Hi

Thanks for the query

The refusal of feeds by the child is due to presence of enlarged tonsils and adenoids behind the nose.

Both, adenoids and the tonsils are the lymphoid organs which are present when a child is born. It is present in all the children which contribute to the immunity of the child till the child is two years of age.

Unfortunately, in some children the enlargement of both of them causes repeated cold, nasal block, ear related problems, breathing difficulty, refusal to take feeds, snoring, recurrent infections, etc.

The present scenario is very similar to that mentioned above. The enlarged adenoid is the main culprit behind the ear infection. And, the enlargement of the same is causing the child to refuse the feeds and worsening of the infection. This is because, when there are enlarged adenoids and tonsils, the child has to breathe through the mouth rather than through the nose. Hence, the child cannot breathe as well as take food simultaneously.

My advice to you is:
1. Give plenty of warm water for the child to drink.
2. Encourage your child to take soups, fresh fruit juice and semisolid feeds.
3. Use saline spray for the nose to keep it patent and to clear any mucus plugs present in the nasal cavities.
4. Change the linen of the child every night before going to bed.
5. Avoid those things which will affect the breathing if the child.
6. Clarithromycin can induce gastritis which can complicate the situation further. Hence, give plenty of water for the child to drink.
7. Avoid water getting into the ears.
8. Do not send the child to nursery as the child might be prone for cross-infection from other children or vice versa.
9. Get the tonsils and the adenoids removed once the child becomes 2 years of age. Following which, the child will recover completely and starts gaining weight.

Hope this answers your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Thanks for writing back

Q: My son when gets severe cold suffers from wheezing & has to be put on Nabulizer, what causes this & how long will he will be suffering like this. Is there any particular food that can trigger wheezing/Infections?
A: This was an important piece of information provided by you, it has made my job easier. The root cause for all the problems is the allergy. Your son is suffering from nasal allergy as well as hyper-reactive air way disease. When a child is prone for nasal allergy the lymphoid organs usually gets enlarged in order to resist against allergy and the inflammation. Due to enlarged adenoids and the tonsils the child will have recurrent cold, nasal discharge, mouth breathing, snoring, ear problems, etc.
Allergens such as dust, smoke, certain foods like milk, fish, eggs, etc. can instigate an allergic reaction, thereby inducing the chain of events.

Q: Also as you have mentioned to remove tonsils & adenoids when he is 2. is that a painful surgery?
A: There are no painless surgeries. Before surgery, the child will be completely anesthetized and operated. Post surgery, there will be some pain for a couple of days, for which the doctors will be giving adequate pain killers.
Q: Will they be present even when he is infection free?
A: If the tonsils and adenoids are not removed, yes they will remain even in the absence of infection. Once both of them are removed, he will be symptom free.
Q: Can doctors spot them when he is not suffering from any infection??
A: Yes, definitely! An x-ray of the nasopharynx taken in the lateral view can show the presence of the adenoids and direct examination of the oral cavity can show the enlarged tonsils.
Q: Are there any side effects?
A: Post surgery there will be no side effects. If the enlarged and tonsils remain for a long then there are chances that it can lead to various other problems.
Q: Are these present in every kid or just mine?
A: As I mentioned before, both the tonsils and adenoids are present in all the children who are born. But, in those individuals who are susceptible for allergy or in those children in whom the tonsils and adenoids are enlarged above the normal limits, the above symptoms might be present.

Hope this answers your query; I wish him good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Welcome back

Q: what's the Youngest age to take the T& A out.
A: The child should be at least 2 years of age and weighing more than 10 Kg.

Q: The GP don't prefer an ENT Appmnt that easily & If its not serious then there is no chance of Getting surgery done.
A: For few more months, you can continue with the measures which we discussed previously. I do not think it is a very serious problem. Try persuading your doctor to refer the child to a good ENT specialist.

Q: Which is the best place & doc if you know Who can do this for us
A: You can get the surgery done from any private or government hospital. It is usually performed by an ENT specialist. It is a simple surgery which is done by all the ENT specialists, it will not require more than an hour to complete the surgery.

I do understand it is difficult for the parents to see their offspring suffering. But the choice is limited and hence the best thing to do at present is to persuade your doctor to refer your child to the ENT specialist at the earliest and follow their advice.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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