Does your child need to see an Ear, Nose & Throat Specialist?

19 Jan

My baby was born a healthy gal. But after she caught a cold from her lurgy big bro, who was bringing home everything from childcare, she developed a wet cough that just wouldn’t shift.

At her 4mo immunisations, our family doctor explored whether she had had the cough for over six weeks, which we realised that she had. Best practice at the time was if it had been for over 6 weeks, then a course of antibiotics was recommended. Having worked as a Social Worker on the Paediatric Ward & Intensive Care- I was well aware of how serious bronchiolitis or something similar could be for a little one, so I was happy to proceed with the antibiotics.

The cough didn’t shift. So we were referred to a respiratory specialist in our capital city. We had her tested for Cystic Fibrosis - such an anxious time for us, but she came back clear. We went back to the specialist, and had two more courses of antibiotics.

She got another cold toward the end of her last round of antibiotics, and after that cold cleared, so did her cough. Hoorah. She was around 6mo now.

Her specialist landed on a ‘floppy trachea’ and said that would account for the cough & her noisy breathing. Mild forms of floppy airways are common in babies, and she would outgrow it. I wasn’t entirely convinced, but I was happy that the cough was gone and we could leave it for now.

But as she grew, her noisy breathing got worse. I was studying baby sleep, and I started to realise that she was a mouth breather, especially while she was sleeping. She wouldn’t breathe through her nose at all, really.

I kept asking the doctor when I saw her- I know we said it’s normal, but it just doesn’t seem right to me- are we still happy with this? She explained that the floppy airway would account for the noisy breathing, if that’s her only real symptom.

I think it was at her 12mo immunisations that I mentioned that I felt that there was something more going on for her and I felt it in my gut that we were missing something. Our doctor honoured that - “if you feel something, listen to it.” The sign of a good health professional- someone who appreciates a mother of the expert on her child.

I had noticed that when Zali was crying, that her tonsils looked quite prominent- the doctor took a look and sent us to an Ear, Nose & Throat Surgeon (ENT) for further input.

Then, COVID. Our initial ENT appointment was over the phone. I told him her symptoms- noisy breathing, mouth breathing, restless sleep. He asked if she slept a lot, and I said no. He asked if she had any pauses in her breathing, and I said no, maybe just when she is congested sometimes. He said it’s likely that she will need her tonsils and adenoids removed, but let’s wait until after 2yo as she is still so little. I was happy with this. We had a follow-up appointment booked for when she was 20 months.

In the meantime though, her symptoms got significantly worse. She started to have really restless sleep; flopping all over the bed, getting herself into weird positions, crying out regularly in the night. I noticed her having pauses in her breathing (sleep apnea). She would snort, then stop breathing……… then catch her breath and breathe rapidly for a few seconds and then do it again, over and over. She had a sleepover at her Nanny & Poppy’s when my husband and I had a date night, and Nanny reaffirmed that she was stopping breathing throughout the night.

A couple of nights later, I was sleeping in my bed with Zali on her mattress next to ours- and I shot up from a deep sleep, put my hand on her back and started to shake her, trying to get her to rouse. She finally snorted and wriggled around. I still don’t know whether I had woken up from a bad dream, or whether I had just tuned in to an extra long pause in her breathing and was trying to help her to come out of it. Either way, I didn’t sleep for hours after this.

After this I decided to book another appointment with her ENT, as restrictions had lifted and we were able to be seen face to face. He took one look at her- or, listened to her rather- and watched the video of her sleeping, and agreed that we needed to do something about it sooner rather than later.

So now, the little babe is booked in for a tonsillectomy & removal of adenoids.

He explained that the tonsils were responsible for the narrowing of the airways and noisy breathing, and the adenoids were responsible for blocking the nose. He said that we didn’t need to worry about her stopping breathing and not starting again- it was more-so the quality of her sleep was poor as she was constantly waking herself up. More recently, and perhaps coinciding with her having less naps as she has grown, she has been constantly tired and not very ‘copey’ as I would describe her. It seemed as though the rubbish sleep was catching up with her.

If you notice your child with any of the following symptoms, it is worth exploring:

Mouth breathing
Snoring
Sleeping in weird positions such as bum in the air, half way off bed, head right back- this is all in a bid to open airways
Noisy breathing
Restless sleeping or difficulty staying asleep
Pauses in breathing (sleep apnea)
Always seems tired and irritable despite getting sleep

In my work with parents, I will always screen for underlying health conditions in our initial assessment together. As well as ENT issues, we would be screening for signs and symptoms of tongue & lip ties, food sensitivities, iron & other deficiencies. I will always refer you out for support where it is required.

If you notice your child with these sorts of symptoms, please don’t attempt to ‘fix’ their sleep with a generic routine or settling plan. We need to get to the root of the cause rather than use behavioural strategies to lessen their signalling to us.

And trust that mama judgement. If it doesn’t feel right, keep advocating for your child.

No-one knows your babe like you do.