Objective To analyze the factors affecting post-tonsillectomy hemorrhage in children with chronic tonsillitis (CT) and construct a nomogram prediction model. Methods A retrospective analysis was conducted on the clinical data of 562 children with CT admitted to the Zhengzhou Ninth People’s Hospital from June 2021 to May 2024. All children underwent plasma tonsillectomy treatment, and the incidence of postoperative bleeding events was recorded. Logistic regression was used to analyze the influencing factors of hemorrhage after tonsillectomy in children with CT, and a nomogram prediction model was constructed based on the influencing factors. Results A total of 562 children with CT underwent tonsillectomy treatment, and 48 of them experienced hemorrhage events, with an incidence rate of approximately 8.54%. They were assigned to the hemorrhage group, while 514 children who did not bleed were assigned to the non-hemorrhagic group. The proportion of obesity, secondary infections, fever associated infections, improper eating, and moderate to severe postoperative pain in the hemorrhage group was higher than that in the nonhemorrhagic group (P <0.05). The results of Logistic regression analysis showed that obesity, secondary infections, fever associated infections, improper eating, and moderate to severe postoperative pain were all risk factors for post tonsillectomy hemorrhage in children with CT (OR>1, P<0.05). The calibration curve and ROC curve showed that the model had predictive value for hemorrhage after tonsillectomy. Conclusion Obesity, secondary infections, fever associated infections, improper eating, and moderate to severe postoperative pain are all risk factors for hemorrhage after tonsillectomy in children undergoing CT scans. Based on these factors, constructing a nomogram has certain predictive value for hemorrhage after tonsillectomy.