Enlarged Adenoids & Adenoiditis in Children
Content reviewed against published AAP, AAP, American Academy of Otolaryngology–Head and Neck Surgery, NIH guidelines
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Adenoids are a patch of lymphoid tissue located behind the nose at the very back of the throat (nasopharynx). They are a normal part of the immune system and are largest between ages 2 and 6, naturally shrinking by adolescence. Adenoiditis occurs when the adenoids become infected and inflamed, most often by bacteria such as Streptococcus, Haemophilus influenzae, or Moraxella catarrhalis. Chronic or recurrent infections can cause adenoid hypertrophy (persistent enlargement), leading to nasal obstruction, mouth breathing, snoring, sleep-disordered breathing, and recurrent ear infections. Enlarged adenoids are one of the most common causes of chronic nasal obstruction and obstructive sleep apnea in young children.
Key takeaways
- Adenoids are a patch of lymphoid tissue located behind the nose at the very back of the throat (nasopharynx).
- Duration: Acute adenoiditis typically resolves within 7-14 days with appropriate antibiotic treatment. Chronic adenoid hypertrophy persists until surgically addressed or until the adenoids naturally atrophy, usually between ages 7 and 10. Recovery from adenoidectomy takes about 1-2 weeks.
- Go to ER if: Severe difficulty breathing or inability to breathe through the nose or mouth
- No vaccine currently available
Symptoms
How It Presents by Age
0-12 months
Uncommon in infants as adenoid tissue is still small. May present as persistent nasal congestion, noisy breathing, difficulty feeding due to nasal obstruction, and mouth breathing. Enlarged adenoids may contribute to recurrent ear infections.
Risk level: Low — uncommon at this age
1-3 years
Adenoids begin to grow significantly. Chronic mouth breathing, snoring, and recurrent ear infections are the most common presentations. Parents may notice the child always breathes through the mouth, snores loudly, and has frequent ear or sinus infections. Speech may sound nasal.
Risk level: Moderate — peak onset period
3-7 years
Peak age for adenoid hypertrophy. Classic presentation with habitual mouth breathing, loud snoring, sleep apnea episodes, "adenoid facies" (elongated face, open mouth), and recurrent sinusitis or ear infections. May affect school performance due to poor sleep quality.
Risk level: Moderate to high — most symptomatic age group
7-12 years
Adenoids typically begin to shrink. Persistent enlargement at this age may cause ongoing sleep-disordered breathing, chronic sinusitis, or eustachian tube dysfunction. Some children continue to need treatment if symptoms remain significant.
Risk level: Low to moderate — usually improving
Treatment
Antibiotics (acute adenoiditis)
Amoxicillin-clavulanate is first-line for acute bacterial adenoiditis due to high rates of beta-lactamase-producing organisms. A 10-14 day course is typical. Clindamycin or a second-generation cephalosporin may be used for penicillin-allergic children.
Intranasal corticosteroid spray
Nasal steroid sprays such as mometasone or fluticasone may reduce adenoid size in mild to moderate cases and can be tried as a first-line non-surgical approach for 4-8 weeks. Studies show modest benefit in reducing adenoid hypertrophy.
Adenoidectomy (surgical removal)
Recommended for chronic nasal obstruction unresponsive to medical therapy, obstructive sleep apnea confirmed by sleep study, recurrent acute adenoiditis (4+ episodes in 12 months), or recurrent ear infections requiring ear tube placement. It is one of the most commonly performed pediatric surgeries.
Adenoidectomy with ear tube placement
When enlarged adenoids coexist with chronic ear infections or persistent middle ear fluid, adenoidectomy is often combined with tympanostomy tube insertion. This combination reduces recurrence of ear infections more effectively than tubes alone.
Watchful waiting
For mild symptoms without sleep apnea or recurrent infections, observation is appropriate since adenoids naturally shrink with age. Monitoring for worsening symptoms, particularly sleep-disordered breathing, is essential during this period.
Home Care
- Use saline nasal spray or saline rinse several times daily to reduce nasal congestion
- Run a cool-mist humidifier in the bedroom at night to keep airways moist
- Elevate the head of the bed or use an extra pillow to ease nighttime breathing
- Keep the child well-hydrated to thin nasal secretions
- Avoid known allergens and irritants such as cigarette smoke and dust
- Use adhesive nasal strips at night to help open nasal passages (older children)
When to Worry
Go to the ER if:
- Severe difficulty breathing or inability to breathe through the nose or mouth
- Prolonged pauses in breathing during sleep (apnea lasting 10+ seconds)
- Significant bleeding from nose or throat after adenoidectomy
- High fever with stiff neck and lethargy (possible retropharyngeal abscess)
- Inability to swallow saliva with drooling and difficulty breathing
Call your doctor if:
- Child habitually breathes through the mouth day and night
- Loud snoring every night that disrupts sleep
- Recurrent ear infections or chronic middle ear fluid
- Persistent thick nasal discharge lasting more than 10 days
- Nasal voice quality or speech changes
- Child having difficulty concentrating or performing at school due to poor sleep
- Bad breath that persists despite good oral hygiene
Keep an eye on:
- Snoring with observed pauses in breathing or gasping during sleep
- Chronic mouth breathing causing dry mouth, dental problems, or changes to facial structure
- Frequent ear infections (3+ in 6 months or 4+ in a year)
- Daytime sleepiness, irritability, or behavioral problems from poor sleep
- Persistent nasal congestion not responding to treatment for 4+ weeks
Prevention
- Frequent handwashing to reduce viral respiratory infections
- Keep up to date on routine childhood vaccinations including pneumococcal and influenza vaccines
- Avoid exposure to secondhand smoke and environmental irritants
- Treat allergies and allergic rhinitis promptly to reduce nasal inflammation
- Address recurrent ear infections early to prevent chronic adenoid inflammation
- Maintain good nasal hygiene with regular saline rinses during cold season
Contagion & Incubation
Incubation
Acute adenoiditis typically develops during or shortly after a viral upper respiratory infection (3-10 days after the cold begins). Chronic adenoid enlargement develops gradually over weeks to months of recurrent infections.
Contagious for
The adenoid infection itself is not contagious. The underlying viral infections that trigger adenoiditis may be contagious for 5-10 days.
Duration
Acute adenoiditis typically resolves within 7-14 days with appropriate antibiotic treatment. Chronic adenoid hypertrophy persists until surgically addressed or until the adenoids naturally atrophy, usually between ages 7 and 10. Recovery from adenoidectomy takes about 1-2 weeks.
Frequently asked questions
How long does enlarged adenoids & adenoiditis in children last?
How does adenoiditis / adenoid hypertrophy spread?
When should I take my baby to the ER?
Can adenoiditis / adenoid hypertrophy be prevented?
When can my child return to daycare?
Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Illnesses
Bottom line
Enlarged Adenoids & Adenoiditis in Children is treatable with appropriate medical care. Seek emergency care if severe difficulty breathing or inability to breathe through the nose or mouth.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.