This pre-referral guideline covers obstructive adenotonsillar hyperplasia in children from 1-16 years of age.

Initial work-up

Symptoms include:

• Sx – snoring +/- apnoea
• History - parental observations and description of sleep patterns
• Snoring alone - this does not require surgical management
• Sleep disturbance characterised by laboured respiration, restlessness and waking at night with daytime somnolence or chronic mouth breathing by day
• Observed episodes of
• Complications i.e. failure to thrive

Pre-referral treatment

• Observation by parents while child asleep and snoring – for laboured breathing, restlessness and apnoea
• Quality of life survey, obstructive adenotonsillar hyperplasia
  

When to refer

Child presents with:

• Sleep disturbance => 3 months
• Snoring
• Sleep apnoea >5–10 seconds
• Mouth breathing all the time
• Tonsils meeting in the midline +/- trouble swallowing from large tonsils

Referral form (pdf)

Parent handout (pdf)

Resources

Kids Connect (RCH Primary Care Liaison)

Kids Health Info (Parent fact sheets online)

Contact information

References

Paediatric Handbook Ear, Nose and Throat Conditions, Chapter 21 (pp312-324); Robert Berkowitz and Michael Marks; Seventh Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia