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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,Ìýobstructive 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)

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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