The tonsils are part of the immune system and function to trap germs from entering the body through the mouth and nose. They contain white blood cells for fighting infection and can may become swollen with infection. They can also be large due to the normal growth of a child, and in some cases, may be so big they impede breathing, by narrowing airways. Snoring, laboured breathing, sleep issues, poor hearing, bedwetting, behaviour and learning difficulties, are some of the concerns which can arise from enlarged tonsils.
Most commonly affected are children between the ages of 3 and 6 years.
The tonsils are located in three places - in between the nose and the back of the throat; on the back surface of the tongue; and in the throat – if you open your mouth wide and say ahh you can see them situated, one on each side between the uvula – the daggling bit hanging down in the middle.
Three sites for tonsils:
- Lingual tonsils are situated on the posterior surface of the tongue.
- Palatine tonsils are located on the right and left side at the back of the throat.
- Pharyngeal tonsils, known as adenoids, are located in the back of the nose.
The palatine tonsils and adenoids can cause the most problems. This is medically known as tonsil hypertrophy and adenoid hypertrophy and in some cases will need surgical removal.
Enlarged tonsils differs from tonsilitis, which is an inflammation of the tonsils.
What causes enlarged tonsils
Enlarged tonsils are not considered abnormal and thought part of normal growth of children which usually resolve as the child grows bigger. However, concerns can arise when children suffer from allergies and are frequent exposed to bacterial or viral infections [2].
Common symptoms of enlarged tonsils
Common symptoms of enlarged tonsils and adenoids concern sleep, breathing and frequent infections. Enlarged tonsils mainly affect breathing during sleep, whilst enlarged adenoids are associated with breathing through the nose. The size of tonsil tissue is not related to severity of symptoms.
- Snoring and interrupted breathing whilst sleeping, restless sleep, frequent waking, bedwetting and unusual sleeping positions
- Mouth breathing and breathing which sounds strained
- Frequent colds
- Daytime restlessness, excitability and tiredness due to insufficient quality sleep
- Behavioural and learning difficulties
- Poor hearing (not responding or paying attention)
Associated health concerns
Frequent infections, glue ear or middle ear infections, jaw misalignment and sleep apnea are some of the issues which can be associated with enlarged tonsils.
Sleep apnea can be a long-term issue which interferes with growth and development, and may increase the risk of heart and blood vessel health concerns.
Respiratory tract infections such as (the common cold). Breathing through the mouth can mean viruses bypass the filtration system in the nasal passages which trap germs.
Middle infections and glue ear can occur due to enlarged adenoids interrupting the natural flow of air to and from the inner ear. Hearing and speech can be affected.
Jaw misalignment, bite and changes in the position of the tongue can occur from mouth breathing [1].
What can help?
Support the immune system
Pharyngeal tonsils (adenoids) and the palatine tonsils are major lymphatic tissue used by the body for immune defence. These can be supported by specfic foods and supplements.
What children eat can help their immunity
- Fruit and vegetables provide many vitamins, minerals and antioxidants
- Fermented foods such as kefir and yogurt provide probiotics
- Eggs, milk, and fish are foods high in vitamin D
- Citrus fruits, strawberries, kiwi fruit, broccoli, and capsicum add vitamin C
- Meat, fish and poultry provide protein - building a healthy immune system
- Zinc is found meat, fish and poultry, pumpkin seeds and legumes
- Fish, chia seeds and flaxseeds can offer anti-inflammatory support through their high omega-3 content
- nuts and nut spreads, seeds, avocado, greens and salmon provide vitamin E - important for immune regulation [3].
Supplemental support
Probiotics support healthy functioning of the immune system and can improve quality of life for those suffering from nasal dysfunction [7].
EPA and DHA can modulate the immune system and reduce inflammation.
Minerals - zinc, copper, selenium and iron benefit the healthy development and function of the immune system.
Vitamins – A, B, C, D and E are essential for various functions of the immunity [3][4].
Elderberry (Sambucus nigra) has traditionally been used to prevent and treat respiratory problems [5].
Echinacea can be used as a preventative and treatment of respiratory tract infections [6].
Saline nasal sprays are an easy and gentle way to clear a child’s runny or blocked nose quickly and are suitable for daily use. Beneficial for nasal symptoms due to colds and allergies. they help moisten nasal tissue and clear excessive mucus and pathogens [7].
