Every parent knows how exhausting it is having babies who don't sleep through the night.
Sleepless nights with several wake-ups make for tired days that slip by. Suddenly, several months have gone by, and your babies are old enough to go longer between overnight feeds, and you can attempt to sleep train your twins (we did this when our twins were four-and-a-half months old).
Longer stretches of sleep are within reach, and they're luxurious once you have them.
Everybody—parents and twins included—sleeps all through the night (twins for 12-13 hours, no problem) and is well-rested for several months. For a few years, even.
Life is great.
Then, if you're like us, one night, successful sleep stops.
It starts with a wake-up (or two, if you're counting per twin). You assume it's an anomaly because your usual routine had been disrupted and that you'll be back to normal shortly.
Then, week by week, one wake-up turns into two, or three, or four—or more. Our twins started waking up several times a night for a prolonged period of time.
We hadn't had any major life or home changes that could have triggered this change, so we tried adjusting schedules and routines to pinpoint the cause of this dramatic disruption in the quality and duration of our twin toddlers' sleep.
Over the course of several months, we'd gone from seamless, sound sleep all night long, to five or six wake-ups a night, and things began to feel very reminiscent of the newborn days with our twins, where we'd chug along on sleep fumes, getting a 45-minute chunk of sleep here, another hour or so of sleep there.
It all became exhausting, and we had to find a solution fast because consistent, quality sleep is so crucial during these prime years of growth and development for our children.
We'd already been monitoring the sleep situation for several months, but, from that point forward, things switched into high gear.
I knew if we went to our pediatrician without concrete evidence, we'd likely be told that's just how it is with toddlers, especially twins. You don't sleep for the first few years.
But this wasn't just a tired plea from an exhausted parent.
But this wasn't just a tired plea from an exhausted parent. We'd already had two years of fantastic sleep, and we knew this wasn't normal.
It wasn't a regression. It was something else. We had to find out what.
But in order to do that, we needed a referral. And in order to get that referral, we needed a reason. A reason with a valid explanation to make sure we weren't waiting six to 12 months to see a specialist.
So, during a few more weeks of less-than-rejuvenating sleep, we took clear notes (and pictures, and videos) of things that happened while our toddlers were sleeping.
Positions they slept in. Sounds they made. Number of hours they'd sleep before waking up abruptly again…and again…and again.
While we tried to fall back asleep between steady wake-ups, we'd research. The symptoms. The possibilities.
As any parent who's ever Googled medical symptoms knows, it's super easy to go down medical rabbit holes very quickly, so we made sure to stick to reputable medical sources while trying to figure out what was going on with our children at nighttime.
And we came to realize that it wasn't only about overnights because, as time went on, the lack of quality sleep was also affecting each of our twins during the day.
That's why we knew we couldn't wait months longer and had to advocate for answers.
Eventually, we had enough to warrant an immediate referral from our pediatrician to a specialist.
We were right, the reason our twins stopped sleeping through the night was medical.
...the reason our twins stopped sleeping through the night was medical.
They had enlarged adenoids that were blocking 80 percent of their airway and causing multiple wake-ups every night, preventing them from getting a good night's sleep for a prolonged period of time.
How do you get diagnosed with enlarged adenoids?
We suspected our twins had enlarged adenoids, but in order to confirm what we suspected, our twins had to be referred to a physician who specializes in airway issues.
We booked in with our twins' pediatrician for an exam, to share our concerns, and to get his advice. After sharing what we'd witnessed during overnights over the course of several weeks, he agreed they'd benefit from being referred to an ear, nose, and throat (ENT) specialist for further testing.
Luckily, I was already a patient of the laryngologist (a physician, surgeon, and subspecialist of otolaryngology who has specialized training to diagnose and treat voice disorders, airway issues, and swallowing problems, as well as ear, nose, throat, and neck disorders), so we were able to get in relatively quickly for an exam and scope of our twins' adenoids to confirm whether they were enlarged, and if so, if they would require surgery.
