As children head back to school, parents are often focused on new routines, school supplies, and getting back on schedule. But the start of the school year can also bring an increase in childhood ear, nose, and throat (ENT) problems.
“We typically see an uptick in childhood infections as school starts again,” says Mark Boseley, MD, a pediatric otolaryngologist with ENT & Allergy Associates in Tarrytown, NY. Ear infections and viral upper respiratory infections are among the most common ENT issues he sees in school-aged children.
While many childhood illnesses resolve on their own, recurring or persistent ENT problems can affect a child's hearing, sleep, comfort, attendance, and ability to participate in the classroom.
Knowing what to watch for can help parents recognize when an issue may require additional evaluation.
How ENT Problems Can Affect the School Day
A child's ears, nose, and throat play an important role in communication, breathing, sleep, and overall comfort. When an ENT problem interferes with one of these areas, it can sometimes affect how a child functions at school.
For example, fluid behind the eardrum can temporarily affect hearing, making it harder for a child to follow classroom instructions. Likewise, a child who is not sleeping well because of frequent snoring may be tired or have difficulty concentrating during the day.
ENT Symptoms Can Look Like Inattention
Hearing problems in school may become more noticeable in a busy classroom, where background noise can make speech harder to understand.
Parents and teachers may notice that a child:
- Frequently asks for information to be repeated
- Has difficulty following multi-step directions
- Watches other students before responding
- Turns up the volume on televisions or devices
- Speaks louder than usual
- Sits unusually close to the teacher
- Seems inattentive during verbal instruction
- Experiences changes in school performance
If these behaviors persist, parents should discuss them with their child's pediatrician, ENT specialist, or audiologist.
Poor Sleep Can Affect Daytime Performance
Sleep is another important part of a child's school-day health. Frequent snoring, mouth breathing, restless sleep, or pauses in breathing can sometimes be associated with enlarged tonsils or adenoids and sleep-disordered breathing.
“We have found that poor sleep has a correlation to difficulty in school,” Dr. Boseley explains. “Symptoms would include snoring with restless sleep or snoring with pauses in breathing at night.”
Occasional snoring during a cold may resolve as the illness improves. However, frequent or disruptive snoring should be discussed with a healthcare professional.
Common Back-to-School ENT Concerns
ENT concern | Signs parents may notice | Possible school-related effect | When to seek care |
Ear infection or middle-ear fluid | Ear pain, pressure, muffled hearing | Difficulty hearing instructions | Persistent pain, fever, drainage, or hearing changes |
Cold or sinus symptoms | Congestion, drainage, cough, facial pressure | Discomfort and missed school | Symptoms that persist or worsen |
Sore throat or tonsillitis | Throat pain, fever, painful swallowing | Reduced participation or absence | Severe, recurring, or prolonged symptoms |
Hearing difficulty | Repeated questions, increased volume, unclear responses | Difficulty following lessons | Persistent or teacher-reported concerns |
Snoring or mouth breathing | Loud breathing, restless sleep, daytime tiredness | Fatigue or difficulty concentrating | Frequent or disruptive symptoms |
Ear Infections and Fluid in the Ears
Ear infections and viral upper respiratory infections are common among school-aged children, particularly as children return to classrooms and spend more time around other children.
Colds and other upper respiratory infections can cause swelling or a eustachian tube blockage, preventing the tubes from properly equalizing middle-ear pressure.
Signs of an ear infection or middle-ear problem can include:
- Ear pain or pressure
- Tugging at the ear
- Fever
- Drainage from the ear
- Muffled hearing
- Frequently asking others to repeat themselves
- Turning up the volume on devices
Parents should also pay attention to how long symptoms last.
Ear pain for greater than 48 hours is one symptom Dr. Boseley recommends parents pay attention to, along with prolonged sore throat or prolonged nasal drainage accompanied by high fever.
If ear pain persists or a child develops changes in hearing, parents should contact their child's healthcare provider.
Hearing Problems in the Classroom
Hearing difficulty may be especially challenging in a busy classroom, where background noise can make it harder for a child to understand what a teacher or classmate is saying.
If a teacher reports that a child frequently misses verbal instructions or appears unable to hear during classroom activities, parents may want to consider a hearing evaluation.
An audiologist or pediatric ENT can help determine whether the issue is related to temporary middle-ear fluid, hearing loss, or another underlying condition.
Colds, Nasal Congestion, and Sinus Infections
It is common for children to develop colds after returning to school. Nasal congestion, drainage, cough, and other upper respiratory symptoms can make children uncomfortable and may occasionally result in missed school.
However, not every prolonged common cold is a sinus infection. Healthcare professionals consider factors such as how long symptoms have lasted, how severe they are, and whether they improve or become worse after initially getting better.
Parents should contact their child's healthcare provider if symptoms are persistent, severe, or worsening.
Dr. Boseley specifically recommends paying attention to prolonged nasal drainage accompanied by a high fever, particularly when symptoms are not improving.
Children with chronic nasal congestion may also experience mouth breathing, disrupted sleep, or difficulty participating comfortably in school activities.
