The tragic events in Oakland over recent weeks have highlighted the risks of surgery for children. Thirteen year old Jahi McMath underwent routine surgery to remove her tonsils that obstructed her airways at night. She suffered heavy bleeding and cardiac arrest on December 12, three days after complex tonsillectomy surgery.
These events have ignited a debate over the prolonging of Jahi’s life even though she has severe brain damage. We won’t discuss these issues or the reasons why Jahi’s family elected to have the surgery. But we will discuss the diagnosis of sleep apnea in children, the surgery commonly used to treat sleep apnea in children and some of the potential complications and risks. Please speak with your child’s doctor if you have concerns about your child.
What causes snoring and sleep apnea in children?
- More common causes:
- Enlarged tonsils or adenoids
- Dental conditions, such as a large overbite
- Less common causes:
- Tumor or growth in the airway
- Birth defect, such as Down Syndrome that causes enlargement of the tongue and jaw
- Obesity
Why is surgery performed for children with sleep apnea?
- Surgery can be performed for children when sleep apnea is caused by enlarged tonsils or adenoids
- More than 530,000 children under the age of 15 have their tonsils removed each year. About 80 percent have obstructive sleep problems – snoring, irregular breathing – and the rest are because of infection, according to The American Academy of Otolaryngology-Head and Neck Surgery.
- Surgery can be a permanent solutions because tonsils don’t grow back.
- A recent NIH study showed that surgery can improve some behaviors in children with sleep apnea, but surgery should not be the automatic first choice
- PAP (positive airway pressure) can also be used for children with sleep apnea instead of surgery or after surgery, if surgery doesn’t work.
- Children can out grow enlarged tonsils, in some cases, with no treatment.
What are the risks of surgery for sleep apnea?
- Any surgical procedure has risks due to anesthesia or infection.
- There is a risk of bleeding in the first few days after the operation, but this is very rare.
- There are two times during which post-operative bleeding is most likely to occur: within the first 24 hours after surgery and six to 10 days after surgery when the scabs come off. It is estimated that 0.2% to 2.2% of patients hemorrhage within 24 hours after surgery, and 0.1% to 3.7% of patients experience post-operative bleeding six to 10 days after surgery. (from ent.about.com)
- Pain during recovery is the most common side effect.
If you suspect that your child has difficulty breathing at night, talk to her doctor.
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