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Lots of symptoms can signal tonsil and adenoid issues in children

It’s not uncommon for some school-aged children to act up or have a difficult time focusing at school. However, as parents search for answers — ranging from poor diet and sleep habits to attention deficit or a behavioral disorder — they could be overlooking a more obvious, and curable, health condition. 

Tonsils and adenoids — the lymph organs (lumps) in the back of the throat and nose — are lymphoid tissue and assist with the immune system. Sometimes they are removed because they become chronically or repeatedly infected, but they can cause problems even when they are not infected. Some children have large tonsils with no apparent cause. 

Enlarged tonsils and adenoids are one of the main culprits for obstructive sleep apnea in children, a condition in which the airway is interrupted, causing restless sleep. Studies show that as many as 10 percent of all children may have sleep disturbances as a result of large tonsils and adenoids. Currently, this is the most common reason for a tonsillectomy/adenoidectomy. As anyone who has endured sleepless nights knows, a lack of sleep can cause irritability and an inability to concentrate, which can be particularly challenging in the learning environment.

The symptoms

If your child is having negative daytime behaviors, look for these nighttime symptoms: 

  • Heaving snoring
  • Mouth breathing throughout the night
  • Restless and fitful sleep, moving all around in the bed
  • Sleeping in unusual positions, such as sleeping propped up or with head tilted back
  • Gasping episodes— periods of not breathing during sleep
  • Age-inappropriate bed wetting
  • Difficulty waking up in the morning and not awakening refreshed

Behavior effects from obstructive sleep: 

  • Excessive daytime sleepiness, fatigue and even falling asleep at inappropriate times 
  •  Irritability and poor concentration 
  • Poor school performance 

Other ways enlarged tonsils and adenoids may affect a child:

  • Eating problems due to difficulty swallowing or diminished senses of smell 
  • Delayed growth. Growth hormone is predominantly produced during deep sleep. Poor sleep hinders this production.
  • Constant nasal congestion which can result in nasal voice, nasal drainage, cough, mouth breathing or drooling
  • Abnormal dental development
  • Unclear speech
  • Recurrent bleeding from the tonsils
  • Significant difference in size (asymmetry) between the left and right tonsils 

If your child has disruptive sleep patterns or negative behaviors, talk to your doctor to see if the tonsils and adenoids may be the cause. Your doctor will do a thorough exam, take a family history and may order a sleep study to rule out sleep apnea not caused by enlarged tonsils and adenoids. 

What you can do

Treatment options:

  • Non-invasive treatments such as nasal steroids. This may improve symptoms due to enlarged adenoids or decreased airflow in the nose
  • Tonsillectomy and adenoidectomy. These surgeries have proven results of improving sleep quality and reducing the negative consequences of poor sleep. Removing the tonsils and adenoids does not weaken the immune system. In fact, their removal may actually reduce the frequency of illnesses in some children.

If your child is suffering from the negative effects of enlarged tonsils and adenoids, talk to your doctor to see what option best meets his or her needs.


About Shaunda Rodriguez DO