How do adenoids and tonsils contribute to ‘resistant eating?’

Large adenoids plug the back of the nose. Eating can become uncoordinated, tasteless, breathless and difficult. The delicious tastes and smells that normally flow through the mouth and nose become dull and uninviting. Large tonsils can ‘catch’ foods – the resulting gagging alarms young children, and can cause them blacklist entire food groups. Families may see a gradual narrowing of their previously ‘good eater’s’ range of accepted foods.

Enlarged adenoids and tonsils also cause snoring and disturbed sleep. When severe, this stalls a child’s progression through their deep-wave sleep cycles and can reduce nightly secretion of Growth Hormone (with its body and appetite building effects). ,

Parents report their slender kids show little interest in food, prefer soft or bland foods, or chew their foods endlessly at mealtimes. The range of ‘acceptable’ foods become increasingly limited as the child ages, and family mealtimes become a laborious, long and painful affair for everyone. (A word of warning: when correctly treated, these same parents often wish they had a lock for the pantry door, as growth, appetite and interest in food – as well as grocery bills! – skyrocket!).

HOW DO I RECOGNISE ‘RESISTANT EATING’?

This helpful guide from the talented dieticians at www.feedingbytes.com highlights the following signs:

1. Limited food selection. Resistant eaters often accept only 10-15 foods or fewer.
2. Limited food groups. Refusing one or more food groups is fairly common among resistant eaters.
3. Anxiety and/or tantrums when presented with new foods. Resistant eaters may gag or become ill when presented with new foods.

WHAT FACTORS CONTRIBUTE TO RESISTANT EATING?

• Medical issues such as adenoid/tonsil overgrowth, food allergies, or gut issues
• Poor oral-motor skills, jaw or tongue control
• Sensory processing skills; sensitivity to smell and taste
• Environmental factors , including accidentally  unhelpful habits such as allowing daytime grazing or inappropriate mealtime behavior.

WHAT TO DO ABOUT RESISTANT EATING?

If adenoid and tonsil overgrowth is at play, early diagnosis is best. The signs to ok out for include:

• snoring, gasps or ‘breath pauses’ during sleep
• mouth-breathing and grinding
• back to back colds, or the ‘snotty nose that never ends’
• restless, unrefreshing or ‘very active’ sleep with sleep-walking/talking, night terrors or bed-wetting
• disruptive, combative or inattentive daytime behaviour* (see below).

HOW TO HELP RESISTANT EATERS.

1. Involve the child in food preparation to help learn about the food outside mealtimes.
2. Incorporate fun, play-based interactions with food to reduce anxiety. Everyone learns better when they are not stressed – ‘food time’ includes looking, smelling, touching, tasting and eating.
3. Don’t give up! Research shows it takes up to 15 exposures on every sensory stage such as viewing, smelling, touching and tasting the food, before some children will accept a food into their diet.
4. Help your child keep a food journal. Children who cannot read yet can draw pictures of the food they are learning about.
5. Implement gradual changes to familiar foods. Vary the temperature, texture, shape or taste and involve the child in the process to help her accept a wider variety foods.

© Copyright // All rights reserved

Dr Kristy Fraser-Kirk

Paediatric + Adult ENT Surgeon

Advanced Ear + Hearing Implant Surgeon

#evolveENT #healthykidshappyfamilies

🥦 🥕 🥯

* Remember! In isolation, or if occurring only intermittently, many of the above symptoms may simply be part of normal childhood development. Childhood is not a disease, after all, and symptom lists are just that.

So don’t panic!

Simply observe resistant eaters mindfully, watch for symptom clusters and seek a measured assessment from your specialist GP or a reputable ENT if you are worried your child ticks ‘too many’ of the above boxes.

The post Mealtimes a pain? How to help ‘resistant eaters’. appeared first on Evolve ENT.

Personally, I dislike the term ‘hayfever’. It seems to trivialize the relentless morning sneezing, facial itch, nasal congestion, embarrassing sniffing and the swollen red eyes of a ‘bad day’ with allergic rhinitis.

So instead, I ask ‘is your child an itchy, scratchy, sneezy sort of kid?’

It’s a phrase I learned from a talented Brisbane ENT, Dr Jonathon Askew, who has a gift for making complicated things seem easy. It works a treat to differentiate those kids with AR needing treatment from those who are on the sometimes-sniffly end of ‘normal’.

To the parents who have to stop and think about it, relax! Your kid is probably ‘sniffly normal’ and going through a bad patch. To be occasionally itchy, sneezy, or snotty is normal, (and medicating normal kids long-term is bad medicine, plain and simple).

My advice? Throw a Kleenex (and perhaps an antihistamine) at ‘em and move on!

But for the parents of truly atopic kids, the answer is usually an emphatic ‘YES!’… Followed closely by, ‘She’s always been like this! / It’s horrendous! / His teachers all complain about the sniffling. / It drives us CRAZY! / He gets such a sore, red nose. / He gets teased dreadfully. / She is TERRIBLE in the morning. / We can’t go to Grandpa’s anymore, because of the cats.’

WHY DOES IT HAPPEN?

