What are tonsils and why do they need removing? (What is a tonsillectomy or adenotonsillectomy?)

How inflamed tonsils compare with normal tonsils

How inflamed tonsils compare with normal tonsils

What are tonsils?

Tonsils are soft tissue located at the back of your throat; they are part of the body’s lymphatic system (so are adenoids). When they are working properly, they help to recognise bacteria and viruses entering through the mouth and produce white blood cells to fight off infection.

Tonsils are particularly useful during childhood while the body is still encountering new bacteria and viruses for the first time and building up the immune system. Doctors seem to be of differing opinion as to how useful they are as adults; I’ve some that have called them redundant and unnecessary, I’ve also met other doctors who view removing them as an absolute last resort.

Why do tonsils need removing?

Tonsils may temporarily swell while fighting infection, sometimes they become so swollen that they result in a very sore throat and fever (tonsilitis), they may also partially obstruct the airways and not respond to non-invasive treatmeants.

Surgery may be recommended to help treat:

  • Multiple case of tonsillitis (seven cases of tonsillitis or strep in the last year, or five cases or more over each of the last two years).
  • Breathing problems related to swollen tonsils
  • Frequent and loud snoring
  • Periods in which you stop breathing during sleep (sleep apnea)
  • Bleeding of the tonsils
  • Trouble swallowing chewy foods, especially meats
  • Cancer of the tonsils

Back in the 1980s, having your tonsils out was kind of a childhood rite of passage. It was a very common procedure and often parents had already experienced a tonsillectomy in their own childhood. Medical opinion has now swung in a different direction and there is a more stringent list of criteria that often needs to be met (as well as requiring parent consent / advocacy). For a balanced medical opinion, try this post by Christopher Johnson (a pediatric intensive care physician) .

What is tonsil grading?

Surgery is most likely to be recommended if tonsils are consistently swollen at Grade 3 or Grade 4 coupled with other complications (such as snoring and/or sleep apnea).

What are the 4 grades of swollen tonsils

What are the 4 grades of swollen tonsils?

Basically tonsils are graded based on how much of the airway they block.

  • Grade 0 = tonsils are within the the tonsillar fossa
  • Grade 1 = tonsils obstruct 0-25% of oropharyngeal airway
  • Grade 2 = tonsils obstruct 26-50%
  • Grade 3 = tonsils obstruct 51-75%
  • Grade 4 = tonsils obstruct 75%

What are the possible side effects of swollen tonsils?

  • Fever / temperature. Keep in mind that children can react in their own individual ways – they may keep getting low grade temperatures instead of a fever.
  • Runny nose and congestion (as well as the sore throat).
  • Difficult or painful swallowing.
  • Swollen and tender glands (lymph nodes) on the sides of the neck.
  • Bad breath.
  • Fever and chills.
  • Tiredness and headache.
  • Stomach upset or pain.
  • Mouth breathing, noisy breathing, and/or snoring (due to enlarged tonsils blocking the airways). Obstructive sleep apnea. The swollen tonsils and/or adenoids can intermittently block airflow. It sounds like your child is silent and then there’s a big noisy sucking in of air.
    • In Miss 2 it can be so loud that I can hear it through her closed bedroom door and can sound like something’s fallen off a shelf and hit the floor! It’s a crappy and frightening thing as a parent that can result in just sitting with them in the dark either to check that they are breathing or to give them a gentle nudge to help them breathe again. If you’ve spent time with them hooked up to an oxygen saturation monitor then you’ll be familiar with what a stark difference there is between their oxygen levels when alert and upright versus lying prone to sleep.

  • Fatigue. They might seem like they’re getting enough hours of sleep but in reality the quality of sleep is poor because their body is struggling to get enough oxygen through the night. It’s a bit like starting each day on a half tank of gas.
  • Developmental delays. Sleep is critical for young children. During those early years, they are rapidly growing and learning. They need sleep to focus during the day; to have time for their brain to make connections between all the things they have learned or experienced; and their brain releases a growth hormone while they sleep. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can make it harder for them to stay on track.
  • Behavioural difficulties. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can result in daily misery that they don’t know how to express.

Keep in mind that young children (i.e. toddlers) may not be able to describe their symptoms to you and it may not even occur to them to do so (especially if they chronic health issues). They may also be confused by referred pain; the ears and throat share nerves (as well as being linked by eustachian tubes) so they may say their ear is sore when the infection is actually in their throat. Another possibility is if they keep exhibiting teething type behaviour well after all their teeth are in (i.e. chewing on fingers or a dummy constantly, lots of drool) combined with a temperature and bad breath – the cause may actually be their tonsils!

What does surgery (a tonsillectomy) involve?

Surgery will normally take place at a hospital (probably as an outpatient). The doctor will review medical history in advance and make recommendations about pausing medications. You will normally be advised not to take anti-inflammatory medications within 7 days of surgery. They will also discuss post-operative pain medication.

