The air passages in children are smaller compared to adults; wherein any obstructions to the airway will produce symptoms much earlier. Noisy breathing in infants can be due to congenital reasons like a disproportionately large tongue, soft and compressible cartilages of the larynx and narrowing of the airway.

Infants have breathing problems due to upper airway infections, and these usually last for a short duration. However when symptoms such as snoring and mouth breathing at night persist, including difficulty in feeding during the day too, then it could be cause of concern that warrants a visit to a specialist ENT doctor. The commonest cause of these airway obstructions are enlarged adenoids and tonsils. The adenoids and tonsils are part of the lymphatic system and have an important role in immunity. Babies tend to put any object they grasp into their mouths, giving them a ‘4D’ experience. These objects in their surroundings, which they swallow or inhale help in developing their immunity. As the child becomes more mobile, they are exposed to a wider range of immunological stimulation. This is best exemplified as the child goes to school. As the lymphatic system is working overtime the size of the adenoids and tonsils also increase.

Dr Tambi Abraham Cherian

Dr Tambi Abraham Cherian, Specialist ENT, Thumbay University Hospital

The increased size of these tissues causes a blockage to breathing and feeding. The symptoms of snoring and mouth breathing can pass with time as the child grows, but may persist if there is an unusual hypertrophic growth. Persistent upper airway obstruction in the child can cause apnea with reduced oxygenation during sleep, abnormal development of the mid-face the classical ‘adenoid facies’ and obstruction to the Eustachian tube, which is the natural pathway for drainage and aeration of the ear. Eustachian tube dysfunction can result in ear infections, collection of fluid in the ear (glue ear), which can cause mild deafness and decreased scholastic performance.

The treatment of persistent, large adenoids and tonsils causing airway and feeding obstruction is surgical, adenoidectomy and tonsillectomy. This commonly performed surgery is performed by the classical dissection and curettage method, and newer technology such as the use of microdebriders, coblation and laser. These offer more precise surgery with reduced blood loss, and with improved anaesthesia make it a relatively safe procedure.

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