There's a rating system for the size of adenoids, and it's the same system that's used for rating the size of tonsils. It's called the Modified Adenoid Grading System, and it rates the hypertrophy (enlargement) of the adenoid tissue by the percentage of nasopharyngeal airway it obstructs and by assessing the contact the tissue is making with the surrounding anatomical structures.
Here's a breakdown of the different grades by percentage of obstruction: Grade 1 (0-25%) Grade 2 (26-50%) Grade 3 (51-75%) Grade 4 (76-100%)
After their nasal endoscopy, which took about 30 seconds per child, and allowed the doctor to visually examine the inside of each of their noses and sinuses, using a thin, light-equipped tube, she confirmed our suspicions; they did, indeed, have enlarged adenoids.
Each of our twins' adenoids were rated Grade 3, with the tissue blocking about 80 percent of each of their airways.
Each of our twins' adenoids were rated Grade 3, with the tissue blocking about 80 percent of each of their airways. The doctor prescribed a steroid nasal spray to help them breathe easier overnight while we completed their pre-operative assessments with their pediatrician and waited for a surgery date for their adenoidectomy.
What is an adenoidectomy?
An adenoidectomy is a surgical procedure done under general anesthesia to remove the adenoid glands. The adenoids are located behind the nasal passage. They're a part of the lymphatic and immune system, and they help trap germs that enter the body through the nose and mouth.
While the adenoids are a part of the immune system, research has shown that removing them doesn't actually increase the frequency of colds or infections, so if they become enlarged and start to cause issues with your children (such as blocking their airway, sleep disturbances, or many of the other symptoms you'll read about, below), then it may make more sense to have them removed than waiting until they begin to shrink.
Adenoids grow to their maximum size when a child is between ages three and five, and then they begin to get smaller, usually disappearing by the time they become an adult.
As a parent, people may ask you why you don't just wait until your kid is older to see if the problem goes away on its own. I've watched the ways in which my children's sleep has been disrupted over the past several months, knowing that they're not getting the restorative sleep they need during the time when sleep is the most important for their personal growth and development.
As I walked with one of my twins to the recovery area, one of the nurses said something that resonated with me and confirmed we'd made the right decision not to wait.
She told me it was such a good idea to go ahead with the adenoidectomy now and get it done when they were three or four years old, rather than waiting 10 years and deciding to do it when they're 13 or 14, when they're exhausted and trying to stay awake during school, when they'd have a longer recovery ahead of themselves.
By doing it now, we were giving them the chance to have their airway issues fixed sooner, so they could get back to better sleep and have more energy to do everything they can and should be doing at this age.
What are the symptoms of enlarged adenoids in toddlers?
There are a lot of symptoms you can see from enlarged adenoids, but your child may not have all—or even any—of them.
One of the most important things to keep in mind with your children is that snoring isn't normal. It might sound cute, but it's actually a sign that there's an underlying issue at work, so if you notice your kids snore, it's something you might want to bring up to their pediatrician.
Another lesser known symptom may be seen after you've begun potty training your twins. If your twins often wake up wet when they used to be able to hold it all night, but now they're waking up wet more often than not, enlarged adenoids could be the cause. While nighttime accidents can be brought on by nightmares, they can also be caused by medical issues, like pediatric obstructive sleep apnea, which can be caused by enlarged adenoids, so if the accidents are a persistent problem, it could be worth bringing up to their pediatrician for further investigation.
If you suspect your twins have enlarged adenoids, other symptoms to watch for include:
- Frequent or recurring nasal congestion / inflammation or runny nose
- Sore throat
- Difficulty swallowing
- Mouth breathing
- Chronic ear and / or sinus infections
- A feeling of fullness in the ears
- Extra wax build-up in the ear, which causes negative pressure from fluid in the middle ear
- Nasal speech
- Trouble sleeping (i.e., frequent sudden wake-ups overnight, sudden gasping or choking from sleep, screaming or running out of their room, coughing that prevents being able to fall sleep)
- Sleeping with their neck hyperextended (whether they're on their back, their tummy, or their side) in an attempt to open up the airway
- Overtiredness or hyperactivity later in the day
- If one of the parents of your twins had enlarged adenoids when they were younger, that could be a contributing factor
What to expect with adenoidectomy surgery
Our twins had their adenoidectomy done as a pediatric day surgery. They had to fast for several hours beforehand, and then we got admitted to the hospital in the morning, where the nurses explained the procedure and showed our twins a mock operating room, where they could help prep a little dolly for their procedure and see what instruments would be used, so they'd be familiar with what was going on when it was time to go with the surgical team to the operating room.
