She stops breathing...could your child have Adenoidal Hypertrophy?

Have you ever heard your child stop breathing? I have.

Alyvia has always been on the chubby side. As a baby, it was cute and many people would often comment on her ‘mouthwatering thigh rolls’. On the centile charts, she was always on the 50th centile for weight and height but as her peers grew taller, her rate of vertical growth was much slower. We never thought anything about it until subtle signs started to appear.

Eating

Alyvia started being weaned around 6 months of age. She took to fruit and vegetables well and enjoyed her pureed foods. When it was time to move on to more textures foods, it was clear she didn’t like having to do the ‘work’ of chewing. We therefore continued to give her pureed food for a little longer. At about 9 months of age, she reluctantly began eating more solid foods but would always eat with her mouth slightly open. When she swallowed each bite, it looked as though she had difficulty in swallowing. If we gave her a slightly larger portion, she would gag and bring up her food again.

Mealtimes were always stressful as we never felt that she actually enjoyed her food. We would often have to distract her in order for her to voluntarily open her mouth to eat. When she swallowed her food, it was a quick swallow and then a gasp of breath again.

Playing

Playtime was Alyvia’s favourite time of the day. She loves books and quickly memorises the story so that she can recite it along with us. When she was very active, we noticed that she would breathe with her mouth open and at times hold her breath. CD timed it once and it was as long as 4 seconds! Usually it is between 2-3 seconds. We discussed this and presumed this was behavioural. She very rarely breathed through her nose.

Sleeping

Getting Alyvia to sleep was also a rollercoaster ride. At 5.5 months, we sleep trained her and she was sleeping in her own room throughout the night. Shortly after this, she fell quite ill with pneumonia and for 10 days or so, she slept with us in our room. We then fell off the wagon again with her sleep and realised we had to sleep train her again. It was a little harder this time but she cooperated and we were soon onto a nice routine at home. We did notice however that whenever she had a slight cold or runny nose, which happened to be very often, her breathing was very noisy. At night, she would often snore very loudly.

At around 8 months, Alyvia was admitted to hospital with Croup. This period was the worst time of our lives (another blog post coming regarding this). Our little baby could not breathe! It mainly worsened in the middle of the night and Alyvia could not sleep as a result. It was traumatizing to see her neck muscles overworking to aid her breathing and her drooling continuously as she could not even spare a second to swallow as it would again disrupt any air that would get into her lungs to help her breathe. I do not wish ANY parent to witness their child with this illness.

Anyway, she was admitted to hospital on 2 occasions with Croup and was given steroids and monitored until her breathing settled. During this time, she slept with us. There was no way she was going to sleep alone after what she went through. She needed her parents. Her breathing did not normalize until a few months later as she took some time to get over the Croup. We were grateful to see her back to her usual self, albeit she had lost considerable weight and her appetite.

Around this time, her snoring was a common thing when she slept. She also began to develop periods where she stopped breathing in her sleep and then gasped for breath a few seconds later. This happened sporadically throughout the night and CD and I would often stay awake at night for hours listening to her breathing and watching her have numerous periods of breathing cessation (apnoea). I knew if we weren’t doctors, we would have panicked to no end but it was a worry and in the back of our minds we both knew this was not normal. We didn’t want to ignore it any longer.

We began to do the thing we love doing best in the CD household…we began to start diagnosing or perhaps overdiagnosing Alyvia’s problem. These ‘special’ times become somewhat of a contest where we both try to outsmart each other with our knowledge. It often ends with me winning (yes I am grinning from ear to ear) while CD tuts and changes the subject...a sign he has lost and doesn’t want to address the defeat.

On this particular occasion, we started to put Alyvia’s symptoms together; she had a high BMI, ‘mouth-breathing’, snoring at night, inability to coordinate eating and breathing properly and periods of apnoea. CD luckily sees these cases in his clinic regularly and was convinced she had an element of sleep apnoea due to her weight and came to the conclusion these all pointed to a child with enlarged adenoids (or adenoidal hypertrophy). Adenoids are glands that are located at the back of the throat where the nose and throat meet and help fight infection. Enlarged adenoids leads to constriction of airways making it more difficult than the ‘regular’ child to breathe. This seemed to be exactly what Alyvia has.

What was the treatment? Definitive treatment when all other options fail is surgery but we did not want that for our 11month old child. We began to debate the pros and cons of surgery with each other. My points were that she was so young and didn’t want her to go through a general anaesthetic. Also, during the time post surgery, I would need some help with her at home and due to our work schedules, taking time off together was going to be almost impossible. Lastly, we wanted to watch and see if she outgrew this. CD mentioned the salient point; when children grow, either when they are older or when they have a growth spurt, their adenoids reduce in size resulting in opening up of the airways and breathing through the nose becomes easy! All problems settle straight away!

This was what we were hoping for and therefore decided to leave her as she was. We would only change our minds if breathing became a real trouble for her and her speech started to get affected (more nasal).

9 months later, Alyvia’s symptoms are slightly better as she has become a little taller and has lost a lot of her baby weight. She has had less cold/sinus symptoms such as a runny/stuffy nose. She still has noisy breathing and the occasional apnoea at night but not as much as before. I dread now with the winter season looming, what kinds of respiratory viruses she may attract that may flare up her symptoms.

I hope that if any of your children display symptoms of recurrent nasal discharge/sinus symptoms, ‘mouth-breathing’ , nasal speech, episodes of breathing cessation at night or snoring and poor oral intake, this may be on your list of things to consider. And remember, the ‘wait and watch’ method is perfectly reasonable as things usually resolve as the child grows, allowing the nasal passage and airways to open up.

If you suspect this in your child, I would ask your GP to refer you to ENT for their opinion.

I hope this was informative.

Please as always, let me know what you think. Direct a friend to this post if you feel they may have a child with these symptoms.

Speak soon

MCD

xxx