Management in early childhood (1–12 years)

Management in early childhood (1–12 years)

In early childhood management should be aimed at dealing with functional problems – airway obstruction, speech and feeding issues – but there is an increasing imperative for surgery to address the appearance of the child. There is no doubt that visible di ff erences can a ff ect a child’s development, both socially and emotionally; however, there is a significant role for psychological and emotional support for the whole family and in some cases for the school community to help the child, family and school understand and deal with the additional pressures that visible di ff erence makes. Surgery can make a significant di ff erence for some patients, but for many surgery should be delayed as long as possible for an optimal outcome in the long term. In the older child airway issues can become a problem and their identification is more di ffi cult. The usual presentation is of sleep apnoea, which often has an insidious onset; the his tory should be actively sought as parents may be accustomed to noisy snoring and daytime tiredness in the child and may not consider it abnormal. Initial investigation is with a home overnight oxygen saturation monitor, w hich, if abnormal, should trigger a comprehensive sleep study . The management of obstructive sleep apnoea includes the use of tonsillectomy/ adenoidectomy , midface advancement and mandibular dis traction as well as a variety of ventilator support devices.