My son is 20 months old and has a terrible snoring problem with what I believe are brief periods of sleep apnea. He can't talk but does try, though no understandable words are formed. We are currently working with a speech pathologist, who suggested that his adenoids are the problem. Is this possible? If so, what are our options? Is surgery warranted at this young age? Will it cure the snoring? He wakes four to seven times a night and only gets between five and seven hours of sleep.

Theresa

Your son REALLY needs to be evaluated by an ear, nose and throat doctor (ENT). Your description is very suspicious for obstructive sleep apnea, but there is no substitute for a thorough history and physical examination. An ENT could help you to determine whether the adenoids (and/or tonsils) are truly obstructive.

Is it possible that your son's adenoids are large enough to obstruct his breathing at night? Absolutely. The adenoids are located immediately behind the nasal cavity. Adenoids are lymphoid tissue, the same sort of tissue that makes up the tonsils and the "glands" in the neck that get large whenever your son gets a cold. Lymphoid tissue has the ability to grow to enormous size. Adenoids can easily grow to a size where they obstruct the airway.

There are only two reasonable options. You can wait it out, hoping that he will outgrow the problem, or you can have an ENT remove his adenoids. There are, unfortunately, no medications to "shrink" the adenoids. (Specifically, there is no proof that corticosteroids, or any other drug, can permanently shrink the adenoids.)

Your son's youth is certainly worrisome. If possible, I prefer to wait until a child is about four years old or weighs 40 pounds before undertaking surgery. However, some toddlers have such severe obstructive sleep apnea that surgery is, unfortunately, necessary. How can you know whether your son's obstruction is "bad enough" to warrant this operation? Sometimes the decision is obvious; in some young patients, the obstruction is so severe that the parents know real fear whenever they watch their child sleep. If it is not this obvious, you could try videotaping or audiotaping your child and playing the tape to his pediatrician. What may seem doubtful to you may be very clear-cut to his pediatrician. If all else fails, the pediatrician can order a sleep study to evaluate your son. Although expensive, a sleep study will give your son's doctor more than enough information to decide whether waiting is a realistic option.

Will surgery cure his snoring? I need to make a few assumptions to answer this question. Assuming that his snoring is related to large adenoids, and assuming that the adenoids are adequately removed by the surgeon, then the answer is "Yes." At the very least, his snoring will be much quieter. If his tonsils are very large, they will also need to be removed. Otherwise, his airway obstruction (and snoring) will continue.