June 09, 2008,
S.S. asks from Schnecksville, PA on June 04, 2008
3 yr.old Son May Need Tonsillectomy/adnoidectomy for SLEEP APNEA, ANY INFO?
My son has been having sleep issues for around 6 months now. He is a very restless,light sleeper and wakes up atleast once a night. Then he is unable to fall back to sleep for another hour or so. Initially we thought it was a separation anxiety type thing. However during my last two visits to his pediatrician they said his tonsils were chronically enlarged, almost touching his uvula.
I have noticed on occasion when watching him sleep that he has pauses in his breathing and afterward he takes a deep breath and then rolls over or moves.
Today we visited a ear nose throat dr. and he has recommended removal of his tonsils and adnoids to help what he thinks is definitely sleep apnea. I should note that my son is very active and does have problems with hyperactivity and poor impulse control. When he doesn't sleep well his behavior is a real problem.
The dr. however did not recommend a sleep study first. Which I thought would be the first step. He said it is not necessary since what we are describing is classic.
Has anyone gone through this? Any info would help. Procedure? Recovery? Did it resolve the problem? Should he have a sleep study? Can the size of his tonsils fluctuate from day to day?
So What Happened?™
I thank everyone for your advice and opinions. I am just so confused by it all and even have had too many differing opinions from the doctors. The ENT said my sons tonsils were enlarged and needed to come out. One dr. from his pediatrician's office said they did NOT look that big to her. A different dr. from his pediatrician's office said they were big. And I took him to a different pediatrician's office for another opinion and she said they looked perfect. Can tonsil size fluctuate from day to day? And the ENT was the only dr. that did not suggest a sleep study. Every other dr. did. His sleeping is getting worse. Last night he didn't fall asleep til 10:00 pm. Was up by 2:30. I sat with him in his room until he fell asleep which took about 15 min. By 3:00 am he was up again. I sat with him again until he fell asleep. Took about a half hour. By 5:15 he was up again. Then he went back in his room and I didn't stay. He was up again by 7:00. I am nearly at my wits end. My marriage is suffering from it. I'm exhausted. I did schedule a sleep study, it is a whole month away. July 14. The second dr. I took him to said she thinks he is waking during the transitions of his sleep cycle. Form deep to medium to light. He does snore, and pause and all that stuff. But now the differing on opinion of the size of his tonsils. I would feel soooo guilty if I put him through the surgery and then it doesn't take care of the sleeping problem anyway. Could he just be scared when he wakes up in his room? Tonight I am going to have him sleep in my bed all night from the beginning and see if he still wakes up. Im ready to get the crib back out or lock the door. I just dont know what is wrong and how to help.
S.K. answers from Philadelphia on June 05, 2008
I went to a very reputable ENT and he didn't reccomend a sleep study either for my 2 year old son. The reason why they don't do sleep studies for young children is because they have to do them in a lab and most of the time the child has trouble falling and staying asleep. Why pay the money for something that won't give you conclusive results. Also, if the parent notices snoring and pauses while the child is sleeping and the dr. does an exam and sees the tonsils touching it is a moot point to do the study. My son had the surgery on May 16th of this year. He had huge tonsils and always snored. More scary though is he started choking on his food and we had to call 911 several times because he turned blue. The surgery was done at Chester County and he was kept overnight. I was told that it is usually an outpatient procedure but because of his age they wanted to keep him for then night. The surgery was quick. It took longer to register and wait for the surgeon to come than the actual surgery. Once he woke up he cried a lot because he didn't know where he was and he was in some pain. they gave him a small amount of morphine which calmed him down. He did have a fat lip because the tool that keeps his mouth open pinched him and there was some blood around his nose and mouth. All of this is completely normal. After we were discharged from the hospital we went home and started him on his antibiotic and children's Tylenol. They don't recommend anything stronger because they are afraid the child will suffer respiratory problems. You want to make sure you give the Tylenol every 4 hours, even when your child seems okay. Once they try to drink something the pain and crying will begin immediately if you don't. Take my word for it. My son had to stay inside and play for several days. The dr.'s are afraid of infection and bleeding. Becoming overly active might cause the scabs to break off early and cause bleeding. If this happens you will need to go to the hospital. So, get a lot of video's your son likes. This is one time when spending more than 2 hours in front of the T.V. is okay. Try and avoid a lot of milk products because once the scabs come off your son might not want to swallow a lot and will drool more. Dairy makes more mucus and will cause more drool. The scabs usually fall off and into his throat, which is also normal, during the second week. My son is fine now and sleeps so soundly I have to put my hand on his tummy to make sure he is breathing. His "allergy" problem has also cleared up. I hope all goes well with your little guys surgery. Take care and two weeks post op your son will be as good as new without the snoring.