The day of the surgery will involve a period of fasting; food or water won’t be permitted because they can impact the anesthetic. It’s a good idea to have family support and a game plan of how to distract your child; an older child may understand why they can’t eat but a toddler is likely to just focus on the fact that they are off routine and they are HUNGRY!

During surgery, your child will be under a general anesthetic. The surgeon will enter through the mouth and the tonsils will be removed with an electrical cauterizing unit.  You can watch videos of surgery on YouTube but they can be a bit difficult to stomach; I preferred this video of a digital tonsillectomy surgery.

adenotonsillectomy

Adenoids and tonsils

Often the adenoids will be removed at the same time as the tonsils (if they are also swollen); this is termed an adenotonsillectomy. Click here for information about the adenoids.

What happens after surgery?

Depending on the age of your child, they may keep them in the hospital overnight for monitoring or they may go to a recovery room and then go home the same day. You should be given a pamphlet with information about post-op care (i.e. like this tonsillectomy guide).

Your child may feel quite groggy and tired for the next few days and also have some nausea; vomiting once or twice is normal but contact your doctor if vomiting persists.

A light, cool diet for the next few days is generally recommended (avoid hot liquids or spicy food) but doctors will often recommend that children eat whatever they want – the abrasion from bread or crackers will actually help to clean the area. (That’s not to say there won’t sometimes be screaming pain because a sharp cracker edge has just struck the surgical site).

Some doctors will prescribe antibiotics. They will normally be prescribed painkillers (like Pammol and Tramadol) and anti-inflammatories (like Nurofen); if your child won’t take the fully funded options consider buying over-the-counter replacements (for kids) that have been flavoured.  It is important to keep on top of their medication (including waking them up around the clock for a few nights) as the pain is severe; it will often peak somewhere around around Days 5-9 due to the way the membranes heal and can be excruciating.

It’s important to keep them rested and hydrated – even if this means just getting small regular sips of water, lemonade ice-blocks, or melty ice=cream into them; overall, the fluids are more important than food.

Common side effects will include:

  • Swollen tongue
  • Bad breath (like a hyena!)
  • White coating on the tongue
  • White scabs over the tonsils

Your doctor will talk you through potential complications and when to seek immediate medical care – i.e. if bleeding occurs (it can be life threatening); they may be able to resolve with medication or surgery may be required.

They need lots of rest for two weeks to promote healing and will be off school during this time due to the risk of infection.  They will also generally have several weeks off sports, exercise, and swimming.

Keep in mind that removing tonsils may only be one part of a wider treatment plan. If the chronic inflammation was linked to allergies then you will still need to work with a doctor to create an ongoing allergy treatment plan.

How to give your toddler a spa bath in winter!

Spa bath in a flexi bucket

I love flexi buckets! I have two: one big pink one and a small yellow one. They can be used for so many things from hanging out laundry, to clothes hampers, packing stuff to visit relatives, toy storage, and winter spa baths!

Miss 2 loves asking for a bucket bath when the temperatures start dropping. Just sit the bucket in your bath, fill it to a nice warm temperature from the taps, add a gentle-on-the-skin bubble bath, and pop in your toddler.

The Goldilocks principle applies when choosing your flexi bucket: not too big, not too small, but just right. You want your toddler to be able to sit upright comfortably and have water up to their armpits (parental supervision is recommended as per any bath). You’ll find that you use much less water than a normal bath and they’re warmer because more of their body is consistently covered.

The great thing is that this also works in a shower! I’ve also seen friends put multiple buckets in one bath (of assorted sizes) so that siblings can spa together (and without fighting).

You can even do this during summer! Put the empty bucket outside on the lawn (water is heavy) and ferry warm water to it. Presto! An outdoor bath in the sun and a happy excited child!

Tip: These are also great to take to a beach so that you can create a mini pool for younger siblings or wash off sandy feet.

Spa bath fun!

What a nightmare! Getting hospitalised for Mother’s Day at the same time as my toddler!

Hospitalised for gastroenteritis

Hospitalised for gastro

Being a solo mother for a medically fragile child with chronic health issues (including multiple food and airborne allergies) poses a heap of challenges at the best of times. Having us both hospitalised at the same time was incredibly difficult and it frightens me to think what would have happened if my family hadn’t been willing to spend an hour driving in to us and forgoing sleep for about 40 hours.

We actually had quite a pleasant Mother’s Day to begin with. We went to a playgroup for a short time and then went on to a wonderful Solo Mother’s event that was being held.

I’d spent Saturday cleaning like mad (which takes hours because of her dust mite allergies) and then feeling unwell with a nose running like a faucet. I still wasn’t feeling well on Sunday and figured I might have a mild cold.

Things all went downhill at 1am (so, I try to tell myself in an upbeat way that really Mother’s Day had finished) when a loud barking noise coming from my daughter’s room woke me and I found her struggling to breathe. Her story is here.