Humans are great. We’re fascinating and impressive creatures. But at the heart of it, we’re just sophisticated tubes. Stuff goes in one end and comes out the other while we go about living our daily lives.

The ‘stuff’ going in, however, is more than simply food, drink and air because the lining of the nose, mouth, and throat also provides endless ‘points of entry’ for dusts, moulds, particles and proteins. With each breath, and each mouthful, we internalise a tasty selection of ‘earth flora’ that is filtered, sampled and presented to our ever-curious immune system – before being covered in slime then swallowed, sneezed or spat out. Yum.

The main players in AR are the nasal ‘turbinates’ – fleshy filters that span the side walls of the nose, about the size and shape of a cigarette. Turbinates are the unsung heroes of the face. Ain’t no one staring deeply into them, or singing songs about kissing them but in a single breath they warm the coldest, driest air to body temperature, moisten it and clean it up for delivery to the lungs. They swell and shrink in turn, letting one nasal airway work while the other one rests (remember feeling blocked on one side, then the other?). They swell and weep when infected, and trap irritating particles to expel all over your work colleagues via the irrepressible sneeze reflex. They get really unhappy with the hormones of pregnancy, and very generously accept some of that fluid from your poor swollen feet when you finally lie down after a long day at work. Any of this sounding familiar?

When you consider the ‘normal’ behaviour of the turbinates, it is easy to see how an over-zealous immune response can lead to the misery of allergic rhinitis.

Intractable sneezing? Can do.

Irritated, itchy, relentless running nose? No worries. Gritty teary eyes? Heck, let’s get the neighbours involved too.

ALLERGIC RHINITIS: WHAT CAN YOU DO?

The first thing to know is that, just like asthma, diabetes and eczema – AR is a ‘medical’ condition… That is, you can’t just ‘cut it out’ with surgery, and while there are treatments, there is no cure*. (*more on this later)

Frequently, the particles AR sufferers are allergic to are multiple, and can hard to avoid. So although ‘desensitization therapy’ can provide a ‘cure’ for the toddler with nut anaphylaxis, for the sniffly ‘tween allergic to Grandad’s cat, grass, pollen, House dust and the mould in Mrs Smith’s roof, you are going to need realistic expectations, some ‘At-Home’ measures and some medications to achieve control.

A blood test can demonstrate exactly what your child is allergic to… But all good doctors know that blood testing kids is no party. So, as the heavyweights in AR are usually house dust, animal dander and (where we live) pollen – I usually encourage families to tackle these ‘likely’ allergens first.

AT-HOME MEASURES:

Young or old, I engage the kids to do their bit. Owning back the bedroom soft furnishings lies at the core of damping down dustmite AR. Show them some cute, minimalistic Scandi bedroom designs and get about redecorating.

That army of soft toys? Out. Tell the kids to choose their favourite three, but the rest need to go ‘on holiday’ into a sealed storage box. The three they choose need to ‘go swimming’ (set the washing machine cycle to hot – at least 60 degrees), then once dry they ‘go camping’ in the freezer overnight. Decorative cushions, rugs, mats and blankets? Same rule – a favourite can stay but out with the rest.

Keep ‘dust collector’ knick-knacks to a minimum, and encourage kids to get involved in keeping bedroom dust levels low. A moist sock worn like a sock-puppet provides a quick and easy way for older kids to help – tell them to moisten the sock under water, put it on their hand, then run it over all their bedroom flat surfaces. With a bit of music, removing settled dust every evening together becomes a fun bedtime ritual.

Pets need to stay out of the bedroom, and for proven ‘dust-allergics’ not responding to simple measures, you may want to consider removing carpets and polishing up those lovely floorboards, and replacing curtains with blinds.

If spring winds upset your child, get familiar with monitoring the pollen count on your local council website – and avoid hanging your linen and their clothes on the outdoor clothesline on high pollen count days.

MEDICAL MEASURES:

I usually recommend an early ‘therapeutic trial’ of a nasal steroid spray for AR sufferers. Where ‘non-nasal’ symptoms like facial itch and ocular symptoms are troublesome, I frequently add an oral antihistamine syrup. As nasal steroids work best when sprayed regularly, I encourage parents to tape the bottle to their kids’ toothbrush, and make it part of their morning routine.

STILL SNIFFLING?

If you’ve done the above and your child’s allergic rhinitis is still poorly controlled, it’s time to get the specialists involved. Your GP will be able to recommend an ENT surgeon and/or an allergist they trust who will guide you in further diagnostic, medical and surgical options.

Yours in Better Health,

Dr Kristy Fraser-Kirk @EvolveENT
Ear and Hearing Surgeon / ENT Surgeon

Bubs, Boogers and Beyond:

Making Medicine Make Sense

Issue 1: Got an ‘itchy, scratchy, sneezy’ kid? Getting to know Allergic Rhinitis.

The post Got an ‘itchy, scratchy, sneezy’ kid? Getting to know Allergic Rhinitis. appeared first on Evolve ENT.

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

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:

–      Fever

–      Irritability

–      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 

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)
• Headache
• Decreased appetite, nausea and vomiting
• 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.

The post Common Childhood ENT Disorders appeared first on Evolve ENT.