Smokers are usually unaware of the smell of tobacco smoke so are often unaware of when smoke permeates the environment. Pollutants can also be a major problem for kids. Day care can be a major factor in some younger kids due to excessive exposure to viruses. Removal from day care for a period of time may be helpful. In older kids, exposure in school is often a problem, both from exposure to viruses, as well as due to problems with exposure to allergens.
Many schools have major contamination problems with molds.
In addition some schools are built on top of toxic areas and can be a major problem. Surgery in children is typically done much less frequently than in adults, but in situations such as abscess, cellulitis of the orbit, or intracranial abscess, surgery may be necessary. It is also done more frequently in patients with cystic fibrosis. Surgery may need to be a two step procedure, in which the surgery is done the first time, and subsequently the crusting and adhesions are removed under anesthesia. A significant number of children with chronic sinusitis may also have adenoidal or tonsillar enlargement which may require surgery in and of itself.