When the ambulance crew arrived at 1.30am, I was deperately trying to keep my daughter upright (who was determined that she wanted to be alone, prone, and asleep), trying to wake her up to full consciousness, and trying not to throw up.  There’s no time to be sick when your a solo parent with a sick child – I also had a sufficiently high embarassment reflex not to want to hurl in front of the three lovely (male) paramedics; there’s something that’s just easier about vomiting in private.

I spent the ambulance ride sucking on a home-made coconut milk ice-block trying to convince myself not to vomit and looking after Miss 2.

I’m so grateful for all of the lovely staff that helped us at the hospital. A nurse read Miss 2 picture books while I was busy vomiting in the hospital bathroom.  My embarrassment reflex declined as I got sicker; I ended up just drawing the curtain for her room and being grateful for the many vomit buckets the hospital stocks.

My parents spent an hour driving in to us and while Nana stayed with Miss 2, Poppa drove me (in the opposite direction) to collect the car seat and various things from home. This took a long time as the vomiting and diarrhoea kept me in the bathroom a lot and the pain often felt like a thousand glass daggers writhing through my intestines. At times I was crawling through my home on my hands and knees on gritted teeth determined to pack. Poor Poppa! he so wanted to help but couldn’t do more than watch quietly as I assembled everything we needed; it can’t have been easy either having me dry wretch all the way back to the hospital.

We finally got back to the Children’s Hospital and the nurses transferred me to the adult hospital’s Emergency Department. Nana and Poppa stayed with Miss 2 while I got admitted. I was so wracked with constant vomiting that I couldn’t even speak to the doctor unless it was in-between the waves of pain (and more importantly once the anti-emetic had kicked in). They did various tests for infection, a chest x-ray, and were monitoring me in case my appendix burst or my gallbladder (squeezed dry by that point) did anything gnarly. Apparently I was horribly pale, shivering uncontrollably (bless the nurses that brought heated blankets!), and looking pretty crap (aside from the vomiting and hobbling to the adjacent toilet), I went through two IV bags of fluids and a bunch of drugs before I was stabilised enough to sip water. As really awkward timing, Miss 2 got discharged almost 6 hours before me! Thank god Nana + Poppa were with her as I’m not sure what would have happened otherwise – it certainly would have been a far more traumatic experience for both of us!

Overall, they thought I had a severe case of viral gastroenteritis with severe pain from the inflammation + a cold/flu virus, and possibly Miss 2’s croup as well. I was unwell enough that they were considering admitting me into of the other wards but Miss 2 needed me so I got discharged to family care and monitoring instead (as there’s still a risk the appendix could progressively worsen). I’m so grateful that this has happened at a time when my family can help care for us as I can’t walk much without the pain starting and am pretty much living on mum’s Fail-safe Porridge and Rehydration Therapeutic Tonic.

What is croup and how does it effect toddlers?

What does croup look like in toddlers?

What does croup look like in toddlers?

Croup is a viral illness in young children which causes narrowing of the upper airways. Croup is often a mild illness but can quickly become serious, so do not hesitate to get medical help.

The funny thing about croup is that it’s like the vampire of toddler illnesses. During the day it may not have a visible impact beyond your toddler eating little (and lets face it sometimes they do want to live on air and crayons) and sounding hoarse. For Miss 2, it was that she woke up on Mother’s Day having largely lost her voice, was eating little, and had a mild temperature in the afternoon.

Toddlers have softer windpipes than older children so it’s often when they lie down to sleep that the narrowed airways will become more apparent. Their breathing may start to wheeze and become progressively more of a struggle; it can also cause a strange cough (stridor). What does a croup cough sound like in a two year old? It sounds a bit like a lion purring or a seal bark; personally I think stridor sounds most like a lion coughing up a fur ball.  The animal metaphors might sound cute but the cough can be so loud that it’s enough to travel between rooms and wake you up at night; it can also be frightening if it’s the first time you’ve heard it and you have no idea what it means!

For many children, croup will be a mild illness (which can recur) and which can be treated at home. For others, they need to see a doctor or require urgent medical care. In New Zealand there is a registered nurse available 24/7 to provide free health advice on Healthline (0800 611 116); they can help assess your child and advise whether to ring for an ambulance or wait to see a doctor the next morning.

Personally, I think that croup is worse for children that have allergies. In fact, as well as viral croup, there is also a form of spasmodic croup which may be caused by Gastric Reflux Disease (GERDs) or by allergies. I’ve also read blog posts from other allergy families where croup has become a recurrent problem for their toddllers.

For Miss 2, I was woken at 1am by her strange noises (the croup cough) and found her struggling to breathe; she’d also started a mild fever while she was sleeping. She already has enflamed adenoids, turbinates, and tonsils as a result of her airborne allergies (and any undiagnosed food intolerances) so having her airways swell further was frightening.  My gut instinct said she needed immediate help and I rang Heathline to check if I should was right, if I should drive her to the children’s hospital (which would delay things) or ring an ambulance. After listening to her breathe, I was told to ring an ambulance.

