Paediatric ear, nose and throat (ENT) disorders are some of the primary reasons for children’s visits to the doctor. ENT issues are more prevalent in children because their bodies and immune systems are still developing. Many structures in the ENT region are not fully developed and may be more prone to dysfunction. Children’s ENT ailments can range from colds and flu to allergies and ear aches, but some ENT conditions do require more urgent attention. Dr David Lau, ENT specialist at Gleneagles Hospital, answers 10 questions that parents often ask.
1. What are some of the most common childhood ENT issues you’ve encountered?
Kids come in with all sorts of ENT complaints. I have seen interesting cases of allergies, sinus issues, and night-time sleep disorders, such as snoring and disrupted breathing during sleep, in children from as young as 2 years old.
2. Allergies are known to be on the rise. What are the main allergies you see, and how do you treat them?
The number one allergy I see in kids is due to house dust mites. They can cause nose, chest, eye, and skin problems. We offer a spectrum of treatments ranging from nasal rinses, sprays or oral medication, to immunotherapy, a form of treatment that helps the body’s immune system fight allergies. It involves either a sublingual method by putting drops of allergen extracts under the tongue or a simple tablet a day. In some cases however, surgery may be a way to improve breathing.
3. Is there anything that I can do to prevent my child from developing allergies?
I'm a great advocate of going back to the basics. When caring for infants, avoid excessive cleanliness (although this is difficult to measure) and do not smoke around them. There is growing research suggesting that exposing infants to germs may help them develop stronger defences against illnesses like allergies later on in life. If possible, breastfeed babies as this will also enhance their immune systems. Healthy, balanced eating also helps. Kids who are unwell should avoid being given antibiotics unless advised by the doctor with a clear reason.
4. How can I help manage the symptoms if they are already present?
If allergic symptoms are already present, then it would be good to minimise the child’s exposure to dust and dusty items like soft toys, rugs, carpets and curtains. Also, do change your bed linen regularly. Make sure your air conditioning filters are cleaned every week. It might also be useful to determine if pets are causing the allergy – dander from cats and dogs can sometimes trigger allergic symptoms.
5. How should I treat a child with a common cold?
Keep an eye on the child’s temperature. As a rule of thumb, you need to get the child to a doctor if their temperature remains at 40°C and above. Keep the child hydrated and cool, and give them lots of rest and cuddles. If the child can swallow comfortably, you can give them some vitamin C gummies.
6. When is it time to take a child with ENT issues to the doctor?
Your child should definitely see the doctor if they have:
- Difficulty swallowing fluids for more than a day
- A temperature that stays at 40°C and above
- Seizures or fits
- A rash
- A cough lasting more than a fortnight
- A stiff neck or bad headaches, which could be a sign of something more serious
7. When should emergency medical treatment be sought for the child?
Parents should consider taking their children to the emergency room if the child is experiencing symptoms like breathing obstruction, bleeding, or severe pain in ears, nose or throat.
Foreign bodies stuck in noses, ears and throats also require immediate medical attention. It’s not a good idea to attempt to remove the blockage yourself as this may cause more damage to the delicate areas and structures in the ENT region.
Trauma and lacerations of ears and noses from sports or rough play are other common causes for children’s admission to the Accident and Emergency (A&E) department.
8. What should I prepare for my child on the way to the hospital?
When you get to the A&E department, it is always useful to come prepared with the child's identification papers like a passport or birth certificate, and of course, your own. If you have an insurance card, document or policy number for e-filing at the A&E department, that could also help simplify the paperwork.
Distractions can be useful in helping your child cope with a difficult situation. Bring their favourite toys along or if you have time to spare, prepare an emergency bag filled with items that could comfort your child in times of need. If you don’t have any of those on hand, cuddling and holding your child would work as well.
9. I read that antibiotics can disrupt our gut health by killing both the good and bad bacteria. What is your approach to the use of antibiotics?
Antibiotics are useful for certain bacterial infections. Because most childhood colds and flus are viral in nature, they are best treated by our own immune systems. Antibiotics do not treat the source of the infection here. Furthermore, inappropriate and over-use of antibiotics means the child's immunity isn't properly built up. I generally do not prescribe antibiotics for common coughs and colds.
10. What is something that not many parents know about, when it comes to paediatric ENT conditions?
Allergies (particularly of the nose) can affect sleep, behaviour, and even exacerbate conditions such as hyperactivity disorder. Recognising the allergy is the first step towards effective treatment and can actually help to improve these symptoms.
Article reviewed by Dr David Lau, ENT specialist at Gleneagles Hospital
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