MY DAUGHTER, who is nearly six, has suffered with tonsillitis for about two years. She sees our GP every couple of months
with a high temperature, swollen glands, earache and a sore throat. The doctor at our local ENT department has advised surgery to remove her tonsils, and said that she may also need grommets because her hearing has been affected.
I have read everything I can on the subject and most doctors seem to say that surgery is unnecessary in most cases. Should I get a second opinion? Could I ask for a “sleep study” — the doctor seemed to put a lot of emphasis on my daughter’s sleep pattern?
Stuart Conroy, Chelmsford
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The decision to put your child through an operation is never easy, and you are right to get as much information as possible before making up your mind. You are entitled to request a second opinion, so ask your GP. If you wish to see another specialist within the NHS, your GP will know the best in your area and could make the referral. If you would like to be seen privately, your GP will, again, be able to recommend someone and write a referral letter.
It is true that surgery is often unnecessary for children with sore throats because they often grow out of the problem with time. Your daughter, however, seems to be badly affected. Most specialists would agree that a tonsillectomy is reasonable for a child getting tonsillitis with pain, swollen glands and fever every two months for two years. Surgery would be effective in preventing further infections and limiting your daughter’s time off school.
It is possible that she may eventually grow out of the problem, but meanwhile she is suffering a lot.
Sleep disturbance is another reason that surgery would be reasonable; large tonsils and adenoids can partly block a child’s throat, so that breathing becomes obstructed and difficult when the throat muscles relax at night. Measuring the amount of oxygen in the blood with a simple finger-monitor overnight may show that the oxygen levels drop because of obstructed breathing.
However, some children repeatedly wake up a little when their breathing becomes blocked, before the oxygen levels drop. This will give a “normal” reading for simple oxygen monitoring (despite the fact that the child has disturbed sleep, which can lead to daytime behavioural problems). More detailed overnight monitoring can pick up this kind of problem, but it is available in few places in the UK.
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Surgery to remove the tonsils and adenoids will almost always cure the problem, and a case history suggesting sleep disturbance is usually enough evidence to inform the decision for surgery.
Six weeks ago my two-year-old son died as a result of “adenovirus”. He died overnight, and my GP says that this virus causes 25 per cent of all deaths of children under five. Before my son’s death we had never heard of adenovirus. Can you tell me about it?
Name and address supplied
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I am very sorry to hear about your son. Adenovirus is a common virus and we know that there are at least 51 forms. Most children will acquire the infection at some point during the first five years of life and symptoms are usually mild. These might include a cold or sore throat. But some forms of the virus can be more serious. There are two types that can cause diarrhoea and vomiting in young children. This can result in severe symptoms lasting up to a week.
Adenoviruses are also a major cause of conjunctivitis, which is recognised by bloodshot eyes. In severe cases a child may develop croup, bronchitis or bronchopneumonia.
However, it is unusual for a child to die, and I am surprised that your GP attributed such a large proportion of child deaths to the virus. Deaths are rare and usually occur only in children with a compromised immune system. For example, children who are receiving chemotherapy would be at risk. In them, the virus could lead to serious liver problems.
The infection is transmitted from person to person, mainly via the faecal-oral route. There is no standard treatment, although work is being carried out into whether medication could be effective in treating adenovirus in immune-compromised children. The best way for children to avoid getting it is simply to be scrupulous about hand-washing.
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My granddaughter, 6, has Molluscum contagiosum, an unpleasant condition. We are told that the infection will eventually go away, but can we alleviate it? Her elder sister shows no signs, — but how contagious is it? Should we keep her away from her cousins?
Name and address supplied
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This is a mild skin infection that is most common among five to ten-year-olds and can be difficult to get rid of. I expect your granddaughter has a number of lesions. Usually they number between two and 20 but sometimes up to 100. The lesions can be flesh-coloured, white, pearly or yellow and are most often confined to the face, body and extremities.
They can look unsightly and may feel tender, but don’t usually cause any other problems. The infection is spread by close contact and through shared clothing and towels. As well as using only her own clothes and towels, your granddaughter should be discouraged from close contact such as kissing — but there is no reason why she shouldn’t play with her sister and cousins.
Unfortunately there is no easy way of getting rid of the lesions other than letting nature take its course; they should disappear within six months to two years. However, about one child in ten will have an associated eczema-type reaction in the area of the lesions, which may respond to treatment.
Jane Collins is chief executive and honorary consultant paediatrician at Great Ormond Street Hospital
How to contact Dr Collins
Dr Jane Collins answers questions on your children’s health every Tuesday. E-mail DrJane@thetimes.co.uk or write to her at: Features Department, The Times, 1 Pennington Street, London, E98 1TT. Please include your name, address and telephone number. Dr Collins is unable to enter into correspondence.