She was so sick that she slept most of the night in the Emergency Ward bed; she needed to be kept semi-upright (to help her airways). Her fever worsened, even with parecetamol, and didn’t break until morning. The recommended treatment for croup is oral steroids. This made me nervous as:

  • she’s allergic to topical steroids
  • even temporary steroids can cause massive behavioural changes and tantrums in toddlers.

Her allergy to topical steroids results in awful periorficial dermatitis rather than anaphylaxis and having her airways potentially constrict in life threatening ways – so I opted for the oral steroid.

It definitely helped with her breathing. She still had virtually no voice on Day 2 or 3 (it might take a week to return) and I still had to sit up with her on Night 2 but her breathing was manageable at home and no where near as bad as the night she was hospitalised. Thankfully she also hasn’t had any major tantrums so far; mind you, she’s probably too tired to tantrum yet. She’s eating very little as her throat is so sore and is mainly sticking to formula, sips of water, and the occasional mouthful of soft foods.

NOTE – Thank you to all the readers that have shared their stories with me!

I continue to feel that croup can be a much more serious illness for families with medically fragile children – including food allergies, airborne/environmental allergies, asthma, and reflux. Doctors will most commonly look for croup in babies and very young toddlers but plenty of allergy families have shared that their children have continued to have viral croup up to age 10!

If you’re familiar with what a croup cough sounds like then do advocate on behalf of your child for medical care if it’s needed – you’re the one awake in the wee hours of the night hearing it (and they may not have the cough during the day)!  Don’t hesitate to ring for an ambulance at night if your child is struggling to breathe!

It’s worth investigating what charges there are for your local ambulance service and if they have a subscription service. If you live in New Zealand, it’s around NZD$90 for each medical emergency (non-ACC) call-out of a St John’s ambulance but you can get an annual ambulance subscription for the whole household for NZD$65 per year. I’m so glad that I signed us up for membership after her ambulance trip just before Christmas!

 

What methods can I use for potty training my toddler?

Potty Training

What methods can we use for potty training?

Potty Training! It’s something that we all experience as parents as we help our children transition out of nappies. I’ve posted previously on:

 

Slow

The slow method is great if you’re wanting to stretch toilet training over a number of months.

Maybe it’s winter and you want to wait for warmer weather before fully embracing nuddy time; maybe you have an eldest only child who is showing signs of being ready but isn’t ready to embrace going nappy free; maybe you have a spirited child who responds badly to pressure, or a your family frequently faces change, or your child has health concerns or other stress factors.

I note this is the method I’m using with stubborn and spirited Miss 2!

  1. Regularly embrace talking about bodily functions. Talk about needing to wee or poo. Read stories about potty training.
  2. Storybots have a great video for toddlers about how the human body works, including how food gets turned into energy (and waste products!).
  3. Buy a potty and place it somewhere in the house where it’s easy for your toddler to access.
    • I was resistant at first to having it in the lounge but toddlers really do only think about what’s right in front of them. It’s good to put it next to their picture books, or in front of the tv, or by a window they can look out of. It’s also useful to have a plastic mat under it if you have carpets!
  4. Encourage your child to sit on the potty regularly. It helps if you read them a story to keep them occupied.
    • Try giving them regular naked time. This helps them get accustomed to their body and it also means they don’t have to grapple with clothes when they get to the potty. Watching themselves accidentally wee or poo can also help them form a connection in their mind between how they felt beforehand and what then happened (it’s not like they can see when it’s all conveniently happening in the nappy!).
    • Make a happy fuss about buying them underwear. Keep in mind that although different brands will use the same sizing on their labels, the real size and the way they actually fit will vary hugely. It can also help to buy underwear with decorative bows or buttons at the front so that they can easily see which way to put them on!
  5. See what works for you and your child.
    • If they’re having lots of accidents and you’re getting frustrated cleaning up messes, you may want to have them out of nappies just for a set time each day (i.e.  nappies in the morning and undies in the afternoon).
    • Maybe your child took an interest in potty training for a week or two and then adamantly decided they wanted their nappies back. That’s fine! Keep gently encouraging them to use the potty and offer them the choice each day of whether they want to wear nappies or undies.
    • Have a think about whether you want to use nappies, nappy pants, training pants, undies; or a mix. Some toilet training experts advise against nappy pants and say that they delay things but they are really useful as a parent and if you’re taking the slow approach anyway….
  6. Take time off and try again later.
    • Some toddlers won’t be ready on the first try.  You may need to wait 4-6 weeks and then try again. LOTS of parents find that their eldest will take the longest to potty train and that younger siblings will be much quicker (a big part of that is because they really, really want to be like their big brother or sister!).

Medium

Ideally, this method will allow you to toilet train in the space of 1 – 2 weeks. You do need to plan for it in your schedule but there’s a bit more flexbility in it. Make sure that your child is showing all the signs of readiness and they have good bladder control (1-2 hours).

It’s a good idea to do this during warm weather when your child doesn’t need to wear a lot of clothes. You can even put the potty outside and encourage them to use it while running around the garden naked.

