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Could my son be suffering from asthma?

 Your son's blocked nose when he sleeps probably makes him breathe noisily or snore and so can wake him as well as the rest of the household. It is probably due to either enlarged adenoids or tonsils or both.

Adenoids and tonsils are what make up the special lymph tissue at the upper end of your son's respiratory tract. This tissue is important in your son's defence against infection because it mops up the germs which he breathes in (adenoids) or swallows (tonsils) and prevents them from infecting his lungs or other parts of his body. Whenever the tonsils or adenoids are exposed to infection they enlarge to fight it.

Between the ages of one and four years your son's tonsils and adenoids are likely to be larger because this is the age when he is most likely to be fighting off bacteria and viruses that his body has not come across before.

Sometimes the tonsils or adenoids get so big they can temporarily cause problems.

Because they lie at the top of the upper airway they can partly block it off causing snoring when asleep, mouth breathing when awake (which might make your son eat with his mouth open), nasal speech which sounds as though his nose is always blocked and sometimes difficulty swallowing which could put him off his food.

The swelling can block his Eustachian tube and alter the pressure in his middle ear. This could reduce his hearing at times and cause recurrent ear infections and earache.

Usually your son would be expected to grow out of these problems after a year or two as his tonsils and adenoids shrink down with time. However, if his growth or sleep are severely affected or if he has reduced hearing he may need surgery to remove either his tonsils or adenoids or both.

In the 1960's many children underwent tonsillectomy almost as a routine. It became apparent that this was unnecessary and sometimes dangerous as the operation requires a general anaesthetic and can occasionally cause heavy bleeding from the operation site in the throat.

These days surgeons consider each child carefully and will only operate if they think the enlarged tonsils or adenoids are causing more problems to the child's health by being left in than if they were taken out. It is rare for any child to have them removed below the age of two years as so many children improve on their own after this age.

You ask whether his blocked nose is a symptom of asthma. If your son had asthma he would have additional symptoms such as coughing or wheezing at night or when he runs around or if he came into contact with animals he might be allergic to such as dogs, cats, rabbits or horses (not all children with asthma react to animals).

Asthma is commoner in some children with allergic rhinitis which causes symptoms like hay fever, such as a blocked runny nose and sneezing. Your son's blocked nose could be due to allergic rhinitis. In this case his GP might want to try a low dose steroid nose spray twice a day to see if this helped his symptoms.

Occasionally it is possible for there to be some other more unusual problem causing blockage at the top of his airway. I would suggest that you ask his GP to refer him to an ear, nose and throat surgeon who can thoroughly check his upper airway.

If his snoring turns out to be due to enlarged adenoids and/or tonsils the surgeon will probably want to review him over the next six to 12 months.

If he continues to have problems more than six months from now, in particular if his growth or appetite are affected, he may need surgery to remove his tonsils and/or adenoids.

We recommend readers seek personal medical attention in appropriate circumstances.