One of the most common reasons kids visit the pediatrician is for problems related to their ear, nose, or throat. The occasional ear infection, sore throat, or runny nose is an expected a part of growing up. But if your child is having recurrent problems—or they affect their ability to hear, speak, swallow, and breathe—they should see a specialist.

“Children are not just small adults, as the adage goes — there are many conditions and considerations we encounter that are unique to their age, size and development,” says Ryan Kearney, MD, a pediatric physician at Summit Health. “Pediatricians are trained to appropriately recognize and address these differences and diagnoses that often do not occur in typical adult patients.”

Ryan Kearney treats children of all ages from infancy to adolescence. Some of the most common ear, nose, and throat (ENT) problems he sees are acute and chronic ear infections, nasal and sinus congestion, adenoid and tonsil inflammation, airway and breathing obstructions, nosebleeds, and even tongue ties. Many of these conditions can be corrected with appropriate counseling and education, particularly around allergen avoidance strategies, medications and even surgical procedures.

“Ear, nose, and throat issues can have tangible negative impacts on a child’s immediate quality of life but also on their future development. These can include impacts on breathing, communication and even sleeping,” he explains. “My goals are to help patients and families by proactively identifying problems and initiating the appropriate evaluation and treatment plans.”

The first five years of childhood is a critical time for learning and development. It is important to recognize any potential problems and intervene right away before valuable time is lost. Here are eight red flags that mean it is time to check in with a specialist.


  1. Your child has chronic ear infections.

The condition is extremely prevalent in children under five because the eustachian tube—the small passageway in the ear canal that connects the throat to the middle ear—is quite narrow and has not fully formed yet. As a result, fluid does not drain out of the ear very well.

Dr. Kearney recommends referral and evaluation by an ENT surgeon to discuss ear tube surgery for many patients with chronic ear infections. During this procedure, a hollow cylinder is placed into the eardrum that prevents fluid from building up in the middle ear. This reduces the number of inner ear infections, as well as the need for antibiotics.

“Ear tubes help in two ways,” explains Dr Kearney “First, they relieve the fluid that has built up over time and may be a source of hearing loss. Secondly, they reduce side effects from the overuse of oral antibiotics. Once the tubes are in place, any future ear infections can be treated with a topical antibiotic ear drop.”


  1. Their speech is delayed.


Hearing loss can significantly impact a child’s speech and development. If your little one is missing developmental milestones, it is important to rule out any potential hearing-related problems. For most patients that come to Dr Kearney with a speech delay, they are typically referred to a pediatric audiologist for a formal hearing evaluation.

There are several causes of hearing loss in children. Chronic ear infections are often the culprit because fluid lingers in the middle ear for too long. Ear tubes can help correct this problem.

Nerve-related hearing loss can also occur. Hearing aids may be used to amplify sound when this is identified. However, ENT surgeons with additional training can also surgically place a device known as a cochlear implant behind the ear that stimulates the hearing nerve and can help restore sound for some children.

“The first few years of language development are critical. The brain centers for language development are forming during this time and require sensory input from functioning ears to most-fully develop. That is why we aggressively screen all babies with a newborn hearing test and continue to evaluate children when they are young,” explains Dr. Kearney. “If there is a speech delay, we want to figure out if it is related to hearing because that is generally a very-treatable cause.”


  1. You can’t seem to keep strep throat away.

Strep throat and tonsillitis are infections that cause soreness and difficulty swallowing. Like ear infections, the mainstay of treatment is antibiotics. It is very common for children to get strep throat since it is highly contagious and easily spread around schools and daycare centers. However, if your child has more than three throat infections in a year, it is time to be looked at by an ENT surgeon.

The tonsils and adenoids are immune-related tissues in the back of the throat and nose. In some kids, however, these tissues end up trapping bacteria and themselves becoming sources of acute and or chronic infections. When children experience recurrent throat infections, Dr. Kearney often recommends referral to an ENT surgeon to discuss possibly removing the tonsils and adenoids. The procedure helps reduce the frequency and severity of the infections.


  1. Noisy breathing — during the day or night — has you concerned.

Does your child breathe heavily through their mouth or snore? Nasal congestion, sleep apnea, or an obstruction can make it difficult for kids to move air the way they should. Snoring or gasping for breath during what should be otherwise restful sleep are common symptoms of sleep apnea. Removing the tonsils or adenoids can improve your child’s breathing because there is more room in the airway.

“Sleep apnea can cause issues with learning, growth, and brain development, as well as long-term health consequences like high blood pressure. If a child is having symptoms of sleep apnea, pediatricians and ENT typically recommend taking the tonsils and/or adenoids out because it usually corrects the problem,” says Dr. Kearney. Before determining if this is necessary, a child will usually have an overnight stay in a hospital or sleep center to monitor their breathing at nighttime.


  1. Your kid is always stuffy.


Nasal congestion can be extremely debilitating for children. Anything that prevents the mucus from draining — a persistent cold, allergies, or an anatomic blockage — can cause an infection to develop in the nose or sinuses.

Like adults, children may also have a deviated septum, which causes the nasal passages to be uneven, or other anatomic obstruction to even and smooth air flow through the nostrils. If suspected, Dr. Kearney advises trying medications first. His goal is to maximize the amount of air that can flow through the nasal passageways so the mucus can drain properly. When symptoms persist, particularly in older adolescents, ENT surgeons will occasionally recommend a procedure to correct any underlying defects.


  1. Those pesky nosebleeds won’t quit.

Nosebleeds, which can be caused by dry air, nose-picking, and allergies, are common in kids under 10 years old. Usually, nosebleeds are not a cause for concern. However, if your child’s nose is bleeding more than once a week, or if the blood is very heavy, they should be evaluated. Common helpful at-home interventions include application of petroleum jelly to the nose and overnight use of a humidifier. Nose cautery is a simple procedure that ENT surgeons can perform in the office to seal blood vessels if other interventions don’t result in improvement in symptoms.


  1. You were told your baby has a tongue-tie.


Normally, the tongue moves freely within the mouth. But sometimes babies are born with a tongue-tie — a condition that causes the tip of the tongue to be attached to the bottom of the mouth by a band of tissue that’s either a bit thicker or longer than usual. Babies with tongue-ties may have difficulty latching during breastfeeding or making certain sounds. Dr Kearney and his colleagues can usually correct tongue-ties in their office by simply snipping this band of tissue.


  1. There have been too many prescriptions for antibiotics.

Antibiotics are a group of medications used to treat bacterial infections like strep throat. While these drugs are extremely helpful when needed, they can also have some rare but potentially harmful side effects. When they are used frequently, the bacteria in your child’s body can also develop resistance to the antibiotic, making future potential infections more difficult to treat.


Dr. Kearney says that children who are prescribed antibiotics frequently for ear, throat, or sinus infections should be evaluated by a specialist. There are relatively simple and safe procedures that often significantly reduce the need for antibiotics.