Your child is ill again. How can an ENT specialist help?

Starting nursery or the first year of school brings new people into a child's daily life — and various viruses along with them. Immunity is still developing, so children may be ill frequently, especially in autumn when the virus season begins. When is another virus to blame, and when should you see a specialist? Our clinic's otolaryngologist, Dr. Elza Bikova, explains what problems may lie behind frequent illnesses, how an ENT specialist can help and how children are examined.

An ordinary virus or a “red flag”?

Illness prevents a child from attending nursery or school, sleeping properly and recovering fully, while parents have to work out how to combine caring for their little patient with their own everyday responsibilities. Although frequent illness can be challenging, it is more important to pay attention to how the child recovers.

Young children may be ill between 6 and 12 times a year. What matters is how long each illness lasts and whether the child recovers fully between episodes. A runny nose caused by a virus and other upper respiratory tract infections usually last around 7–10 days. Symptoms should gradually improve during this time. If a child feels well between illnesses, recovers fully and has periods without a runny nose or cough, frequent illness may be a feature of their age. Not every runny nose means the child needs to see a doctor immediately. If they feel well and the symptoms are gradually improving, treatment to relieve symptoms and observation may initially be enough. However, a doctor's visit should not be delayed if:

• a runny nose lasts longer than 10 days;
• after an initial improvement, the child feels worse again, develops a fever, or has a worsening cough or blocked nose;
• the child does not recover fully between illnesses, and a mild runny nose without a fever persists for 2–3 weeks;
• acute tonsillitis, middle ear infections or sinusitis recur frequently;
• the child complains of pain in both ears, has discharge from an ear or experiences worsening hearing;
• repeated courses of antibiotics are needed within a short period.

The frequency of illness should also be monitored. In the second and third years of nursery, the number of episodes should decrease. When school starts, a new environment, contact with other children and stress can also contribute to more frequent illness, but this should not become the norm.

What can lie behind frequent runny noses and recurring infections?

If a child regularly has a blocked or runny nose, ear infections, worsening hearing, snores at night, breathes through the mouth or experiences episodes of sleep apnoea — pauses in breathing — these problems may often share a common cause that needs to be identified to choose the right treatment.

The most common causes of chronic ENT problems in children are adenoids, or an enlarged nasopharyngeal tonsil, and allergic rhinitis. The subsequent treatment approach differs depending on whether the nasopharyngeal tonsil or the nasal lining is responsible.

Enlarged adenoids can obstruct breathing through the nose, contribute to recurring infections and cause hearing problems. For example, if the nasopharyngeal tonsil blocks the openings of the auditory tubes, fluid cannot drain easily from the middle ear and therefore accumulates. Signs of adenoid problems may include:

• a persistently blocked nose and mouth breathing;
• recurring runny noses and episodes of sinus inflammation;
• frequent middle ear infections;
• fluid accumulation in the middle ear and reduced hearing;
• snoring and disturbed breathing during sleep.

Allergic rhinitis, on the other hand, can cause persistent nasal blockage and recurring runny noses that parents may mistake for yet another cold. The ENT specialist's task is to establish what is causing the recurring complaints and choose an appropriate approach. If treatment does not help, a more detailed examination, an allergist's consultation or, in some cases, surgery may be needed.

What happens during an ENT consultation?

Every ENT consultation starts with a conversation. The main aim of the first visit is to get acquainted and help the child feel safe, making it easier to cooperate with that ENT specialist and doctors in general at future visits. It is important for the doctor to understand not only the current complaints but also the child's medical history, and to speak to the child directly. This helps build a sense of security, and the child may mention things their parents have missed.

This is followed by an examination, which can be carried out with the child sitting in a chair or on a parent's lap. If the child is anxious, we can often manage without special instruments at the first visit: it is often possible to look at the child's ears and mouth without them.

If there are concerns about hearing difficulties, the doctor may perform tympanometry to measure eardrum mobility and middle ear function, and often an audiogram or other hearing tests to assess how the auditory nerve is functioning. Up to the age of 5–6, audiometry uses elements of play, so the examination can turn out to be quite entertaining.

The most unpleasant procedure is endoscopy, which is indispensable for obtaining information about the nasopharyngeal tonsil and the condition of the nasal cavity, but it is not always performed at the first consultation. The first steps are to assess the acute situation and relieve symptoms, with further examinations carried out once the child is well.

How can you help your child feel less afraid of the ENT specialist?

A child's experience in the doctor's office depends on how safe they feel. Preparation for the visit therefore begins at home — with a calm conversation and the parents' attitude. It is not right to promise a child that they will feel nothing. Doctors do not aim to cause pain, but the child will feel something — tingling, tickling — and may be frightened. To make the visit calmer, parents can:

• practise opening the mouth and sticking the tongue out together at home;
• bring a favourite toy — the doctor can first examine the teddy bear's or bunny's nose and ears so the child understands what to expect;
• be ready to set an example — if the child is reluctant to cooperate, the doctor can examine mum or dad first. This will show the child that there is nothing frightening to expect;
• let the child sit on their lap — this may help them feel safer;
• choose a suitable appointment time — a well-rested child who has eaten usually copes with anxiety more easily;
• listen to the child's fears — if the child is not ready for a particular examination, it is important to respect this and consider whether it can be postponed;
• trust the doctor's experience — not all examinations need to be performed immediately, and the doctor will help explain what is necessary in the particular situation.

The most important thing is not simply to relieve symptoms each time, but to understand why they keep returning. Timely assessment and good cooperation with an ENT specialist can help improve a child's quality of life and reduce the difficulties caused by recurring illnesses.