Hi and thanks for the query, key issues in the management of the child actualy include frequency of experiencing these symptoms, the actual size of these adenoids and ensuring that the medications prescribed are in the right doses and taken properly. If these drugs are taken properly and these symptoms continue to persist, it might be appropriate to consider the removal of the adenoids for two main reasons. The first is recurrent infection of the adenoids predispose to spread of infection to nearby structures like the ears and sinuses and could lead to infection of these structures. Secondly, a chronic inflammation of the adenoids or recurrent infection, especially with a bacterium called beta hemolytic streptococci, could lead to long term heart and joint disease later in the child called rheumatic fever. A throat culture to identify specific organism for culture and antibiotic sensitivity testing might be useful at the early phase, and monthly injections of penicillin could also help. But if these measures fail, or depending on the ENT specialist s clinical appreciation, Adenoid removal could be done to save the child from all these complications. Thanks and best regards, Luchuo, MD.