The procedure itself only takes about 20 minutes, but from the time you check in at admitting until the time you leave the recovery room after your twins' post-operative monitoring, you can expect to be at the hospital for about eight hours.
If you run into unexpected issues or delays, then you'll of course have a longer stay before you're discharged.
In the days after surgery, your children may experience pain and swelling in their throat and uvula. The swelling usually goes down after 48 hours.
They may also experience an earache, nausea, vomiting, a croupy or barky cough during the first day or so after surgery, a stuffy or runny nose (do NOT blow their nose for two days after surgery, just gently wipe what drips out), and snoring.
An unexpected symtpom of recovery is that their voice might sound funny for a couple of days as they heal from the surgery, but the even more interesting one is the bad breath they'll likely have for the first week or so after surgery. It's normal and doesn't mean there's an infection. Brushing their teeth and rinsing gently with salt water can help downplay this side effect.
If your twin(s) experience a high fever (over 38.5 degrees that doesn't go down with medication), alert the surgical team and head to the emergency room for evaluation as it could be a sign of a post-operative infection that requires a course of antibiotics to clear up.
Diet following adenoid removal
After an adenoidectomy, your child(ren) may have a poor appetite for the first day or two afterward, so it's best to keep their diet to soft and easy-to-swallow foods, like ice cream or popsicles, milkshakes or smoothies, mashed potatoes, scrambled eggs, or pasta, Jello. The most important thing is to keep them hydrated while they're recovering, so offer clear fluids, like water or apple juice, often to help reduce pain and swelling in the throat.
If their throat gets dry, that can cause pain, so in addition to staying hydrated, it's a good idea to use a cool mist humidifier in their room at night. A saline nasal mist spray can also help ease discomfort.
Other considerations
Expect to take it easy (as easy as you can with twin toddlers) for a few days after their surgery. Get them excited to watch a bunch of movies and do quiet, relaxing things at home.
Follow your doctor's orders for pain management in the days following their surgery. We had to rotate acetaminophen and ibuprofen while our twins recovered from their procedure. If you stay on top of pain management, your twins will recover more quickly because they'll be less likely to run into problems with eating, drinking, sleeping, and regular everyday activities.
Some kids are ready to head back to preschool or class after three or four days. Other kids need a bit longer to full recover and be ready to get back to their normal activities.
Sometimes, when the adenoids need to be removed, the tonsils might also need to come out. This is done on a case by case basis, so if you're unsure, ask your ENT for their advice and reasons why the tonsil may or may not need to be removed when the adenoidectomy is performed.
The difference after an adenoidectomy
It's been six weeks since both of our twins had their adenoids removed. In the first and second days after their procedures, they were already starting to speak more.
More words, but also more clearly. They began enunciating more than they had the day or two before.
Within a week, they began initiating conversation. Before, they'd always answer us if we asked them something, but now they were seeking us out and actively starting conversations about things. There were follow-up questions. There was a back-and-forth. It was an incredible change in an incredibly short timeframe.
Beyond the leaps in language, we're making our way back to better sleep. They immediately got longer, better sleep. Deep, quality, restorative sleep that helps ensure our twins won't be exhausted during the day and getting overactive from not getting the sort of sleep they need overnight.
Because their airways have been opened back up and are no longer obstructed, they're sleeping better than they had been for a long time, which is so important during this prime time for the growth and development of their brains.
Did your twins have enlarged adenoids that had to be removed? Did you notice any difference in their sleep or speech after their surgery? Let us know in the Comments section below or connect with us on Instagram to share your thoughts!
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