It’s helpful to start this once your child shows clear signs that they are getting ready to do a poo. Some kids might have a ‘poo face’ that they start to make, some kids might have a corner they go and hide in (like in a closet or behind a chair), some might assume a squatting position.

Make sure that you stay at home for the first 3 – 7 days so that your child can relax into the change without the stress of accidents and distractions.

Have a think before you start about whether you want to use rewards as a potty training incentive.

  1. Make sure that you are starting at a settled time when there are no big changes to the family routine (like a new baby, moving house, starting kindy).
  2. Immerse your child in toilet training preparation. Go shopping for a potty and undies. Read potty books. Watch videos about using the potty. Talk about the steps for using the toilet.
    • You can even take photos of them practising each step and print these off. Encourage them to talk about each of the steps they need to take.
  3. Have your child in underwear all the time (except when sleeping). Encourage your child to sit on the potty at regular intervals each day and build these into your routine (i.e. when they wake up, 20 minutes after meals or bottles, before the bath, before bed etc.). Make sure that you stick with these every day so that your child comes to expect the reminder.
  4. Praise them when they’re successful and don’t make a big fuss when there are accidents. There will be accidents at first but these should decrease quickly if they’re ready.

Fast

In theory, this will help your child toilet train in a day or two. It is very reward orientated and won’t suit every child (or parent!)

Make sure that your child is showing all the signs of readiness and they have good bladder control (1-2 hours). Also, make sure that they are confident removing clothing and can easily pull pants up and down.

Decide in advance what rewards you will use.

You will need to be at home for a few days and may want to wait for warm weather so your child doesn’t need to wear lots of clothes.

  1. Make sure that you are starting at a settled time when there are no big changes to the family routine (like a new baby, moving house, starting kindy).
  2. Immerse your child in toilet training preparation. Go shopping for a potty and undies. Read potty books. Watch videos about using the potty. Talk about the steps for using the toilet.
    • You can even take photos of them practising each step and print these off. Encourage them to talk about each of the steps they need to take.
  3. The Day Before: Tell your child that tomorrow will be a special day and that you will be having a toilet training party. Practice the steps of toilet training with a special doll that can pass water. Explain that the aim is to stay clean and dry, and to do all wees/poos in the potty. The night before show them the special treats they will get the next day.
  4. The Big Day: Give them lots of fluids when they wake up and at breakfast. Take off the wet nappy and put on new undies/knickers. Introduce a reward chart and tell them they will get stickers on the chart for keeping their undies/knickers clean and dry by using the potty.
  5. Roleplay with the doll straight after breakfast. Go through the steps of toilet training. Have your child feel inside the doll’s underwear to check if they are clean and dry. Praise the doll and clap. Ask your child if they are clean and dry; check and if dry, praise them and put a sticker on reward chart. Give the doll a drink and then have the doll wee in the potty. Praise the doll and give the doll a treat.
  6. While sitting next to the potty, ask your child if they need to wee or poo. Have your child sit on the potty. You may need to read a story or sing a song to encourage them to stay on. Praise them for practising sitting on the potty. If they do a wee or poo, flush the waste down the toilet, wash hands, and then give them an instant reward.
  7. Set a timer and sit them on the toilet every 30 minutes. Praise them if they have stayed clean and dry, put a sticker on the reward chart. Praise them for sitting on the potty. If they do a wee or poo. give them an instant reward.
  8. Give your child lots of fluids, foods that will make them thirsty, and foods with lots of fibre. Keep practising with the doll. If they accidentally wee or poo in their underwear, don’t make a fuss just quietly clean them up and remind them to do wees/poos in the potty.  Let them associate receiving attention with using the potty.

Highlights for 2016

ALLERGY FRIENDLY COOKING

BAKING & DESSERTS

MEALS

 

PARENTING

PRODUCT REVIEWS

What are adenoids and why do they need removing? (What is an adenoidectomy?)

What are adenoids?

What do swollen adenoids look like?

Miss 2 is now on the waiting list for surgery. She needs her adenoids removed, her turbinates (inside her sinuses) reduced, and her tonsils will continue to be monitored.

What are adenoids?

Adenoids are soft tissue located located behind the sinuses; they are part of the body’s lymphatic system (so are tonsils). When they are working properly, they help to recognise bacteria and viruses entering through the nose and produce white blood cells to fight off infection.

Adenoids are particularly useful during early childhood while the body is still encountering new bacteria and viruses for the first time and building up the immune system. Doctors tend to consider them most useful up to age 7; in adolescence they begin to shrink and by adulthood they can practically disappear.

Why do adenoids needs removing?

Sometimes in childhood the adenoids swell and stay swollen. This can be due to frequent infections, due to a chronically over-active immune system (i.e. in an atopic child there might be ongoing aero-allergens and food allergies), or for reasons unknown.

This swelling is particularly problematic the younger the child is because their airways are so small to begin with! Also, swollen adenoids often aren’t the only problem. Look at the picture above and imagine that there is also swelling in the nasal passage (swollen turbinates) and that there are also swollen tonsils in the throat – that can result in a highly miserable toddler!

