Paediatric ENT: what is different in children
- Topic
Children's ears, nose, throat and airway are smaller and shaped differently, so the same illness can behave differently than in adults.
What it is
Most ENT visits in childhood are for ear infections, sore throat, noisy breathing, snoring and neck lumps. Children differ from adults in anatomy (a short, more level auditory tube, large adenoids and tonsils, a narrow subglottis), in what is common at each age, and in what is at stake: hearing in the first years shapes language. This page gives the overview and points to the specific pages.
Common problems by age
| Age | Common ENT problems | Key concern |
|---|---|---|
| Newborn and infant | Congenital hearing loss, laryngomalacia (noisy breathing), congenital neck masses | Screening hearing; airway |
| 6 months to 3 years | Acute otitis media, croup, foreign bodies | Pain, airway, language |
| 2 to 8 years | Adenotonsillar hypertrophy, snoring and sleep apnoea, otitis media with effusion | Sleep, behaviour, hearing |
| School age and adolescents | Recurrent tonsillitis, neck lymph nodes, noise exposure | When to operate; lymphoma in adolescents |
In clinical practice
- Children with otitis media with effusion often have no pain; the clue may be poor attention, speech delay or turning up the volume.
- Snoring with pauses, mouth breathing, bedwetting, behaviour or attention problems can be sleep apnoea.
- Foreign bodies in the nose and airway are frequent in young children; a one-sided foul nasal discharge in a toddler suggests one.
Next step / Initial management
- Use age-appropriate exam: otoscopy with the child held securely, look at tonsils, palpate the neck and listen to breathing at rest.
- Check the hearing screening result and language milestones at every well-child visit.
- Refer the same day to the emergency service a child with stridor at rest, drooling or difficulty breathing; do not examine the throat with a spatula if epiglottitis is suspected.
- Refer on a routine basis to paediatric otolaryngology for suspected hearing loss, persistent effusion with hearing difficulty, sleep apnoea or recurrent tonsillitis meeting surgical criteria; see the specific pages.
Test yourself
Think of the answer, then tap the question to see it.
Why do young children get more middle ear infections than adults?
Their auditory tube is smaller and more level, so the middle ear drains poorly; their immunity is still developing and the adenoids can harbour bacteria.
At what age do adenoids usually reach their largest size?
Around 6–7 years; they then regress by adolescence.
What is the most common cause of obstructive sleep apnoea in children?
Enlarged tonsils and adenoids; obesity is another common cause.
Connections
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Ear Infections in Children (National Institute on Deafness and Other Communication Disorders (NIDCD), 2022); Adenoid Hypertrophy (StatPearls (NCBI Bookshelf), 2023); Stridor in Children (StatPearls (NCBI Bookshelf), 2023); Subglottic Stenosis (StatPearls (NCBI Bookshelf), 2023); Lymphadenopathy (StatPearls (NCBI Bookshelf), 2026); Sleep Apnea in Children (National Heart, Lung, and Blood Institute (NIH), 2025).
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Representative model, for educational purposes only.