This is the third and final article in a series of three, covering conditions involving the Ears, Nose and Throat. This one is for the letter T, throat. The throat is the front part of the neck, and starts at the back of the mouth, extending down to include the pharynx, the tonsils and the larynx. There are two main conditions which affect children’s throats that will be covered – obstructive sleep apnoea and tonsillitis.

Obstructive Sleep Apnoea (OSA)

Obstructive sleep apnoea is becoming more recognised as a medical condition with serious implications for children. It affects 2-3% of children, whereas snoring affects 15-20%. Children with simple snoring and no apnoeas do not need medical intervention.

OSA in children is essentially the same as the condition that effects adults. When we fall asleep, the muscles around the airways can collapse and the tonsils and adenoids can cause an obstruction of the airways. This can cause apnoeas, where breathing stops for up to 20 seconds, while the lungs generate enough force to overcome the obstruction. Then the airway will snap open, giving the characteristic choking/gasping sound. While the breathing is stopped, the oxygen levels can drop much faster in children than adults and this reduction in oxygenation is what causes a lot of the symptoms.

OSA can cause behavioural problems or issues at school due to poor concentration if left untreated.

It is diagnosed by a specialist and may include overnight ‘polysonography’, which includes monitoring of the heart, brainwaves and oxygen saturation.

The most common cause is enlargement of the tonsils and adenoids. These grow rapidly between the ages of 2 and 7 years old. Having them removed cures 80-90% of cases. Other reasons for children to have OSA include obesity, allergies, and underlying medical conditions such as Down’s syndrome, which can have associated low muscle tone, causing floppy airways. These may respond to sensible weight management, medication and CPAP respectively.

Key Point – If your child is a loud snorer, with pauses in their breathing, choking or gasping in their sleep, if they wake in the morning tired, or with a headache, they may have OSA. Take them to your GP to discuss the next step!

Tonsillitis

Tonsillitis, a common and generally innocent condition. The average GP will see more than 100 cases a year. But it can become dangerous if it causes dehydration, or an abscess, or repeated absence from school.

Tonsils sit as a pair at the top of the throat, you can usually see them when you open your mouth, and act as part of the first line immunity defence. If they become infected and inflamed, this is tonsillitis. Symptoms generally consist of a sore throat, which is often accompanied by fever, headache, tiredness and pain on swallowing.

Most cases of tonsillitis will get better by itself. Even if it has been caused by a bacteria. Taking antibiotics will generally only shorten symptoms by a day, and this isn’t worth the risk of side effects, such as diarrhoea, and hypersensitivity, and the creation of superbugs. If your child can get better by themselves, it will help them develop a better immunity and reduces the chances of getting sick from that bug again.

Obviously there are some situations when children must be brought to see their doctor.

• Children of aboriginal and Torres Strait Islander descent and those from the Pacific Islands, due to an increase risk of complications
• Children with a past history of rheumatic fever
• Children with a severe form, especially if there is a rash (Scarlet Fever)
• Children showing difficulty with breathing, including increased snoring
• Children showing difficulty opening their mouths
• Children with difficulty swallowing and showing signs of severe dehydration –

If your child has severe dehydration, they may be:

• extremely thirsty
• lethargic or less active than usual
• pale and have sunken eyes, tears may be absent when crying
• cold – especially their hands or feet
• breathing faster than usual and have a fast heart rate
• irritable, drowsy or confused.

If your child shows signs of severe dehydration or if you are worried for any other reason, see your GP or go to your closest hospital emergency department.

If they exhibit none of these features and you are not worried, they can be cared for at home, which includes plenty of rest, fluids (hydrolyte icy-poles are a good way to do this) and simple pain relief, in the form of regular paracetamol and ibuprofen. Your child should stay home until the fever stops and they are able to swallow easily again. This can often take up to a week.

If your child has repeat infections, the option of seeing an ENT surgeon to explore the possibility of a tonsillectomy may be sensible. It is a common operation and generally one with a great outcome, but there are some risks, including post operative bleeding and infection which need to be discussed with the surgeon before signing the consent form.

Current guidelines suggest considering a tonsillectomy after seven infections in 12 months, or five infections in two consecutive years, with these infections affecting normal life, eg the ability to attend school or daycare.

Key Point – most children don’t need antibiotics for a sore throat, but get them assessed if they are in the ‘at risk’ group or you are worried.

You’re pretty much guaranteed that someone in your family will be affected by one of the conditions mentioned in each of these articles! The advice mentioned is only that and does not replace seeing your GP if you are concerned.