What are the possible side effects of swollen adenoids?

  • Obstructive sleep apnea. The swollen adenoids can intermittently block airflow. It sounds like your child is silent and then there’s a big noisy sucking in of air.
    • In Miss 2 it can be so loud that I can hear it through her closed bedroom door and can sound like something’s fallen off a shelf and hit the floor! It’s a crappy and frightening thing as a parent that can result in just sitting with them in the dark either to check that they are breathing or to give them a gentle nudge to help them breathe again.

  • Snoring and heavy mouth breathing.
  • Snotty / blocked nose.
  • Repeated ear infections. The swollen adenoids can block the Eustachian tubes and prevent fluid draining from the ears to the throat.
  • Blocked ears meaning that everything sounds a bit like it’s underwater.
  • Blocked nose meaning a deadened sense of smell. This can also impact their ability to taste foods.
  • Sinus headaches / pressure (in conjunction with blocked nose).
  • Sore throat and/or difficulty swallowing.
  • Fatigue. They might seem like they’re getting enough hours of sleep but in reality the quality of sleep is poor because their body is struggling to get enough oxygen through the night. It’s a bit like starting each day on a half tank of gas.
  • Developmental delays. Sleep is critical for young children. During those early years, they are rapidly growing and learning. They need sleep to focus during the day; to have time for their brain to make connections between all the things they have learned or experienced; and their brain releases a growth hormone while they sleep. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can make it harder for them to stay on track.
  • Behavioural difficulties. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can result in daily misery that they don’t know how to express.

Why didn’t the doctor identify this earlier?

Your normal doctor (a GP) and even a paediatrician can’t see that the adenoids are swollen. You need to be referred to the Ears-Nose-Throat clinic at your local children’s hospital. They will be able to look in their nose and throat during the initial visit and then may request a facial x-ray and/or CT scan for confirmation. They may also monitor the adenoids over a few visits in order to confirm that they are chronically enlarged and not temporarily swollen due to infection; they may also try medications for a few months to see if these help.

It can be a bit like diagnosing the wind – you can’t see the wind but you can see the effects of the wind. You may even have the referral because of something unrelated (like repeated ear infections) and as a result of that find out that the adenoids have been swollen all along.

What does surgery (an adenoidectomy) involve?

Surgery will normally take place at a hospital (probably as an outpatient). The doctor will review medical history in advance and make recommendations about pausing medications. You will normally be advised not to take anti-inflammatory medications within 7 days of surgery. They will also discuss post-operative pain medication.

The day of the surgery will involve a period of fasting; food or water won’t be permitted because they can impact the anesthetic. It’s a good idea to have family support and a game plan of how to distract your child; an older child may understand why they can’t eat but a toddler is likely to just focus on the fact that they are off routine and they are HUNGRY!

During surgery, your child will be under a general anesthetic. The surgeon will enter through the mouth and the adenoids will be removed with an electrical cauterizing unit. You can watch videos of adenoidectomies (like this one); they aren’t pleasant to watch but it can be useful to help you understand what will happen.

What happens after surgery?

Depending on the age of your child, they may keep them in the hospital overnight for monitoring or they may go to a recovery room and then go home the same day.

They may feel quite groggy and tired for the next few days and also have some nausea; vomiting once or twice is normal but contact your doctor if vomiting persists.

A light, cool diet for the next few days is generally recommended (avoid hot liquids).

I’m sure my parents don’t have fond memories of me having my tonsils out when I was 4. I still remember staying overnight in the hospital! Mostly my memories are positive ones due to the fact that I got to spend a week lording it over my baby brother that I got to eat jelly and ice cream. No memory of the pain remains but the joy of those unexpected treats has lasted decades!

They will prescribed antibiotics and some light pain relief. They need lots of rest for 4-5 days to promote healing but the good news is that it is a much faster heal time than for having tonsils removed. They will also generally have 7-10 days off school and 3 weeks off sports, exercise, and swimming.

They will generally have post-surgery check-ups; your doctor will talk you through potential complications and when to seek immediate medical care.

They may have nasal stuffiness for a few months after surgery and may need nasal drops. Snoring may continue for several weeks after surgery (and may temporarily get louder). Their voice may temporarily change for a few weeks to a few months!

Keep in mind that removing the adenoids may only be one part of a wider treatment plan. If the chronic inflammation was linked to allergies then you will still need to work with a doctor to create an ongoing allergy treatment plan.

Looking for more information? I read through a wide number of sites  and this was the one I found most useful.

How can I help prepare my child for potty training?

Potty training

 

You’ve decided that your child is developmentally ready to potty / toilet train and you want to pave the way for starting soon; or, you have a younger sibling who wants to understand what all the fuss is about and be involved (me too!)

Here are some things that you can do to help get them thinking about their body and the potty:

Read books about potty training. Often there are lots of picture books at the library so read a few until you find ones that work for you. Miss 2 is quite fond of Pirate Potty, (the same author also does Princess Potty) and Dinosaur Doo.