Sore Throat, Strep Throat, and Tonsillitis
A sore throat is a symptom that can have several possible causes. Strep throat in children is a bacterial infection that requires appropriate testing and treatment. Tonsillitis in children is inflammation of the tonsils and may result from a viral or bacterial infection.
Symptoms may include:
- Sore or painful throat
- Fever
- Swollen tonsils
- Pain or difficulty when swallowing
- Recurrent throat infections
Prolonged sore throat, particularly if this presents on one side of the throat, is one concern Dr. Boseley recommends parents not overlook.
An ENT evaluation may be appropriate for children who experience frequent tonsil infections or who also have problems with breathing, swallowing, or sleep.
Snoring, Mouth Breathing, and Enlarged Tonsils
Occasional snoring can occur when a child has a cold or nasal congestion. However, frequent snoring, mouth breathing, gasping, restless sleep, or pauses in breathing may warrant further evaluation.A child snoring occasionally during a cold may not require treatment, but frequent snoring can indicate an underlying breathing problem.
Enlarged tonsils and adenoids can contribute to obstruction during sleep in some children.
Dr. Boseley recommends that parents consider an ENT evaluation for children experiencing snoring with restless sleep or prolonged mouth breathing.
Parents should also watch for pauses in breathing during sleep, particularly when they occur alongside frequent snoring.
Back-to-School ENT Health Tips
Parents can take several practical steps to support their child's ENT health as the school year begins:
- Address unresolved ear pain or hearing changes before school starts.
- Follow up on persistent fluid behind the eardrum after an ear infection.
- Ask teachers to report frequent requests for repetition or difficulty following verbal directions.
- Encourage regular handwashing and good cough etiquette.
- Remind children not to share cups, utensils, or water bottles.
- Monitor recurring ear infections, sinus symptoms, or throat infections.
- Pay attention to frequent snoring, mouth breathing, or restless sleep.
- Use hearing protection at particularly loud school events, concerts, and sporting activities.
- Keep recommended medical and hearing follow-up appointments.
Dr. Boseley also has a simple recommendation for families preparing for the new school year: “I would recommend your child gets their appropriate vaccinations and maintains good hygiene going into the new school year.”
When Should Your Child See a Pediatric ENT Specialist?
Many common childhood illnesses can be managed by a pediatrician. However, an ENT evaluation may be helpful when ear, nose, throat, hearing, or sleep-related problems are persistent or recurring.
According to Dr. Boseley, parents should consider an ENT evaluation for children with:
- More than three ear infections in six months or four in one year
- Frequent tonsil infections
- Snoring with restless sleep
- Prolonged mouth breathing
Other reasons to discuss a pediatric ENT evaluation may include persistent fluid behind the eardrum, ongoing hearing concerns, recurrent sinus symptoms, persistent nasal obstruction, difficulty swallowing, or disruptive sleep symptoms.
Seek urgent medical attention for symptoms such as difficulty breathing, severe dehydration, sudden hearing loss, or other severe or rapidly worsening symptoms.
Frequently Asked Questions
How can an ear infection affect a child at school?
Ear pain can make it difficult for a child to concentrate, while fluid behind the eardrum can temporarily affect hearing. A child may have difficulty following spoken instructions even after the pain from an ear infection begins to improve.
What are signs that my child is having trouble hearing in class?
Repeated requests for clarification, difficulty following verbal directions, speaking unusually loudly, or teacher-reported concerns may be signs of hearing difficulty. Persistent concerns may warrant a hearing test with an audiologist.
When can a cold become a sinus infection?
Healthcare professionals consider the duration and severity of symptoms and whether they improve or worsen over time. Colored nasal mucus alone does not necessarily mean that a child has a bacterial sinus infection.
When should recurring sore throats be evaluated by an ENT?
An ENT evaluation may be appropriate when throat infections are frequent, severe, prolonged, or associated with enlarged tonsils, swallowing problems, snoring, or disrupted breathing during sleep.
When should snoring in children be evaluated?
Frequent, loud, or disruptive snoring should be discussed with a healthcare professional, particularly when it occurs with mouth breathing, gasping, restless sleep, or pauses in breathing.
When should my child see an ENT instead of a pediatrician?
A pediatrician can manage many routine childhood illnesses. An ENT may be helpful when ear, hearing, sinus, throat, nasal, or sleep-related problems are persistent, recurrent, or affecting a child's daily life.
Support Your Child's ENT Health This School Year
The start of the school year is a good time to pay attention to your child's hearing, sleep, breathing, and recurring ear, nose, and throat symptoms.
“What I want parents to know is that if something seems to be recurring or isn't improving, it's worth having it evaluated,” says Dr. Boseley.
If your child is experiencing recurring ear infections, hearing concerns, frequent throat infections, persistent nasal obstruction, or snoring and restless sleep, talk with a pediatric ENT specialist, or audiologist about the next step.
ENT & Allergy Associates provides pediatric ENT care throughout New York, New Jersey, Pennsylvania, and Texas.