Troubling Trifecta

Schools and daycares can be great opportunities for children to learn, grow and make friends. They’re also a playground for germs and illnesses that multiply and spread.

“Kids are exposed to hundreds of viruses and bacteria at school and daycare every day,” said Justin Fuller, MD with Riley Physicians. “There is no real way to completely prevent these kinds of problems other than emphasizing good hand hygiene.”

Three areas where children tend to have problems are in their ears, nose and throat. Older kids can usually tell their parent or guardian when they feel sick, but it can be harder to tell something is wrong when the child is too young to communicate or when they’re non-verbal.

“I tell people, they’re pretty good at knowing how their kid normally acts,” said Paul Johnson, MD with IU Health Southern Indiana Physicians Ear, Nose and Throat (ENT). “Some kids just act like they don’t feel good, and that’s the first symptom.”


Chronic ear problems are the vast majority of children’s issues seen by the ENT team. Some signs to look for include: children pulling at their ears, severe fussiness, fevers and kids who’ve been walking well who suddenly start falling more frequently.

“Children are more likely to develop ear infections in comparison to adults, based on their anatomy,” said Fuller.

“The Eustachian tubes, which equalize pressure between the middle ear and mouth/nose cavity, are more likely to become obstructed and lead to ear infections in kids than in adults.”

Ear infections or middle ear fluid that does not resolve over several months will occasionally require ear tube placement by an ENT specialist.

“Tubes help ventilate the middle ear and prevent fluid accumulation, which can prevent the necessity of antibiotics and missed days of school or work,” said Fuller. “This can also help hearing and speech development for kids who have chronic fluid in the middle ear from recurrent ear infections.”


Nose issues in kids have very simple symptoms.

“They walk around with their mouth open, they snore and have runny, drippy noses,” said Johnson. “It sounds simplistic but that’s the case. There’s not any subtlety usually when the nose is the issue.”

He said the most common nose issue in children he sees as an ENT is big adenoids that plug up the nose. Adenoids are the same type of tissue as tonsils, but they’re located behind the nasal cavity. When they are very large, they can obstruct the flow of air going through the nose and can cause breathing problems.

Allergies are another common nose problem for kids. They typically perk up in the spring and fall when pollen from different plants is in the air. One tip to reduce allergy symptoms is to monitor pollen counts and stay indoors during the times of day when the pollen levels are at the highest.


Swollen tonsils are a common indicator for illness. They’re part of the immune system, and when it revs itself up to make more white blood cells to fight the illness, it causes the tissue in the tonsils to swell.

One throat-related illness many parents deal with is strep throat. Strep throat can be accompanied by symptoms including fever, sore throat, headache and stomach ache.

“Sometimes younger children will have fever and complain of a stomach ache or headache without mentioning a sore throat, or they may just refuse to eat or drink,” said Fuller. “Strep is easy to treat, and susceptible to just about any antibiotic but can lead to missed school and work days for parents.”

Another issue may be that the child’s tonsils are large all of the time and not just when they’re sick. That can cause breathing troubles including sleep apnea.

“The most common reason I take tonsils and adenoids out in kids is for sleep apnea, not chronic tonsillitis,” said Johnson. “If you have a little kid who snores all night long, is a restless sleeper, is hyper during the day, has trouble concentrating and may wet the bed, he or she may need to see the doctor.” All of these are signs and symptoms associated with obstructive sleep apnea from big tonsils and adenoids.”

While a pediatrician can typically handle treatment for these areas, children may be referred to an ENT for reoccurring issues.

“In the case of tonsils and adenoids: I’m just a glorified plumber and they’re plugging up the works,” said Johnson. “But just because you show up in our office doesn’t mean we’re going to be signing your kid up for a tonsillectomy or ear tubes.”

Non-surgical treatments and management are used by both pediatricians and ENTs for ear, nose and throat issues. Johnson explained that it doesn’t always seem like that’s what’s happening because by the time a child gets referred to him they may need surgery.

“It’s no fun to have your tonsils and adenoids out,” said Johnson. “Some people don’t want to do it because they’re scared, but it fixes the problem and may ultimately be the way to go.”

Featured Riley Physicians provider seeing patients for pediatrics:

Justin Fuller, MD


Featured IU Health Southern Indiana Physicians provider seeing patients for ear, nose and throat issues:
Paul Johnson, MD