“They just get ill a lot”: when should you look for a deeper cause of a child’s ENT problems?

Runny noses, colds and ear infections are common in preschool children, so parents often see them as a phase they simply have to get through. However, a persistently blocked nose, mouth breathing, regular snoring or recurring ear infections may indicate a problem that needs closer assessment. Our clinic’s otolaryngologist, Dr. Ilze Ivane, explains when a child’s ENT problems should no longer be dismissed as ordinary illness and when treatment is needed.

Should you simply wait for the illness to pass, or see a doctor?

Preschool children are still learning hygiene habits, while their immune systems are developing and learning to recognise viruses and bacteria. Close contact with other children at kindergarten or siblings at home encourages the spread of different viruses. Frequent illness in young children is therefore not unusual: preschool children may experience an average of 7–10 upper respiratory illnesses a year. What matters is how the child feels between illnesses.

As a child grows, normal breathing through the nose is important. Young children do become ill more often, but not everything should be considered normal. A persistently blocked nose, snoring, recurring infections or every runny nose leading to a middle-ear infection are signs that should not be left unchecked; a doctor should be consulted. Frequent and prolonged middle-ear infections can affect hearing, while disrupted sleep can affect everyday well-being: younger children may become hyperactive and find it harder to concentrate, whereas older children become tired and listless.

You should definitely consult an ENT specialist if:

• a runny or blocked nose lasts for several weeks;
• one illness runs into the next and the child never fully recovers between them;
• middle-ear infections recur more than three times in six months;
• fluid remains in the ear for a prolonged period;
• almost every runny nose ends in an ear infection;
• the child breathes through their mouth for a prolonged period;
• the child regularly snores or snuffles, even without a runny nose;
• the child turns the television up loud or frequently fails to respond when called or to surrounding sounds;
• speech or language development is not appropriate for the child’s age.

Do adenoids and enlarged palatine tonsils always need treatment?

Enlarged nasopharyngeal tonsils, or adenoids, can cause persistent difficulty breathing through the nose, snoring and recurring ear problems. However, size alone is not what matters: the tonsils may be enlarged without causing the child any symptoms, in which case treatment is unnecessary. The full combination of symptoms must be assessed.

Treatment may be needed if enlarged tonsils cause:

• sleep apnoea;
• frequent inflammation or tonsillitis;
• recurring middle-ear infections;
• hearing loss;
• significant sleep and breathing difficulties.

When does a child need surgery?

Surgery is chosen only when it is expected to help the child more than medication or watchful waiting, enabling easier breathing, better hearing and fewer illnesses. Of course, it will not prevent all future illnesses, but it can significantly improve the child’s quality of life.

Surgery is not the first solution. A doctor considers it when other treatments are insufficient and the problem substantially affects the child’s quality of life. No two patients are the same, and no single treatment suits everyone. Two children may have similar symptoms, but one recovers easily while the other experiences difficulties with hearing, sleep and development. ENT specialists therefore treat the child, rather than just the diagnosis, and will always choose the gentlest treatment to address the problem.

There are no silly questions before your child’s operation!

At the start of each consultation, the ENT specialist assesses the symptoms, the child’s medical history and previous treatment, and examines the ears, nose and throat. Further investigations may be needed depending on the situation. If surgery is the most appropriate solution, preparation follows: blood tests and a consultation with an anaesthesiologist.

Our clinic’s doctors have observed that it is usually easy to reach an understanding with children: what could be better than coming in, having a sleep, waking up to an ice cream and then eating ice cream at home for a whole week? Parents, however, tend to worry much more. That is why it is important to ask the doctor any questions about your child’s operation. There are no silly questions, and each answer helps you make a considered decision and feel calmer.

Parents can help prepare their child for surgery by talking about it calmly and in an age-appropriate way, without going into frightening detail. To feel calmer themselves before the operation, parents can ask the doctor:

• Why is the operation needed?
• Why is it needed now?
• What benefit can the child expect?
• Are there alternative treatments?
• Are there risks of complications?
• What will the operation and recovery involve?
• When can the child return to school or kindergarten?
• What everyday restrictions will apply during recovery?

The better parents understand what to expect, the more confident they will feel and the easier it will be to prepare their child.