Snoring in children

It’s common for children to snore when they have a cold, but frequent snoring in young children and toddlers is not normal, it’s a sign of a serious medical problem that should be treated by a doctor. Snoring disturbs your child’s sleep which over time can decrease their ability to focus, and cause behavioral issues.

Snoring happens when a person can’t move air freely through his or her nose and mouth during sleep. That annoying sound is caused by certain structures in the mouth and throat — the tongue, upper throat, soft palate, uvula, as well as big tonsils and adenoids — vibrating against each other (see Figure 1).

Sleep apnea or obstructive sleep apnea (OSA) is a common problem that affects an estimated 2% of all children, including many who are undiagnosed. If not treated, sleep apnea can lead to a variety of problems. These include heart, behavior, learning, and growth problems.

Symptoms of sleep apnea include:

• Frequent snoring
• Problems breathing during the night
• Sleepiness during the day
• Difficulty paying attention
• Behavior problems

If you notice any of these symptoms, let your child’s doctor or pediatrician know as soon as possible. Your pediatrician may recommend an overnight sleep study called a polysomnogram. Overnight polysomnograms are conducted at hospitals and major medical centers. During the study, medical staff will watch your child sleep. Several sensors will be attached to your child to monitor breathing, oxygenation, and brain waves (electroencephalogram or EEG).

The results of the study will show whether your child suffers from sleep apnea. Other specialists, such as pediatric pulmonologists, otolaryngologists, neurologists, and pediatricians with specialty training in sleep disorders, may help your pediatrician make the diagnosis.

Figure 1. Throat anatomy

Causes of snoring in children

You’ll notice your child snoring when their breathing is blocked. Here are some of the most common causes of snoring:

• Seasonal allergies can make some people’s noses stuffy and cause them to snore.
• Blocked nasal passages or airways (due to a cold or sinus infection) can cause a rattling snore.
• A deviated septum is when the septum (the tissue and cartilage separating the two nostrils in your nose) is crooked. Some people with a very deviated septum have surgery to straighten it out. This also helps them breathe better — not just stop snoring.
• Enlarged or swollen tonsils or adenoids may cause a person to snore. Tonsils and adenoids (adenoids are glands located inside of your head, near the inner parts of your nasal passages) help trap harmful bacteria, but they can become very big and swollen all of the time. Many kids who snore have this problem.
• Being overweight can cause narrowing of the air passages. Many people who are very overweight snore.

Snoring is also one symptom of a serious sleep disorder known as obstructive sleep apnea (OSA). Obstructive sleep apnea causes periods of decreased airflow and pauses in breathing. When a person has obstructive sleep apnea (OSA), his or her breathing is irregular during sleep. Typically, someone with obstructive sleep apnea (OSA) will actually stop breathing for short amounts of time 30 to 300 times a night! As a result, your child may experience drops in oxygen while sleeping. It can be a big problem if the person doesn’t get enough oxygen. When left untreated obstructive sleep apnea can have long-term effects, including elevated blood pressure.

People with obstructive sleep apnea often wake up with bad headaches and feel exhausted all day long. They may be very drowsy and have difficulty staying awake while having a conversation or even while driving. Kids affected by obstructive sleep apnea may be irritable and have difficulty concentrating, particularly in school and with homework.

What is obstructive sleep apnea?

Sleep apnea is when a person stops breathing during sleep. It usually happens because something obstructs, or blocks, the upper airway. This is called obstructive sleep apnea. Sleep apnea is a common problem that affects an estimated 2% of all children, including many who are undiagnosed.

Obstructive sleep apnea (OSA) can make the body’s oxygen levels fall and interrupt sleep. This can make kids miss out on healthy, restful sleep. Untreated obstructive sleep apnea can lead to learning, behavior, growth, and heart problems.

What causes obstructive sleep apnea?

When you sleep, your muscles relax. This includes the muscles in the back of the throat that help keep the airway open. In obstructive sleep apnea, these muscles can relax too much and collapse the airway, making it hard to breathe.

This is especially true if someone has enlarged tonsils or adenoids (germ-fighting tissues at the back of the nasal cavity), which can block the airway during sleep.

Other things that can make a child likely to have it include:

• a family history of obstructive sleep apnea
• being overweight
• medical conditions such as Down syndrome or cerebral palsy
• problems of the mouth, jaw, or throat that narrow the airway
• a large tongue, which can fall back and block the airway during sleep

What are the signs and symptoms of obstructive sleep apnea?

When breathing stops, oxygen levels in the body drop and carbon dioxide levels rise. This usually triggers the brain to wake you up to breathe. Most of the time, this happens quickly and you go right back to sleep without knowing you woke up.

