Dr. Bob: My 5-year-old snores. Should I be worried?
Answer: There are multiple causes for snoring in children. Most of them are self-limited but when snoring persists, medical attention should be sought.
Since snoring is usually related to partial obstruction of the nasal passages and upper airways, one of the most common causes is an upper respiratory infection (cold or the flu). Once the infection resolves, the snoring should resolve.
Allergies can also cause swelling of the nasal passages or even sinus congestion. The sinuses are air spaces near the upper airways, and they can produce and drain excess mucus that can clog the airways. Attention to the causes of the allergies and possible treatments should be addressed by your pediatrician.
We now know that chronic enlargement of the tonsils and adenoids (both are lymph tissue that fight infections in the back of throat) can cause snoring. Persistent snoring might signal this problem, and this needs attention. It can be associated with sleep apnea (yes, this can occur in children). Untreated sleep apnea can potentially lead to chronic heart problems and is avoidable with proper intervention. This would typically involve removal of the tonsils and maybe the adenoids. While tonsillectomy is not as common as when I grew up (a long time ago!), it still has its place in the management of children with some obstruction of their airways.
To summarize, your 5-year-old’s snoring needs attention. Hopefully, it is related to a problem that will go away but do not let it linger without medical attention.
Dr. Bob: My son is having lots of problems with handling his bowel movements. This poses a significant problem since he sometimes goes days in between stools and sometimes has leaky stools. I don’t understand how both can happen at the same time. At times he is embarrassed at school with the problem. What should I do?
Answer: Withholding of bowel movements can develop into a serious problem and will need long-term care. When this occurs, further evaluation is necessary. I must note that this is exceedingly common, and everyone should be calm and reassuring as the problem is addressed. I have seen hundreds of children with this problem during my career.
It can present as constipation or can even present as diarrhea. This latter presentation baffles most parents. They are convinced that there is no way a child can be constipated and still have loose stools that, at times, are not well-controlled. The underlying problem is that affected children have so much stool that they cannot comfortably have a bowel movement and they tend to retain stool. When they do this, oftentimes loose stool will go around the hard stool and lead to involuntary soiling. Sometimes a vicious cycle of more retention will ensue.
A couple of things might help in the short-term – 1) Make sure that your child is drinking plenty of water; 2) Fruits, vegetables and fiber-containing cereals can be of benefit. These foods are good for our overall health also; 3) Remember that all of us tend to have a bowel movement after we eat (called the gastro-colic reflex – you put food in the stomach and the colon wants to empty). Make sure that you set aside time in the AM after breakfast for your child to sit quietly and try to have a bowel movement. The hustle-and-bustle of everyday life makes this difficult but it is very important to do this.
This problem requires a long-term solution (many, many months) that is best managed in coordination with your pediatrician. The good news is that it is treatable with the proper intervention.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com