How is obstructive sleep apnea treated?
Specific treatment for obstructive sleep apnea will be determined by your child's doctor based on:
Your child's age, overall health, and medical history
Cause of the condition
Your child's tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
The treatment for obstructive sleep apnea is based on the cause. Since enlarged tonsils and adenoids are the most common cause of airway blockage in children, the treatment is surgery and removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy). Your child's otolaryngologist will discuss the treatment options, risks, and benefits with you. This surgery requires general anesthesia. Depending on the health of the child, surgery may be performed on an outpatient basis.
If the cause of the disorder is obesity, less invasive treatments may be appropriate, including weight loss and wearing a special mask while sleeping to keep the airway open. This mask delivers continuous positive airway pressure (CPAP). The device itself is often clumsy, and it may be difficult to convince a child to wear such a mask. Surgery may be necessary.
What happens during tonsillectomy and adenoidectomy?
Tonsillectomy and adenoidectomy (T&A) surgery is a common surgery performed on children in the US. The need for a T&A will be determined by your child's ear, nose, and throat surgeon and discussed with you. Most T&A surgeries are done on an outpatient basis. This means that your child will have surgery and then go home the same day. Some children may be required to stay overnight, such as, but not limited to, children who:
Are not drinking well after surgery.
Have other chronic diseases or problems with seizures.
Have complications after surgery, such as bleeding.
Are younger than 3 years of age.
Before the surgery, you will meet with different members of the health care team who are going to be involved with your child's care. These may include:
Day surgery nurses. Nurses who prepare your child for surgery. Operating room nurses assist the doctors during surgery. Recovery room (also called the Post Anesthesia Care Unit) nurses care for your child as he/she emerges from general anesthesia.
Surgeon. A doctor who specializes in surgery of the ear, nose, and throat.
Anesthesiologist. A doctor with specialized training in anesthesia. He or she will complete a medical history and physical examination and formulate a plan of anesthesia for your child. The plan will be discussed with you and your questions will be answered. This surgery requires a general anesthesia.
During the surgery, your child will be anesthetized in the operating room. The surgeon will remove your child's tonsils and adenoids through the mouth. There will be no cut on the skin.
In most cases, after the surgery, your child will go to a recovery room where he or she can be monitored closely. After the child is fully awake and doing well, the recovery room nurse will bring the child back to the day surgery area.
At this point, if everything is going well, you and your child will be able to go home. If your child is going to stay the night in the hospital, the child will be brought from the recovery room to his or her room. Usually, the parents are in the room to meet the child.
Bleeding is a complication of this surgery and should be addressed immediately by the surgeon. If the bleeding is severe, the child may return to the operating room.
How do I care for my child at home after a T&A?
The following are some of the instructions that may be given to you to help care for your child:
Increased fluid intake
Pain medication, as prescribed
No heavy or rough play for a duration of time recommended by the surgeon
What are the risks of having a T&A?
Any type of surgery poses a risk to a child. A child may begin to bleed from the surgery within the first two weeks after the surgery, and may require additional blood and/or surgery. Some children may have a change in the sound of their speech due to the surgery. The following are some of the other complications that may occur:
Bleeding. This may happen during surgery, immediately after surgery, or at home.
Dehydration. This can occur due to decreased fluid intake. If severe, fluids through an intravenous, or IV, catheter in the hospital may be necessary.
Difficulty breathing. If swelling of the area around the surgery occurs, it could be life-threatening if not treated immediately.