Can avoiding eating dairy foods help?
It seems a common believe that drinking dairy milk increases phlegm, however the science does not back up this theory.
While it was shown the texture of milk can make some people feel their mucus and saliva is thicker and harder to swallow, there is no evidence that milk leads to excessive mucus secretion [8,9,10,11].
Dairy products contain a rich source of vitamins, minerals and protein which can contribute to the nutritional needs of children and immune health.
The information provided is not intended to be used for diagnosis or treatment. If you are experiencing any health concerns, please consult your doctor for advice.
References
- Enlarged tonsils and adenoids: Overview https://www.ncbi.nlm.nih.gov/books/NBK536881/
- https://www.msdmanuals.com/en-au/home/children-s-health-issues/ear-nose-and-throat-disorders-in-children/enlarged-tonsils-and-adenoids-in-children
- Verduci E, D'Auria E, Bosetti A, DI Profio E, Vizzuso S, Milanta C, Pendezza E, Borsani B, Zuccotti GV. Immunomodulatory diet in pediatric age. Minerva Pediatr (Torino). 2021 Apr;73(2):128-149. doi: 10.23736/S2724-5276.21.06214-9. PMID: 33880904. https://pubmed.ncbi.nlm.nih.gov/33880904/
- Verduci E, Köglmeier J. Immunomodulation in Children: The Role of the Diet. J Pediatr Gastroenterol Nutr. 2021 Sep 1;73(3):293-298. doi: 10.1097/MPG.0000000000003152. PMID: 33872290; PMCID: PMC9770123. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9770123/
- Wieland LS, Piechotta V, Feinberg T, Ludeman E, Hutton B, Kanji S, Seely D, Garritty C. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complement Med Ther. 2021 Apr 7;21(1):112. doi: 10.1186/s12906-021-03283-5. PMID: 33827515; PMCID: PMC8026097.
- Rondanelli M, Miccono A, Lamburghini S, Avanzato I, Riva A, Allegrini P, Faliva MA, Peroni G, Nichetti M, Perna S. Self-Care for Common Colds: The Pivotal Role of Vitamin D, Vitamin C, Zinc, and Echinacea in Three Main Immune Interactive Clusters (Physical Barriers, Innate and Adaptive Immunity) Involved during an Episode of Common Colds-Practical Advice on Dosages and on the Time to Take These Nutrients/Botanicals in order to Prevent or Treat Common Colds. Evid Based Complement Alternat Med. 2018 Apr 29;2018:5813095. doi: 10.1155/2018/5813095. PMID: 29853961; PMCID: PMC5949172. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949172/
- Kumpitsch C, Koskinen K, Schöpf V, Moissl-Eichinger C. The microbiome of the upper respiratory tract in health and disease. BMC Biol. 2019 Nov 7;17(1):87. doi: 10.1186/s12915-019-0703-z. PMID: 31699101; PMCID: PMC6836414. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836414/#CR65
- Prodeus A, Niborski V, Schrezenmeir J, Gorelov A, Shcherbina A, Rumyantsev A. Fermented Milk Consumption and Common Infections in Children Attending Day-Care Centers: A Randomized Trial. J Pediatr Gastroenterol Nutr. 2016 Nov;63(5):534-543. doi: 10.1097/MPG.0000000000001248. PMID: 27168455; PMCID: PMC5084641 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5084641/
- Balfour-Lynn IM. Milk, mucus and myths. Arch Dis Child. 2019 Jan;104(1):91-93. doi: 10.1136/archdischild-2018-314896. Epub 2018 Sep 6. PMID: 30190283. https://pubmed.ncbi.nlm.nih.gov/30190283/
- Cow’s Milk and Immune Function in the Respiratory Tract: Potential Mechanisms https://www.frontiersin.org/articles/10.3389/fimmu.2018.00143/full
- Thorning TK, Raben A, Tholstrup T, Soedamah-Muthu SS, Givens I, Astrup A. Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence. Food Nutr Res. 2016 Nov 22;60:32527. doi: 10.3402/fnr.v60.32527. PMID: 27882862; PMCID: PMC5122229. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122229/
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