Growth failure and steep disordered breathing: A review of the literature

Objective: While otolaryngologists consider growth failure an absolute indication for tonsillectomy and adenoidectomy (T&A), they may not be accustomed to screening for poor growth, and thus unlikely to consider it when recommending a T&A. This paper will (a) familiarize otolaryngologists with the definition, prevalence, and etiology of growth failure and (b) review the published findings that examine the inter-relationship among steep disordered breathing, growth failure, and adentonsillar hypertrophy in children. Methods: This paper is divided into three sections. The first section presents a brief overview of growth failure for the otolayngologist. The second section reviews the evidence base linking steep disordered breathing, growth failure, and adenotonsillar hypertrophy in children. The anthropometric outcomes of children presenting for T&A, or having steep symptoms assessed, are presented. The third section presents pilot data (n = 28) on the prevalence of growth failure and steep disordered breathing among children presenting for T&A at our institution. Results: Among children presenting for T&A or having steep symptoms assessed, growth failure was at least twice the expected rate in six of eight published studies. Across these six studies, this rate ranged from a tow of 6% of children < 3rd percentile for weight and 6% < 3rd percentile for height in one study, to a high of 52% who were < 3rd percentile in weight in a second study, and 44% who were <= 5th percentile for height in a third. Among children presenting for T&A at our own institution, 14% were <= 5th percentile in height, and 11% were <= 5th percentile in weight. Among children under 6 years of age, 21% were either <= 5th percentile in weight and/or height. Conclusions: Published studies, as well as our own pilot data support the hypothesis that SDB, secondary to adenotonsillar hypertrophy increases the risk of growth failure in children. Adenotonsillar hypertrophy and steep disordered breathing may be unrecognized risk factors in the etiology of growth failure. Otolaryngologists can play an important role in identifying growth failure, and referring children to the appropriate specialists. (c) 2005 Elsevier Ireland Ltd. All rights reserved.