This pattern can repeat itself all night in obstructive sleep apnea. So people who have obstructive sleep apnea don’t reach a deeper, more restful level of sleep.

Signs of obstructive sleep apnea in kids include:

• snoring, often with pauses, snorts, or gasps
• heavy breathing while sleeping
• very restless sleep and sleeping in unusual positions
• bedwetting (especially if a child had stayed dry at night)
• daytime sleepiness or behavior problems
• sleepwalking or night terrors

Because it’s hard for them to get a good night’s sleep, kids might:

• have a hard time waking up in the morning
• be tired or fall asleep during the day
• have trouble paying attention or be hyperactive

As a result, obstructive sleep apnea can hurt school performance. Teachers and others may think a child has ADHD or learning problems.

How is obstructive sleep apnea diagnosed?

Talk to your doctor if your child:

• snores regularly
• is a restless sleeper
• falls asleep during the day
• has other signs of sleep apnea

Your doctor might refer you to a sleep specialist or recommend a sleep study.

A sleep study also called a polysomnogram, can help doctors diagnose sleep apnea and other sleep disorders. Sleep studies are painless and risk-free, but kids usually need to spend the night in a hospital or sleep center.

During a sleep study, doctors check:

• eye movements
• heart rate
• breathing patterns
• brain waves
• blood oxygen levels
• carbon dioxide levels
• snoring and other noises
• body movements and sleep positions

How is obstructive sleep apnea treated?

When obstructive sleep apnea is mild, doctors might check a child’s sleep for a while to see if symptoms improve before deciding on treatment.

Many children with sleep apnea have larger tonsils and adenoids. The most common way to treat sleep apnea is to remove your child’s tonsils and adenoid.

When big tonsils cause sleep apnea, doctors will refer families to an ear, nose, and throat doctor (ENT). The ENT (otolaryngologists) might recommend:

• removing the tonsils (a tonsillectomy)
• removing large adenoids (adenotonsillectomy)

These surgeries often are effective treatments for obstructive sleep apnea.

For other causes, a doctor may recommend continuous positive airway pressure (CPAP) therapy. In CPAP therapy, the child wears a mask while he sleeps. The mask may cover the nose only or the nose and mouth. It’s connected to a machine that pumps air to open the airways. The mask delivers steady air pressure through the child’s nose, allowing him to breathe comfortably. Continuous positive airway pressure is usually used in children who do not improve after tonsillectomy and adenoidectomy, or who are not candidates for tonsillectomy and adenoidectomy.

Children born with other medical conditions, such as Down syndrome, cerebral palsy, or craniofacial (skull and face) abnormalities, are at higher risk for sleep apnea. Children with these conditions may need additional treatments.

Overweight children are also more likely to suffer from sleep apnea. Most overweight children will improve if they lose weight, but may need to use CPAP until the weight is lost.

When excess weight causes obstructive sleep apnea, it’s important to work with a doctor on diet changes, exercise, and other safe weight-loss methods.

Signs your child’s snoring may be something more

If you are concerned about your child snoring, here are some things to pay attention to at night and during the day.

At night:

• Does your child snore on a regular basis?
• Are there gasps or pauses when your child wakes up?
• Does your child ever seem to stop breathing while asleep?
• Do you notice heavy sweating during sleep?

During the day:

• Is your child difficult to wake up?
• Is your child irritable and cranky?
• Do they have frequent headaches or fall asleep during the day?
• Is your child experiencing behavioral problems?

Observe your child’s habits and discuss what you see with your child’s primary care provider. In some cases, he or she may refer you to a sleep specialist at Children’s Hospital of Philadelphia to evaluate your child.

Snoring in children diagnosis

Your doctor will look in your child’s throat to check out her tonsils. Your child’s doctor might send your child to an ear, nose and throat (ENT) specialist if there’s a chance that your child’s adenoids or tonsils or a nose obstruction is causing the snoring, or if the doctor thinks that obstructive sleep apnea (OSA) might be the problem.

The doctor might recommend that your child uses an oximeter. This tool measures your child’s oxygen levels during the night to find out whether there are any times when he stops breathing.

Snoring in children treatment

Snoring that isn’t related to obstructive sleep apnea (OSA) and other conditions is usually more of a nuisance than a danger. Encouraging your child to sleep on her side, rather than her back, might help with this kind of snoring.

If a blocked nose is causing the snoring, the doctor might get your child to try a corticosteroid nasal spray.

If your child has recently gained some weight, your doctor might suggest a gentle exercise and weight loss program.

If your child’s snoring is linked to obstructive sleep apnea (OSA) caused by enlarged adenoids or tonsils or a nose obstruction, your doctor might refer you to a surgeon or ear, nose and throat specialist for advice about having surgery.