children with moderate to severe pain received similar intraoperative opioid dosages, increased postoperative opioids (P < 0.05), and had longer PACU stays (P < 0.05) compared to those with no to mild pain. Respiratory events were not associated with age, sleep-disordered breathing, or opioid use. This study suggests that children undergoing tonsillectomy experience significant pain and respiratory events. Further study examining nonopioid treatments are warranted to determine the best practices for this high-risk group of children.