can I insist on a referral and if so who to?

[chickensaladagain]

11yo dd has suffered with bad breath on and off pretty much since starting school

I have been to the doctors a number of times with her and been told she doesn't drink enough, so we've massively upped her fluid levels, it's hayfever, it's a virus

she snores like a trouper, sleeps with her mouth open, looks tired and pale and gets big purply bags under her eyes like she hasn't slept for a week

her tonsils are large but not infected -they are just big

she starts high school this year and one or 2 of the children she's currently in class with have started mentioning it to her not in a nice way

it's definitely not a dental problem

she does have hayfever and eczema but the bad breath does not discriminate amongst seasons

I need to get this sorted for her and don't want to be fobbed off again, or feed her daily antihisimines when we don't know what is actually causing it

can I insist on a referral?
if so should I be taking her to ENT or an allergy clinic?

Is there are any chance she has sinus problems. They are really difficult to diagnose in children. It took an mri scan to diagnose my sons sinus problems which were finally cleared up with a couple of courses of antibiotics. But he was miserable for about 6 months with it before then.
I took him to the gp because he was waking up in the morning with headaches and gp looked up his nose and said no sign of sinus problems. But because he had a febrile convulsion a few months early at 8 yrs old the gp referred him to a paed, who organized eye test, mri, eeg etc. All this took 6 months for them to come back saying the mri scan showed up infection in the maxillary sinus.
He has rhinitis and other food allergies and was prescribed flixonase which is a steroid nasal spray normally for 18+ as well as the antibiotics.

Have a look up about Halitosis in children, That can cause really bas breath.

Halitosis is bad breath

Please consider referral to a paediatrician, ideally one with an interest in sleep. Failing that, ENT. She may well have obstructive sleep apnoea...

"she snores like a trouper, sleeps with her mouth open, looks tired and pale and gets big purply bags under her eyes like she hasn't slept for a week"

Sounds like she might have enlarged adenoids as well as tonsils, and possibly some sort of obstructive sleep apnoea as a result. I think the referral would be to an ear, nose and throat clinic. I don't think you can insist on a referral but you could try a different GP surgery, suggest the diagnosis yourself, and see what they say.

Cross post with Tufferic

She does snort when she is asleep -could that be apnea?

Yep, specially if it's preceded by a pause, e.g., snore snore snore pause pause snort.

Ask for referral to ENT Consultant. I've heard problems with adenoids can cause bad breath, couple with snoring etc sounds like they might be problem. Good luck.