Sleep is so essential for our children’s overall development and health, but we cannot address unhealthy sleeping habits if there are medical reasons for a child’s restless nights.
There can be multiple causes including growth spurts, Iron deficiency, excessive stimulation etc.
There are also a couple of ear, nose and throat (ENT) related conditions that can contribute to poor sleeping – let’s look at the two most common causes from an ENT perspective amongst infants and toddlers.
Adenoid hypertrophy or enlargement
Any form of a blocked nose causes difficult noisy breathing and discomfort while sleeping. The most common cause for a chronically blocked nose that we as ENT specialists see is enlarged tonsils and adenoids.
Adenoids are lymphoid glands that form part of your immune system. They are located behind the nasal cavity where they trap viruses and bacteria or allergens that try and enter and infect the upper respiratory tract. When they are constantly exposed to viruses or bacteria (for example at creche or school) or even to allergies, they enlarge and block the passage where air needs to pass from the nose to the airway. Therefore, adenoids are often enlarged in children, but shrink as we grow older and our immunity improves. Adenoid hypertrophy causes snoring, blocked and runny nose, nasal voice, mouth breathing and postnasal drip with night-time wet coughs.
Severe cases can even lead to obstructive sleep apnoea where your child stops breathing for a few seconds at a time. Your child will snore loudly and wake sporadically during the night due to these pauses in breathing and will not be able to enter deep sleep cycles. In the long run this is detrimental to their sleep and overall health as essentially, they are not getting enough oxygen to their bodies and their hearts and lungs must work extra hard. It can lead to failure to thrive and poor growth, behavioural problems, and poor school performance due to lack of concentration, enuresis (bed wetting), and even heart failure.
Chronic mouth breathing also has long-term effects such as poor dental health, bad breath, abnormal development of the jaw and teeth.
Another complication of adenoid enlargement is the obstruction of the eustachian tube leading to middle ear infections. This brings me to the second most common ENT cause for poor sleeping.
Middle ear infection of effusion
The middle ear has a natural drainage pathway to the back of the nose called the eustachian tube. Any fluid build-up in the ear from inflammation or an ear infection is supposed to drain naturally via the eustachian tube. When the adenoids are enlarged and block the eustachian tube’s opening, this cannot happen, and fluid builds up and becomes stagnant in the middle ear. This leads to recurrent infections or chronic fluid build-up called an effusion. You know the feeling you get when your ears need to pop when landing in an aeroplane? That is the pain a child has almost constantly when there is pressure build up in their middle ear, especially when lying down and there is increased blood flow to the head. That is enough to keep anyone awake at night.
Not only is it painful for children, but it can cause difficulty in hearing and eventually delay their speech development because of the muffled sounds. In severe cases it can even affect their balance. Some mothers notice how their infants walk differently when their ears are acting up.
These conditions are very common in infants from around 6-8months of age into toddlerhood.
There are certain medications that can be prescribed if caught early to try and reverse the inflammatory process and essentially shrink the adenoids, but often it can require surgery. The surgery is a low-risk, quick procedure where the adenoids are removed through the mouth (often combined with a tonsillectomy) and grommets can be inserted into the eardrums to drain the fluid.
Once these medical conditions have been resolved there will be a marked improvement in their sleeping already.
Thank you to Dr Nina du Toit who is an ENT at The Club surgical centre for the article and her valued input