Importance of the nasal breathing in children

Babies are nasal breathers and do not know how to breath through the mouth when they are born.
At birth, human babies are obligate nasal breathers.

Breathing through the nose enables adequate facial growth and proper positioning of the teeth. It also leads to calm and restoring sleep.

Noisy breathing or snoring is not normal in children. The commonest cause of nose block is allergic rhinitis. A child with blocked nose leads may have bad breath and suffer with sinusitis more frequently. Also these children are less interested in eating as they cannot smell food and hence enjoy it.
Another common cause of mouth breathing in children is Adenoid hypertrophy or Adenoid enlargement. These are lymphoid tissues like tonsils in the space at the back of the nose. The size of adenoids is usually confirmed with a nasoendoscopy.

Breathing through the mouth can cause the following

• Unexpressive face; 
• Changes in positioning of the teeth; 
• Dental caries; 
• Aesthetic facial alterations (elongated face, hypotonic lips);
• Gritting or grinding of teeth (bruxism); 
• Sleep disorders (superficial or restless sleep); 
• Attention deficit or learning disorder; 
• Mood swings.

Read more on allergies,sinusitis and adenoids in the following links:

http://sheelusrinivas-entpractice.blogspot.in/2013/01/allergen-avoidance-is-it-worthwhile.html

http://sheelusrinivas-entpractice.blogspot.in/2017/01/sinusitis-in-children.html

http://sheelusrinivas-entpractice.blogspot.in/2015/05/removal-of-adenoids-and-tonsilswhich.html

When to consult an ENT Doctor for my child?

"Your child's Pediatrician is the primary care provider and incharge of your child's health."

Parents should consult a Pediatric ENT only if the child's Pediatrician has suggested them to do so.

Pediatric otolaryngologists are concerned with treatment of medical and surgical ENT disorders in children. They have been trained to take care of children from newborn period to teenage years.

Children are not just small adults.The disease presentations and management can differ from adults.Right from the clinical approach for diagnosis differs in children.It needs specialised training and experience in working with children to keep them comfortable while examining them.

A child will not always be cooperative and will not be able to answer medical questions or express their problems. Sometimes they have their own ways of expressing concerns. I cannot forget a 3 year old telling me her ears are "singing" and we did go ahead and found a cause.

If we learn to interact with kids, they are also capable of giving information.They may not answer direct questions or get overwhelmed with questioning.

Interaction with the child is a must for a pediatric otolaryngologists as child is the one who needs attention.This is especially useful in diagnosing social and communication disabilities.Many times parents are in denial or do not know age appropriate behaviours,in these situations direct interaction with the child is a must.

All of the above requires experience,skill and judgement with the team including the primary treating pediatrician.

Finally be a child with the child....and the doctor for the family.

Preschool Health Screening: Is it necessary and what does it involve?

Schools have started and I have started getting visits of little ones whose parents are advised to see ENT doctor following the childs health screenings in school.

 Preschooler

There are a few points about school/pre school health screenings,I would like to discuss here.

Before we start, lets talk about "Neural Plasticity" and 'Critical Period" 

During early period of life, neurons in brains are moldable (plastic) and it is easy to teach any skill to a child. Once the child is above 5 years,it is difficult to do rehabilitaton and bring them age appropriate. Hence we say that the critical period is the early infant or toddler years.

Let me take you through some common questions asked by parents:

1. Preschool screening: Is it mandatory? Should it be made mandatory by law?
My toddler has been visiting pediatrician regularly,why another screening?

The pediatrician is definitely your child's primary physician.When you visit a pediatrician in well baby clinics/immunization clinic, usually they record the growth and development of the child.
However, there are other aspects of development like speech,language,cognition,social and emotional behaviour.
In many parts of the world,it is mandatory by law.

2. Parent permission is compulsory for any screening.

3. Child's birth records and health records should be available during screenings.This is for the screening practioner to understand the child's growth (age appropriate) or to make provisions for any insults at birth and need extra time required to achieve age appropriate milestones.