Talk to them about their body;  Storybots have a great video for toddlers about how the human body works including how food gets turned into energy (and waste products!). If they have particular ‘tells’ that they are about to do something in their diaper (like squatting, grunting, pulling a face, going to find a quiet place) then call their attention to their body’s signals and the ‘feeling’ that they need to wee or poo. Encourage them to tell you as soon as they have wet or dirtied a nappy so that you can change it straight away.

Get into the habit of talking to them about your own toileting habits; i.e. “I need to stop washing the dishes and go do a wee on the toilet.” It might feel a bit ridiculous at first but no more (hopefully) than pretending to be a monkey, or having your umpteenth imaginary cup of tea, or answering ‘What’ and ‘Why’ over and over and over again. The lesson that your modelling is that your listening to your body, stopping what you are doing, and going to the toilet.

Have an open door policy at home (if you can) and let them come to the toilet with you; let’s face it, most toddlers want to anyway! Talk about needing to go to the toilet and verbalize the steps (like flushing, washing hands etc.).

Get a potty and have it available. For a long time, I had it in the bathroom because I wanted that association of needing to go a particular room to do wee / poo. I’ve learned that it’s far more effective to have it on a plastic mat in the lounge, where she can see it all the time and it’s easy to reach, now that we’re actively potty training.

Ask them each day if they’d like to sit on the potty. Sometimes they might want to just sit on it, fully clothed + a nappy, and roleplay wiping their bum with toilet paper. This is fine! Just keep an eye on the toilet paper because they will happily unwind an entire roll.

Encourage them to roleplay with a doll/teddy. Help them to undress their toy, sit it on the potty, wipe its bottom with a cloth, and praise the toy .

Provide easy access clothes (i.e. no more overalls!). They need to be wearing pants they can pull down easily or a skirt that they can lift. Play games to see who can pull their pants down the fastest when getting changed into pyjamas at the end of the day or encourage them to pull their pants down themselves before each nappy change.

Ask them each day if they’d like a nappy/diaper or undies/knickers. One day they may surprise you and say ‘Undies!’.

Sometimes they will ask for undies before they’re ready to use a potty (because their friends are wearing them). That’s fine! Let them wear underwear over their diapers and get used to the idea. Encourage them to practice putting them on and off themselves. Let them help you choose ones that they like (i.e. they think are pretty / cool / exciting / awesome).

 

When should we start toilet training?

Toilet training.jpg

Potty! Starting toilet training.

Toilet training often varies from country to country; it may be impacted by culture, environment, and personal experiences. In New Zealand, the average age for children to be toilet trained at night is 3-6 years, statistically boys take longer. I’ve met people from other countries where toilet training occurs much earlier; it sounds like various countries in Asia often start quite early and I’ve met people from the United States who’ve commented that it can almost feel competitive there to have your child toilet trained as early as possible.

In general, in New Zealand we tend to be a bit more relaxed about it. Please remember that toilet training can be immensely stressful for your child. Disposable diapers are now so efficient that often they stay feeling dry even after doing wees; there’s a convenience in being able to wee while you eat breakfast, or play in the sandpit, or chase after your friends. Toilet training means having to stop what your doing, go to another room, fiddle with clothes, undertake a series of steps that everyone expects you to remember, and then go back to whatever you were doing. It can be annoying. It can be scary. It can be miserable wetting your clothes. It can simply feel strange feeling an empty space underneath your bum. It’s important that your child is ready and that they feel safe, supported, and encouraged.

When is my child developmentally ready?

Watch for the following signs:

  • They show signs of bladder control.
    • They can go 2 hours without doing a wee.
    • They can stop & start their wee.
  • They wake up dry from a nap.
  • They show an interest in the toilet and others using it.
  • They have enough language skills that you can teach them words that will form part of your toilet training process (i.e. potty / toilet, wee / poos, flush, wash hands, dry hands, help me).
  • Can follow simple instructions.
  • They feel happy and settled; they are not going through any other changes.
  • Note: Toilet training can be impacted by genetic inheritance (surprisingly!). If one or both of the parents took a long time to toilet train (especially at night) then your child is more likely to do the same.
  • Note: My experience (and talking to many other families) is that the eldest child will often take the longest to be ready to toilet train (sometimes not till after they’re at kindy and seeing other kids use the toilet); younger siblings will often want to start earlier (sometimes at 18m) because they want to be like their big brother or sister.

 

Does gender make a difference?

Yes. In New Zealand:

  • Girls will often show readiness between 20 – 26 months.
  • Boys will often show readiness between 24 – 32 months.

 

How I can help my child feel ready to toilet train?