L.B. answers from Harrisburg on June 05, 2008
I'm 29 and last year I went through a sleep study. It's not an easy thing to go through, and you 3 year old son may not be able to do it at all. You have to show up there at night, then they attach at least 11 sticky pads with wires runing every which way....and then you have to fall asleep! It was hard at first, but I was able to do it. I really don't think your son could....too much distraction and strange.
If you have noticed your son pause in breathing, then suddenly inhale, and the doctors say his tonsils are large....it sounds like sleep apnea to me as well...then having the surgury I would think would be best. The hardest part will be the recovery....but in the end he will sleep better and probably inprove in his behavior. Tonsils are really not needed from what I understand...and in the long run cause more trouble than what they are worth.
I didn't have sleep apnea...I had to go back for a nap test, which is during the day...I had to take 4 naps for 20 minutes each to see how long it would take me to fall asleep to detrmine if I had Narcolepsy.....my averaged out time for falling asleep was 7 minutes....anything below 5 is considered having Narcolepsy....so it was detiermined I just have a sleep disorder and was put on medication to correct it....so far it is working.
I hope my information helps you in any way. Good luck.
J.K. answers from Harrisburg on June 05, 2008
I responded to a simiar question this morning so I copied my reponse to her and an sharing with you :)
My middle son had this done 2 years ago when he was 6. He also had sleeping problems that included apnea and severe snoring. His surgery went very well! For his recovery he was in some pain, but really doesn't complain about pain so he was harder to assess at that time. I made a face scale with 10 faces that went from smily to sad. I had him point to the face that matched how he felt and gave him the pain meds based on that scale. AS far as not jumping or running....I was a bad Mommy and let him play a good amount of video games and movies. It went that he could watch as much Nick as he wanted. He is a very active child and it really did help keep him still. I had tried different flavors of jello leading up to his surgery so I knew what he liked and made that in mass. I also gave him italian ice to eat to help soothe his throat. He was very sleepy from teh anesthesia the first day but after that he was a bit more energetic. I was very happy afterwards because he was eating very little for a few months before his surgery. He has always been small for his age, but he started to eat and grow after his surgery. Good luck and I hope that this info helped a bit :)
S.R. answers from Pittsburgh on June 04, 2008
My niece had her adnoids out when she was 3. I don't know much about the procedure, but she felt bad for the hours after the procedure and the next day It was like she did not have anything done.
If you are not convinced with the ENT's dignosis, you should get a second opinion. It could not hurt!
A.C. answers from Reading on June 09, 2008
I myself went through this as a child. My parents didn't even try to address the problem until I was almost 10. Being a nurse I understand why they said the sleep story was not necessary. Again just knowing that your son has enlarged tonsils and pauses while sleeping I would agree that it is the tonsils causing it. Procedure is about 20mins -40mins in the OR. Recovery 1-2 weeks. I've had no problems with sleep since I had the surgery as a child.
D.M. answers from Scranton on June 04, 2008
My daughter had her adnoids out in 2005 and her tonsils out in 2006 because of a combination of constant throat infections and sleep apnea. It definitely helped having them removed. She used to snore so badly and stop breathing in her sleep. Her doctor did not do a sleep study because it was clear as to what was causing her sleep problems.
Adnoidectomy was a simple procedure and was done on an outpatient basis. We went to the hospital early in the morning, they did the procedure and by that night she was able to come home. She had tubes put in her ears at the same time too because of other problems with her ears and constant infections. Afterwards she was on a cold diet and no heavy lifting or running for 3 days. I believe she was also on Augmentin and Tylenol for a few days too.
The tonsillectomy was pretty much the same except that she did stay in the hospital for a couple days. Same diet and medication and restrictions afterwards. She said her throat felt sore a day after the procedure but she didn't complain of any real pain.
D.P. answers from Pittsburgh on June 04, 2008
I'm sorry, I don't have specific experience with that but I know that, personally speaking, before sending my son for surgery, I would most definitely get a second opinion. Good luck to you and your son!
S.K. answers from Philadelphia on June 05, 2008
Does he snore? Does he make this gagging/gurgling noise while he sleeps?