4. Who should do it?
A health practitioner or a registered nurse trained in screening.

5. What does it involve?
Apart from physical examination and interacting with the child, they may also plan some activities (like blocks/scribbling etc age appropriate)

6. What are the components in a standard screening?

Eye contact, motor control and body language in a typical kindergardener

Any screening should involve hearing and vision tests.Apart from this: motor development,language development (mother tongue or a language which is spoken at home around the baby),social emotional development and cognition is informally checked.

7. Will they "label" or diagnose my child?
No! its only a screening.If there is any concern, child will be sent to appropriate specialists for confirmatory diagnosis or sometimes only a re screening is advised.

8. Should I be rest assured if my child passes screening for any future health or disability issues?
No.If at any time parents have concerns about the child's growth or development, tey should bring it to the notice of pediatrician who can advise you further.

9. Finally and most important, screening should be done as early as possible,We have better chance of correction and treatment early, best being a child below 3 years of age.
This will give us enough time for intervention and make the child school ready.

10. My child is shy and will not allow screening?
The health practitioners are trained to handle kids and very well trained that each child is different.

Geriatric ENT: ENT Care for the Elderly

The patient population of people more than 65 years old in the population are an integral part of ENT Outpatients.
Like pediatric,Geriatric patients also need a targeted approach to their diseases because they have special issues unique to their population.

The commonest problems I get refereed in the elderly is dizziness and hearing loss. I must mention here that chronic ear infections commonly called as CSOM is the third common diagnosis.
When I used to work in a tertiary care cardiac center, the common presentation was nose bleed due to blood thinners.
Apart from above common presentations,we are very careful in the elderly who present with any swellings or change invoice or breathing and swallowing problems to rule out Head and Neck masses.If the symptoms are of more than 4-6 weeks or any suspicion, a transnasal flexible laryngoscopy is immediately performed in outpatients.

I love interacting with the senior citizens.Its not all about me advicing them, I also get to learn lessons from their wisdom. 

Team for Early Intervention of 0-6 years children with communication disorders

This is not really a blog post with medical information but its a platform I am using to request readers to connect me with like minded professionals.

I am Dr Sheelu Srinivas with following qualifications 

and practising in Bangalore for a decade now.

M.S. ENT (G.S.M.C.and K.E.M.Hospital, Mumbai),MBBS (T.N.M.C.& BYL Nair Hospital, Mumbai)

Specialist Registrar and Associate Specialist U.K. 2001-2006 May

Consultant ENT Surgeon and Department Coordinator Fortis B.G.Rd June 2006-Mar 2015

Honorary Consultant  at Indira Gandhi Institute of Child Health and Spastics Society of Karnataka

•Specialised Training in Pediatric ENT including airway reconstruction and Cochlear implants at CHUV Lausanne, Switzerland (Prof Monnier) and Hacettappe University Ankara Turkey (Prof Seneroglu: Pioneer in operating Anomalous Cochlea)

•Pediatric Disability Training: Deafness and communication disorders including Autism

Balavidyalaya Chennai ,DHVANI Methodolody for Deaf children ,Training the trainer course

Com DEALL, Bangalore: Certificate course in communication disorders in children with disabilities

AVT Courses by Advanced Bionics, Medel and Cochlear Companies

I want to start an Early intervention Center for children with Speech and communication delays.This includes kids from birth to 6 years who may have various childhood concerns like hearing loss,Autism spectrum disorder and so on.

I am looking for investors and also building a team.This team needs passionate psychologists,special educators,occupations therapists and audiologists and speech language therapist.

Iam sure there are many dedicated individuals doing this kind of work and would like to connect with them.Kindly message us on sheelusent@gmail.com 

Tongue tie

Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby's tongue to the floor of their mouth is shorter than usual.

Some babies who have tongue-tie don't seem to be bothered by it.

In others, it can restrict the tongue's movement, making it harder to breastfeed.

Other potential problems could be difficulty in sticking tongue out and sticking it side to side.

Treatment of choice depends on the infant's ability to feed. 

Division with scissors in outpatients is the optimum treatment up until the age of 12 weeks after which, without general anaesthetic, it is not feasible

There is anxiety among parents that child will not learn speech and language due to tongue:this is not true. Learning speech and language is a higher skill.

Drooling in Children | ENT E-Learning Hub

Drooling in Children | ENT E-Learning Hub