  • Have an open door policy at home (if you can) and let them come to the toilet with you; let’s face it, most toddlers want to anyway! Talk about needing to go to the toilet and verbalize the steps (like flushing, washing hands etc.).
  • Get a potty and have it available. Ask them each day if they’d like to sit on the potty. Ask them if they’d like a nappy/diaper or undies/knickers. Most days they won’t; persevere – it took a year before mine decided that we were actually toilet training rather than just her having a passing interest.
    • Sometimes younger children will want to roleplay – especially while you’re using the toilet. Let them practice sitting on the potty fully clothed and ‘wiping’ themselves with toilet paper.
    • Sometimes they will ask for undies before they’re ready to use a potty (because they’re friends are using them). That’s fine! Let them wear a nappy over their diapers and get used to the idea. Encourage them to practice putting them on and off themselves. Let them help you choose ones that they like (i.e. they think are pretty / cool / exciting / awesome).
  • Some experts will encourage cloth nappies (so that they can feel being damp) or training pants but discourage nappy pants as delaying / confusing things. Personally, I advocate doing what works for you. My daughter is strong willed and does not respond well to change so I’m going for the long & slow approach; it’s far more practical (and cost effective for me) for her to be in nappy-pants if we leave the house, bare bum / underwear at home, and a nappy at nap / night.
  • Read books about potty training. Often there are lots of picture books at the library so read a few until you find ones that work for you.
  • Consider adding incentives. We started actually potty training because Miss 2 decided that she wanted to see the magic doggy appear. She loves looking down and seeing the doggy appear, then saying ‘Bye Bye Doggy’ as it gets emptied & washed. Apparently the WeePal stickers are also a great way of teaching little boys to aim!

    WeePal stickers

    WeePal stickers

 

When should I see a doctor?

  • If your child has ongoing constipation.
    • Sometimes get scared / uncomfortable about doing poos in the potty. They can get so worked up about it that they literally hold it in by sheer force of will. Talk to your doctor (for help with loosening up that blockage) and let your child know it’s okay to do poos in a nappy until they feel ready to let it go in the potty!
  • Your child says it hurts to go to the toilet.
    • Little girls will more commonly get Urinary Tract Infections (UTIs) than boys. Ouch!
  • Frequent little wees.
  • No day training progress by 4 years (to rule out any physical / medical issues).
  • If they are not night trained by 5 or 6 years (again, to rule out any physical/medical issues).

 

For more great tips about toilet training, check out Laura Morley’s workshops, or her FAQs blog on LooLoo Toilet Training Solutions.

 

How a slice of bread gave my daughter an allergy attack

Different circumstances this time to the peanut butter. A few weeks ago I tried the rounds of asking bakeries near our GP’s office on the off-chance that any of them made bread on-site that was soy free. To my delight, there was an artisan bakehouse, specialising in bread, that assured me (after checking) that they had a white Farmhouse Loaf that was absolutely definitely soy free.

It sounds really simple but Miss 2 and I were so overjoyed to be able to eat soft fluffy white bread. It’s a long drive from home so I sliced it up, we ate beautiful bread for a couple of days, and I froze the rest for emergencies while I kept practising making bread myself.

That simple pleasure was enough to earn a calendar entry and feature into menu planning for this week since we had another appointment with the GP. When we ran out of bread two days ago, instead of making bread, I decided to pull the emergency bread out of the freezer as a treat since we’d be able to replace it.

Why was this a problem? Because when I went to the same bakery today and asked the same questions (always, always double check just in case a recipe has changed or a product supplier)… this time I was told that it does contain soy protein and that I must have been informed incorrectly last time.

wp-1486016286127.jpg

What!!

In a painful twist of irony, we’d sat eating that same damn bread (from the freezer) at the playground before going to the doctor’s appointment. I had a sinking feeling when I realized that I couldn’t remember if there were 4 slices or 6 slices in the bag I took out of the freezer. Did we eat it yesterday? I honestly don’t recall because it wasn’t on my threat radar and my focus was entirely on the hospital appointment. It does explain an earlier allergy attack recorded in my daily notes that I thought couldn’t be from soy because we’d absolutely definitely had no exposure that week (turns out that was wrong…).

It was hard not to be angry and frustrated when I’d been really specific with my questioning and explaining that it was a food allergy. I’m angry that staff got ingredients wrong when it’s being made on site. I’m angry that the store has made my daughter suffer, not once but twice. Her allergy rash started to present before we even got home and was worse by bed time; her eczema had also started to throw up red warning flags. She was too unsettled to go down for her day nap. The afternoon and evening required topical treatment cream, intensive moisturising cream, and oral medication. It’s not enough to prevent the attack but hopefully it helps take the edge off a little.

In reality, there’s always too much to do as a solo parent to spend more than a few minutes dwelling on the unfairness of another approaching storm. I’m grateful that I was cautious and asked again (so we didn’t end up with a second loaf). I’m grateful that food allergies and eczema aren’t contagious (unlike the 14 days of viral diarrhoea that she was too immuno-compromised to fight off and that had us completely quarantined from close contact leading up to Christmas). I’m grateful that we were able to have a friend over to play this afternoon bringing smiles to her face. I’m grateful that she fell asleep in my arms tonight feeling safe and loved and comforted.