Kids ENT Disorders
Childhood illness is common. And while sleepless nights are awful, in order to build your child’s immune system, minor illnesses are absolutely normal and necessary.
But how much is too much?
There is no denying that high-density modern living exposes our kids to more bugs, more often and much earlier in their development. But life happens, and for most families, ‘avoiding others’ during times of illness, such as at daycare, is simply not an option.
When to see a GP?
ENT complaints make up 1 in 3 clinical presentations to GPs – that makes them an expert in your wellbeing during acute ENT flare-ups. The vast majority of cases require little more than rest, fluids and pain-relief – along with reassurance for parents and lots of cuddles for Bub. Some patients require antibiotics. Some require testing. And a small number – where symptoms are severe, ongoing or recurring – warrant referral to an ENT specialist.
So when should you seek an ENT referral?
At Evolve, we don’t believe in over-treatment. The beauty of Paediatric medicine is that lots of kids, even after a ‘bad run’, go on to get better all on their very own. Resolution – seeing kids go back to being healthy, happy kooky kids – is what Evolve loves best.
But we also know that some kids, sometimes, really need help. We hate seeing underweight, poorly performing kids with sleepless worn-out parents, who’ve been snoring the neighbours awake for years with Grade IV tonsils. We hate seeing kids two years behind and misbehaving in the classroom struggling along with the glue ear and 40dB hearing loss they’ve had since age 3. At Evolve, we’re parents too. We won’t intervene unless it’s really necessary – but for kids who are struggling, ‘doing nothing’ is doing something, too.
Common conditions: When To Refer
To find the balance, we’ve put together a useful summary for parents (and GPs) of our commonest Paediatric ENT presentations, to give an idea of ‘when to refer’).
- Recurrent Headcolds / Recurrent viral illness
- Recurrent upper respiratory tract infections
- Recurrent rhinitis (runny nose, blocked nose)
- Glue ear, ear infections
- Suspected hearing loss
- Speech delay and disorder
- Snoring, sleep aponea and sleep disorder
The ‘Cold that Never Ends’
Reports of kids who are sick ‘constantly’ between 1 and 3 years of age are common in ENT practice. (And as for poor second-borns, covered in their big siblings’ slobbery schoolyard kisses – well, ‘snot free’ is suddenly a thing of the past).
For kids, to be snotty on occasion is normal. But to be continually snotty, bouncing from one head-cold to the next is not. A timely ENT review may well put your child back on the path to good health, good sleep and a better life.
Inflammation of the nasal filters (turbinates) as well as overgrowth of the pad of tissue behind the nose (the ‘adenoid’) can both block the nose physically, and create a reservoir of pathogens that make a child vulnerable to ‘constant’ infections.
Research shows it is quite normal for children attending daycare to experience up to six URTIs (headcolds) annually during their toddler years, (and remember, ‘exposure’ to viruses primes and strengthens the immune system). However, if your child is failing to ‘clear up’ between episodes or if there are concerns about middle ear function (the eustachian tubes providing a convenient pathway for infection between the nose and ear), then an ENT review is useful.
Ear infections can be tricky to diagnose – both at home, and sometimes, at your GP’s.
Young children can’t verbalise what is wrong, because cranky kids wiggle, their tiny ear canals are often hairy and filled with wax, and those eardrums redden if your little one cries or fidgets during examination.
Otoscopy is a good but imperfect tool, and your GP (and we) do our best to paint a picture using what you say, what we see, and what the otoscope reveals.
At home hints an ear infection may be brewing include:
– Pulling or tugging at ears
– Reduced interest in food and drink
– Increased irritability, especially when laid flat or at bed time
– Ear discharge
– A sour-smelling ear odour
– Delayed or distorted speech development
– Poor speech clarity, poor word formation
– Fails to startle at loud sounds, fails to turn to parent approach
Ear infections can take the ‘red, hot, miserable’ form seen in acute otitis media, or the ‘quiet, deaf’ form seen in glue ear. Occasionally, a child will simply be unwell with fevers, and without another obvious source, their dull middle ears may be the most likely culprit.
Importantly, it may surprise you to know that our ability as parents to know if our children have hearing loss is actually poor. Even with hearing loss, kids are crafty and use lots of ‘non-verbal’ cues to navigate their world.
Children suffering more than six ear infections in a year, or those in whom you suspect hearing loss or where speech seems delayed, warrant a referral to a specialist ENT.
Allergic rhinitis, or ‘hayfever’ results in clear nasal discharge, sneezing, nasal congestion and itch of the nose, face, eyes and occasionally mouth and throat. It often presents along with eye redness, grittiness and puffiness. It may be seasonal (happening only at certain times of year), or perennial (present all the time). Allergens include things like pollen, dust mites, mould, cockroach droppings, animal dander and tobacco smoke.
There are multiple over-the-counter and prescription treatments, such as intranasal corticosteroids and non-sedating anti-histamine medications, as well as a host of home modifications that can help you control your child’s allergic symptoms. These can be confidently explored with your GP, most of whom are expert in managing this common but frequently disabling condition.
If symptoms persist despite first-line measures, often a referral to an Evolve ENT to evaluation of the nasal interior and exclusion of other causes may be warranted.
Pharyngitis and Tonsillitis
Pharyngitis and tonsillitis, the most common causes of ‘sore throat’, are usually caused by viral infection – and as such, do not require or respond to antibiotics… (Yes! It’s True! Please, please, please trust your GP on this. GPs are your Specialists in Life. No one knows sore throats like GPs do!)
Respiratory viruses are easily spread by ‘droplet transmission’ (breathing in someone else’s airbone secretions, such as after sneezing or coughing). In these cases, rest, fluids, pain relief and TLC are your best way forward, following consultation with your GP to exclude any alternate diagnoses.
Occasionally, bacterial infection may intervene, warranting a short course of antibiotics.
Symptoms that may accompany pharyngotonsillitis often include:
- Sore throat
- Fever, ‘malaise’ (feeling unwell)
- Decreased appetite, nausea and vomiting
- Abdominal pain (due to reactive lymph nodes surrounding the gut)
- Difficult, painful swallowing
- Throat inflammation, redness and pus
While some episodes of tonsillitis each year are normal, children who are repeatedly affected, those where infections seem especially serious, and those where snoring and sleep disruption are at play often require surgical intervention.
So when to seek specialist review of your child’s tonsils and adenoids?
Research used on to form the ‘Paradise Critieria’ indicates that children suffering 7 bouts in one year, 5 bouts/year over two years, or 3 bouts/year over three years will benefit from tonsillectomy, along with those exhibiting ‘complicated’ or severe symptoms, and those in whom tonsil/adenoid overgrowth causing significant sleep problems.
Still not sure?
Remember – your GP is an expert in ENT care. At Evolve ENT, we are here to support you both. If after perusing this guide together you still have questions, about your child’s wellbeing, we’d be happy to hear from you.
GPs, please submit your referral here.
If you already have a referral from your GP, please submit it here.