When her little boy kept waking all grumpy after a night’s sleep, Chloe Ong knew something was wrong.

“Nothing warms my heart more than watching my son, Raphael, drift off into slumberland every night, knowing he’ll be getting a good night’s rest. Just two years ago, at age 4, Raphael was battling sleep apnoea. This disorder, which interrupted his breathing while he slept, also caused him to snore really loudly — I could hear him from my room two doors away!

“In addition, my little boy would also wake up in the mornings grouchy, was lethargic during the day and took three-hour naps, which was quite unusual for someone his age. Also, if he had a runny nose, he would cough and choke on his mucus. Concerned, my husband Ivan and I made an appointment to see a paediatric ear, nose and throat (ENT) surgeon and a respiratory physician.

“The doctors told us that Raphael’s adenoids, a patch of tissue that sits at the very back of the nasal passage, was enlarged and blocking his airways. Also, our family history of allergies and asthma had contributed to his condition as allergens can also irritate and inflame the nasal passages. Thank goodness our other two children, Ignatius and Lauren, dodged the bullet.

“As a first course of action, Raphael was given antihistamines and a steroid nasal spray. Over the next few months, we monitored his progress, which improved, but he was still not symptom free. So, a year after being on medication, two sleep studies were done to help us determine just how much sleep apnoea was affecting our little boy.

“Sleep apnoea can cause developmental delays if left untreated.”

“The first — an oximetry study — was done at home over three consecutive nights with a portable machine. A plastic clip was placed over Raphael’s finger to measure the oxygen level in his blood, which is affected when his breathing pauses periodically. For the second — he had to check into KK Women’s and Children’s Hospital, so that his body could be hooked up to 50 electrodes. This was to measure the number of times his oxygen level dropped while he was sleeping. This affected his brain wave activity, heart rate, blood pressure and breathing effort.

“Both studies revealed that Raphael’s oxygen levels were moderate. However, sleep apnoea can cause developmental delays if left untreated. To clear the obstruction, his doctors advised us to consider surgery to remove his adenoids and tonsils. It was a relatively simple and safe procedure that would take no more than an hour, but as parents, our heart broke at the thought that our little one would have to go under the knife.

“After a lot of pondering, as well as back and forth, Ivan and I decided to go ahead with the surgery. Yes, there is always a small chance that something might go wrong during the procedure and that surgery might not help at all, but we also felt that the benefits outweighed the risks. As parents, we had to do all we could to give our son the very best quality of life.

“Though we decided not to tell Raphael about the surgery beforehand, I felt somehow that he knew what was about to happen. It could have been my imagination, but my son looked like he was prepared for it. Though he had to fast the night before his surgery, Raphael did not ask me why.

“Raphael started crying when he had to change into the operating gown…I followed him all the way to the operating theatre…”

“My heart was heavy as I checked my son into the hospital, but I knew I had to be strong for him. Although he was calm up till then, Raphael started crying when he had to change into the operating gown. Reassuring him that everything was going to be fine, I followed him all the way to the operating theatre and continued talking to him to keep him in good spirits.

“Needless to say, it was the worst experience of my life. While he was undergoing the procedure, I waited outside and prayed hard that everything would go smoothly. We also started to worry when the procedure took longer than the allotted one hour. Later, the doctors informed us that Raphael had taken a bit longer to come out of anaesthesia, but that he was fine. I gave a sigh of relief — it was finally over!

“The first few weeks of recovery were challenging. Raphael was only allowed to eat cold and soupy stuff, but unlike most kids, he isn’t an ice-cream fan, so he only sipped on some cold drinks. He not only found it challenging to swallow any food shortly after his op, his snoring also worsened because of secretions from his wound. All this made him very grumpy.

“We treated Raphael like a king during his recovery period and showered him with lots of attention. I not only waited on him hand and foot, I even spoiled him with a trip to Toys ’R’ Us. Needless to say, my other two kids felt a bit jealous of their brother!

“After the initial two weeks, Raphael started feeling better, especially since he was also able to eat normally. As he is still sensitive to things such as dust, my little boy still uses the steroid nasal spray and takes a tablet to prevent a relapse. I’m not too thrilled about the steroid spray as it can impede his growth and suppress his immune system. But he is due for a review in a few months and I hope the doctors will take him off his meds soon. At the end of the day, I’m just happy that the surgery was a success and my little boy is now a happy, healthy and well-rested child.”

Operations manager Chloe Ong, 39, lives in northern Singapore with her GP husband Ivan, 39, and children, Ignatius, 4, Raphael, 6, and Lauren, 8.

Sleep apnoea – the facts

Paediatric ENT surgeon Dr Dawn Teo sheds more light on this condition…

• Sleep apnoea is usually caused by enlarged tonsils and adenoids. But sometimes, a floppy airway, malformations in the skeleton of the face, and obesity (the airway gets narrower as you get wider) can also contribute to this condition.

• It is commonly seen in children between the ages of 3 and 5, as this is when their soft-tissue growth is often faster than their bone development. However, some babies are known to have this condition, too.

• Look out for signs like loud snoring or a complete halt in breathing for a few seconds while your child is asleep. Insufficient sleep also gives rise to poor feeding and growth in babies, and behavioural and learning problems in older children.

• Treatment is in the form of a simple half hour surgical procedure that is carried out through the nose and mouth. It doesn’t require any stitches or leave any scars.

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