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Obstructive sleep apnoea syndrome in children is always caused by enlargement of the tonsils and adenoids, and these should be removed at the earliest opportunity after the diagnosis has been made. Although tonsillectomy is not routinely performed below the age of four years, and adenoidectomy not routinely below the age of three years, these restrictions do not apply to obstructive sleep apnoea syndrome where the danger is both progressive and, on occasion, immediate.