Mine seemed to choke while she slept & then settle back down. I had taken her to CHOP about her sleeping, talked to the peds. Finally I asked our ENT. He said GET THEM OUT! We didn't do a sleep study either. She was almost 3.
Best thing we ever did. She recovered easily, she came home that day. She slept through the night for the first time ever that night.
Our dentist saw that she had this a few years later & asked why. When I explained why, he said that there are studies coming out that show that many ADHD diagnoses might actually be sleep apnea caused by large tonsils/adenoids.
As another mom said, there was a similar question regarding the procedure & recovery. I answered that one too so you could refer there as well.
T.B. answers from Pittsburgh on June 05, 2008
my son has reactive airway disease (a type of asthma) and has had breathin issues his entire 5 years. He was really bad at night. we had him tested for sleep apnea (my husband has it) and sure enough, he has it. But instead of surgery, which I was sure was the answer, they prescribed Nasonex nose spray. my first reaction was "nose spray!are they kidding!?" but we tried it, and IT WORKS! one shot up each nostril before bed and he's fine! we started with every night, but now we only do it every other night, or when we can remember! He doesn't need it as often any more! the spray shrinks the nasal tissues or something! I would highly recomend trying the spray before surgery- that should be your last ditch effort!
hope this helps! deffinately get a sleep test before anything!
B.K. answers from Pittsburgh on June 05, 2008
My oldest was 7 when we finally went through this. She snored, got "colds" all the time, and I believe she had apnea as well. Our doctor took one look at her xray and sent us to an ENT and we scheduled the surgury right away. The difference was instant! We noticed it in the recovery room!! My one recommendation is to make sure you give the pain meds right away! We didn't, our daughter didn't like to take meds and I thought as long as she didn't need it why give it to her. Well, we found out that it's easier to prevent pain than get rid of it and almost had to go back to the hospital because of dehydration because her throat began to really bother her and she wouldn't drink or eat. I had jello (in all her favotite flavors), ice cream & soups ready to go. Also when they tell you the recovery time is three weeks they are not kidding. It did take three weeks for our daughter to be her total normal active self. She was almost back to normal quickly, but it really does take the time to get completly back on track. You have to watch and make sure that you don't start any bad habit with them durring the recovery time...guilt may make you lax in some of your normal rules. Get the surgury done, go to the pre-surgury tour, don't cry in front of him, and when he wakes, be smiling! Good luck & best wishes!!
J.J. answers from Philadelphia on June 05, 2008
If you feel unsure about this you can check with a Pediatric Sleep Disorder Doctor. Abington Memorial Hospital has one and she is great. Her name is Jacqueline Genova, M.D. and this is her specialty. You meet for an evaluation and she goes over everything with you. To make an appointment call ###-###-#### it is central schedulings number and request an evaluation with her. I wish I had known about this when my boys were younger. THey snore and while she is not worried yet they have behavioral issues.
Hope all works out.
I work with her now and she is great with this.
Feel free to write me if you have any questions. I am not a nurse so I can't tell you a whole lot. Take Care.
P.M. answers from Harrisburg on June 06, 2008
My daughter had her tonsils/adnoids out when she was 2-1/2. She had sleep apnea and ate minimally as her tonsils were so enlarged that it was difficult for her to eat. It was scary to listen to her stop breathing as she slept.
We did NOT have a sleep study - the other symptoms were there...why put her through it?
She had a WONDERFUL pediatric ENT who scheduled her surgery at a hospital where there was a pediatric anesthesiologist. (Not all hospitals have them - you might want to check it out.) It's normally done as an outpatient procedure, but because she was young, they kept her overnight. We felt safer that way.
The change in her breathing and eating occurred within 24 hours post-op. It was amazing! Well worth it. Day 1, you would have never known she had surgery. However, days 2 and 3 were pretty rough for her. They told us this was normal.
Poor impulse control is VERY normal for a 3 year old boy. Most grow out of it. I wouldn't worry about it for a few years. Those who don't outgrow it have other options as they grow older.
A.R. answers from Philadelphia on June 05, 2008
I would definitely seek a 2nd opinion if your pediatrician is not willing to send your son for a sleep study, as that is the best (if not only) way to diagnose sleep apnea. I would not put my child through anesthesia and surgery on a physician's "hunch".
Depending on your insurance, you may be able to have a sleep study done without a referral (i.e. with a PPO, you can).
Best of luck!!