Sleep disorders are common, affecting about one third of all school-aged children. Young children’s sleep disorders will likely affect the household’s sleep quality and overall energy levels.
Lack of good quality sleep in children or adolescents may impact growth, school
performance, memory, mood and behaviour.
Paediatric Ear, Nose and Throat (ENT) Specialist Dr George Sim looks at some of the common problems which can cause sleep issues in children.

Ear infections
• Acute otitis media
An acute middle ear infection causes pain, fever and an inflamed ear drum. Occasionally the ear drum can burst, which leads to ear discharge. A child with an acute infection will usually be irritable and unsettled both in the daytime and also at night and sleep will be disrupted. Treatment is usually adequate pain relief such as paracetamol and/or ibuprofen. If symptoms are persistent for two days or if their temperature is
high, antibiotics may be required. Infected fluid in the middle ear may take a few weeks to resolve.

• Recurrent otitis media
Recurring middle ear infections are known as recurrent otitis media. This diagnosis is based on three or more episodes within a six month period. Common predisposing factors include children who attend day care, kids with frequent upper respiratory tract infections/snorty noses, and exposure to cigarette smoke.

• Otitis media with effusion or ‘glue ear’
This is accumulation of fluid in the middle ear that is failing to resolve. The fluid has a tendency to be thick and sticky resulting in the term ‘glue ear’. Kids with glue ear will not have acute pain but rather some degree of hearing loss and possible speech delay, learning difficulties in school and imbalance. There may also cause mild ear aches
that can keep the child awake. Some kids will pull or poke at their ears frequently as a result.

If you suspect your child is suffering from any of the above ear infections, it will be worthwhile to see your GP for an initial assessment, Dr Sim advises.
“Very often the care of a paediatric ear, nose and throat surgeon will be involved,” he said.
“A hearing test including an audiogram and a tympanogram will usually be part of the
ENT assessment.
“If surgical intervention is necessary, this will usually involve grommet insertion under anaesthetic.”

Obstructive sleep disorder (OSD)
OSD is a whole range of presenting symptoms ranging from heavy breathing or snoring to sleep apnea, where sufferers can stop breathing for 10 seconds or more.
Obstructive sleep symptoms can include mouth breathing, sleeping in unusual positions,
nightmares, night terrors, bedwetting, waking up tired and also daytime issues with behaviour or concentration. Some kids can have difficulty with swallowing food or choking on some foods.

Dr Sim said tonsil or adenoid enlargement are usually the main causes of OSD in kids.
“Tonsils are the two clump of tissues sitting at the back of the throat,” he said.
“Adenoids are located at the back of the nose which frequently causes nasal obstruction and snorty noses.”
“When tonsils and adenoids are enlarged, they frequently lead to obstruction which then impedes on one’s ability to have a good quality sleep.”
“A child will wake frequently at night and may also have daytime issues. This impacts on the family as parents are constantly worried about their child’s breathing at night. “Behaviour issues or progress in school can also be stressful for parents to deal with.”

If you suspect your child to have OSD, the first step will be to have a consultation with your GP to raise your concerns.
“Very often an audio or video recording of your child snoring/sleeping, such as the recordings taken in a sleep study, will be very helpful in the assessment,” Dr Sim said.
“A paediatric ENT surgeon will usually need to review your child to determine if the tonsils and adenoids are the causes of your child’s obstruction.”
Surgery to remove the tonsils and adenoids is the usual treatment for these conditions.

Tonsillitis
Tonsillitis is the inflammation of the tonsils from either bacteria or virus infection.
Symptoms can include sore throat, difficulty swallowing, bad breath, fever, neck gland
swelling and also disrupted sleep from the discomfort.
“If a child has persistent recurrent tonsillitis, it will be recommended to have a GP review
to determine its severity,” Dr Sim said.
“Also, there should be consideration for the frequent use of antibiotics, time off school
and also time taken off work by parents to look after the child with tonsillitis.”
“Removal of the tonsils will be the treatment of choice to discuss with a paediatric ENT
surgeon.”

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