Tonsillectomy and Adenoidectomy
It's nearly been two years since Nahla's Tonsillectomy and Adenoidectomy surgery. Recently, I shared some of the signs Wolfie has been showing that has prompted us to get a referral to an ENT, and so many of you had questions and wanted more information.
What prompted us to look into this?
It started when Nahla, who was usually a great sleeper, started getting up 6-8 times a night. We didn't know what was causing it; we thought maybe she was scared. We tried moving her room around; we tried monster spray. We tried moving her into a new room. We tried her sleeping in our bed - you name, we tried it! It wasn't until she was assessed by an ENT doctor that we learned a few key things. I wanted to share these with you in case you're experiencing the same!
These were the signs Nahla had that prompted a referral to an Ear, Nose and Throat Surgeon:
Open mouth when sleeping
She sounded congested and nasally
Never woke up refreshed
If you notice any of the above signs, please see an ENT!
The consultation with the Ear, Nose and Throat specialist
Nahla was under review by an Ear, Nose and Throat specialist, originally for enlarged tonsils and recurring tonsillitis. In the consultation, we were informed about her being a 'mouth breather', and surgery was recommended to correct this. After doing my own research into mouth breathing, I was shocked about all the long-term health complications.
I also became aware of things I originally thought were 'Nahla's personality' that were more likely linked to poor sleep caused by lack of oxygen. She was a moody, highly emotive girl who we called a pocket rocket. She literally had so much energy. They refer to this as 'excessive energy', and it's actually because the child is not getting restorative sleep and is running in an overtired state. It's believed that many children are misdiagnosed with ADHD, when they are actually just suffering from sleep-disordered breathing issues (SDB). I wish I was aware of SDB and that a child who snores, has periods where they stop breathing and/ or sleeps with mouth open requires an assessment from an ENT.
Humans are built to breathe through their noses, not their mouths. Breathing through our nose is important as it filters the air that enters our lungs; it also warms the air and ensures we get a good quality of sleep! My girl was diagnosed with Sleep Disordered Breathing (SDB). Her mouth stays open when she sleeps; she snores, tosses and turns during the night, wakes up in sweats, sleepwalks, lisps her 's', constantly sounds congested, and when she wakes, she doesn't seem well-rested. She also has excessive energy during that day to the point that her new kindergarten teachers keep telling me, she has so much energy, she doesn't stop,' SDB is linked to many things, namely behavioural issues. And how could it not be when you're having less than optimal sleep every night? It's only natural you'll be irritated, emotionally fragile and exhausted. The most obvious signs of a mouth breather are snoring (never normal), periods of apnoea and an open mouth whilst sleeping!
Preparing for your child for surgery
I was honest with Nahla, and the day prior, I explained that we were going to the hospital to get her breathing fixed. I explained to her in simple terms all the steps I.e we will go to the hospital, you will get in a gown etc. I only told her 2 days prior. We role-played each step with her doctor's kit and teddy.
1. Be honest and use simple words
2. Give your child lots of 'hospital play'
3. Remind them of the plan for the day so they know each step and what is next
4. Read a book about going to the hospital
5. Involve them in packing the hospital bag, picking their favourite teddy or blanket
6. Make sure you tell their childcare or school they won't be back for at least 2 weeks and to not discuss the surgery with your child
7. Reassure your little one that you will be there every step of the way
Using something like the Breath Of Life mask to get them use to the feeling of the mask on their face can be helpful in the surgery. Demonstrate using the mask on yourself. Make it fun by making a funny noise when putting it onto your face. Then encourage your little one to help you put it onto your face. Prompt your little one to try popping the mask onto their favourite toy before encouraging them to try it on themselves.
The Tonsillectomy and Adenoidectomy surgery
The surgery was extremely tough. I can't tell you how heartbreaking it is to kiss your child on the head and walk away, leaving them in the hands of the care team. The recovery was the most intense thing I have been through. Ten tough days, minimal sleep, my baby in agony begging me to make it stop, weight loss, and pain med refusal, but we've seen drastic improvements in Nahla. She is like a different girl.
The morning of the surgery, Nahla was happy and calm as we drove into the hospital and completed all the paperwork. Once we got to her room, she suddenly became really upset and emotional. I held her tight and reassured her that I was there and the nurse came in and offered us a premed - which is a medication that helps calm patients prior to surgery. Nahla had this and, within 15 minutes, was calm and being quite funny.
My baby was dressed in her gown and had her pink sloth that Nan had bought her to keep her safe. We sat for what felt like hours (was only 40 minutes), waiting to be led into surgery. I had my poker face on, I had been briefed on what to expect, but I was only just holding it together.
She was wheeled in, and I could tell she became overwhelmed with the operating theatre and all the faces and introductions of her care team. I held her hand and spoke to her while they placed the gas mask over her face and asked if it 'smelt like strawberry?" She said no, it smells gross. Her body tensed up, and her little eyes were wide open, unable to speak, but she was looking at me like, 'mum help me'. It was heartbreaking - but I had been warned. Within 20 seconds, she was out, I gave her a kiss on her head, and I walked out… and I burst into tears.
Each ENT surgeon has their own pain management protocol. I was unhappy with the approach given to Nahla; my advice is:
1. Keep on top of pain, give medications as advised and don't skip doses.
2. Paracetamol every 4-6 hours, max 4 doses in 24 hours
3. Ibuprofen may increase the risk of post-op bleeding so ask when and how often you can give
4. Ask about the pain management protocol prior to surgery
5. If stronger medication like Oxycodone is not prescribed routinely by ENT, make sure you have a clear idea of who to contact and how to get if the pain is not well managed (this happened with Nahla, and it was a nightmare to get a script)
Nahla's high level of discomfort and pain meant that she didn't eat much at all, and she lost weight! My advice is: Pain medication 30 minutes before eating
Have foods like custard, jelly, ice cream, scrambled eggs, soups, and icy poles on hand
Local anaesthetic lozenges, lollipops and throat spray are great (chat with a pharmacist)
Avoid dehydration by giving small sips of room temperature water, crushed iced or hydralyte icy poles. Aim for half a cup of water every hour
The most noticeable change in Nahla is her behaviour and personality. She is much more calm, friendly, less moody. She will sit and play by herself at home now, and plays with friends at Kinder. She wakes refreshed and happy. We have had zero night terrors and less frequent night waking.
She still breathes through her mouth sometimes and sleeps with her mouth open. We are continuing to work with an ENT and other specialist to ensure we do everything we can to get her to nose breathe.
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