Q. My 3½-year-old son had his bilateral cleft of the soft and hard palate repaired at 6 months. He still has a small slit in the top of his palate. He has had a sinus infection every month since September. I took him to the ENT and he says that it's because his adenoids are enlarged. In a normal child they would remove them, but he says it will affect his speech too much to remove them. Do you have any further advice?

A. Ear infections at this age are very troublesome. We hate to put anyone, especially a young child, on antibiotics needlessly, especially since in most children the infections will stop by the time they are about 6. At this age the eustachian tube (a small tube that drains the ear and equalizes the pressure in the ear) grows large enough that the infection rate drops).

Your son, however, has two problems. First, there is the recurrent ear infections. Second, there is the cleft palate. While it is possible the cleft palate is causing the infections, we'd want to be sure nothing else is involved. For example, while most 3½-year-olds are no longer on the bottle, a few still use a bottle at night. Some parents smoke. Both of these are associated with increase ear infection rates in children. So if either of these are the case in your house, you might consider making these changes.

After the other causes have been addressed, there is the option of "prophylactic antibiotics." This means we'd treat your son before he actually gets an infection. I know that sounds strange, but it has been used in some cases like this. (I also realize you are interested in DECREASING your son's antibiotic exposure, not increasing it, but prophylactic antibiotics might keep him from getting sick so often). You might consider discussing this option with your son's doctor.

Surgery is another option, but usually we reserve that for only very special cases. That might be your son, but you will want to explore all other options first.

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