Brought to you by Spotsylvania Regional Medical Center
You can depend on Spotsylvania Regional Medical Center to provide expert compassionate care close to home when your child is sick or needs surgery. Many of our nurses, doctors and staff are also parents here in the Fredericksburg community, and we know how important it is to have the right care for your child. We have specially trained staff who know how to treat little ones as they recover from surgery, and the HCA Healthcare network includes a growing list of pediatricians here in Fredericksburg. The first experience many parents will have with their child needing surgery will be the insertion of ear tubes or the removal of the tonsils and adenoids. That’s why we want to share the expertise of Dr. Stephen Bakos, chief of surgery at Spotsylvania Regional Medical Center and a practicing otolaryngologist here in Fredericksburg, about common questions parents have about ear, nose and throat issues in children.
Q: If my child has recurring ear infections, does he or she need tubes?
Dr. Bakos: Ear infections and ear pain are probably the most common reason parents bring their children to see me in the winter. We will evaluate the child and his or her specific circumstances, but generally, any child with six or more ear infections within one year, five or more per year over a 2-year period, or three or more per year over a three-year span is a candidate for tubes. There are also special cases, such as a child who gets extremely sick with ear infections, or children who don’t respond to antibiotics, that will lead us to recommend tubes.
Q: What should parents know about the procedure to insert ear tubes and how to properly care for them?
Dr. Bakos: The biggest anxiety many parents have is that this is the first time their child has undergone surgery. This procedure is done in the OR, but I always emphasize to parents that this is under masked anesthesia—there is no tube in their throat, no IV. They are under light sedation. The procedure takes 5 to 15 minutes, and after the child wakes up from surgery, they can be back to normal activity by the next day.
For protecting the tubes once they are in, there are varying opinions about this in the ENT field, but there is really no great literature to support the idea that a child with tubes can’t get his or her ears wet. I tell parents to live life like there are no tubes. They can go swimming with no protection and enjoy all normal activities.
Q: How long do ear tubes need to stay in and do they need to be removed?
Most tubes will fall out on their own within about a year. And most families find out that the tubes have fallen out when they visit their pediatrician or ENT specialist. It’s not something you necessarily notice. For a child’s first set of tubes, they usually stay in for about a year. Now, some may fall out within a couple weeks of surgery, and that can be OK. It may be that all the child needed was for me to go in and suck out the fluid that was in the ear. Of children who get tubes, 85 percent need only one set, 10 percent need two and only 5 percent need three or more.
Q: So, do ear tubes prevent ear infections?
Dr. Bakos: Tubes do not prevent ear infections. But they allow the infection to resolve and be treated much more easily. Ear tubes allow fluid to drain that would have otherwise built up behind the eardrum. Normally, this fluid would drain through the eustachian tubes, which connect the ear to the back of the nose and throat. But because those tubes are more horizontal in children and don’t become more vertical until we get older, proper drainage can be a problem for some children, and that’s why we insert ear tubes. If an infection does develop once the tubes are in, the child won’t have symptoms that are as severe because that fluid can now drain.
It should also be noted that if a child with tubes has an ear infection, he or she should be treated with ear drops instead of oral antibiotics. This is a much more targeted treatment because the tubes give us a mechanism for the antibiotics to work right at the site of the infection.
Q: What is sleep apnea and what are some signs of it in children?
Dr. Bakos: This is a sleep disorder where breathing repeatedly stops and starts. There are many ways this presents in children. Loud snoring is often a sign of it. Some parents will say it sounds like their kids are sawing logs. Restless sleeping and bedwetting, even in older children, can also be signs. A big sign is if a child is pausing in their breathing at night. I always ask parents if they hear their child stop breathing and gasp during sleep. A very serious sign is if a child’s lips turn pale or blue when they sleep and are not breathing consistently.
Behavior during waking hours can also provide signs of sleep apnea. When children have sleep that is not restful, they may be overactive or hyperactive during the day. Recent literature is suggesting that some children who have been diagnosed with ADD or ADHD may have had undiagnosed sleep apnea as children.
We talk through these symptoms with parents to determine a sleep apnea diagnosis. If the history is not clear, we may recommend a sleep study where children are monitored during the night in a special facility.
Q: What does treatment for sleep apnea look like?
Dr. Bakos: Right now, sleep apnea is the number one indication we see for removing the tonsils and adenoids. We are much more conservative these days about doing a tonsillectomy for a sore throat, but this procedure opens up the airways to improve breathing for children with sleep apnea.
Removing the tonsils and adenoids is still an outpatient procedure, but patients do go under general anesthesia. Recovery for children is about a week or so. I tell parents to keep the child out of school for the week of surgery. For sleep apnea, we perform this procedure from age 2 on up to adulthood. For children, the most common age group is between 3 1/2 to 6.
Parents can call our Consult-A-Nurse line, a free 24/7 referral and health information service, at 1-888-685-1610, or visit spotsrmc.com for more information about our facilities and services. Stay tuned to the Fredericksburg Parent and Family Facebook page in December 2019 for a video interview with Dr. Bakos.