Children and Snoring
Does Your Child Snore?
If so, you are not alone. Researchers have found that 20% of normal children snore occasionally, and 7% to 10% of children snore every night. In many cases, children who snore are perfectly healthy. Still, about 2% of children snore because they suffer from sleep or breathing problems. As a parent, you need to be aware of your child’s sleep and snoring patterns. If you suspect a problem or notice something out of the ordinary, you should seek the advice of a sleep specialist.

A child who struggles to breathe while snoring may be suffering from obstructive sleep apnea syndrome (OSAS). With OSAS, a child may snort or gasp while snoring, and may appear to "suck in" the chest. OSAS is described as breathing that starts and stops during sleep. The stoppage is usually caused when the throat narrows or even closes during sleep.

How do I know if my child’s Snoring is Serious?
Sleep specialists know that there is a continuum from sleep to snoring that is associated with the diagnosis of OSAS. Primary snoring is "normal" and is not dangerous for your child; however OSAS is a condition that can have more serious effects. Children with OSAS may have difficulty sleeping at night and show behavioral problems during the day. Undiagnosed OSAS can lead to problems at school, delayed growth, and even heart failure because of decreases in blood oxygen levels. Both boys and girls can suffer from OSAS, and usually have some of the following symptoms in common:
  • Sleep in an abnormal position, with head off the bed or propped up on many pillows. Snore loudly and often.
  • Stop breathing during the night for a short period- followed by snorting or gasping or completely waking up.
  • Sweat heavily during sleep.
  • Have school or other behavioral problems.
  • Sleep Restlessly
  • Are difficult to wake up, even though sleep should have been long enough
  • Have headaches during the day, particularly in the morning
  • Are irritable, aggressive, or simply "cranky"
  • Fall asleep or daydream in school or at home
  • Have attention deficit disorder with hyperactivity (ADHD)
  • Bedwetting (enuresis) that isn’t outgrown at a typical age (especially if snoring is present)
Some of these symptoms are similar to those described in children with ADHD, such as trouble concentrating, hyperactivity, and nervousness. In fact some children are misdiagnosed as having SDHD when they are actually suffering from OSAS. OSAS can also occur along with ADHD and actually make the ADHD symptoms worse. If you have noticed that your child has some of the above symptoms, you should talk to your pediatrician about seeing a sleep specialist.

What Really Happens When My Child Stops Breathing?
Your child’s muscles are more relaxed during sleep than they are during waking hours, including the muscles used in breathing. In some children with OSAS, the throat muscles relax too much and interfere with breathing. In other children the muscles relax normally during sleep, but a narrower-than-normal throat passage allows the throat to close. In either case, when the child tries to breathe, he or she experiences something like trying to slurp a drink through a floppy, wet paper straw. You may hear deep gasps as your child’s breathing starts, and each gasp may awaken your child for a few seconds.

Anything that makes the throat more narrow or floppy can increase the risk for OSAS. This includes enlarged tonsils and adenoids, or an abnormality in your child’s face or jaw area. Sleep apnea is also common in children with Down’s syndrome and other congenital problems that may affect the nervous system or structure of the face. Other factors known to increase the risk of OSAS in children include: African American race/ ethnicity, obesity, premature birth and having another family member with OSAS.

Allergies and a "stuffy nose" may cause snoring, but rarely lead to OSAS. However, certain sedative medications can promote snoring or slow breathing in children with OSAS.

How do I find out for sure if my child has OSAS?
You should visit a sleep specialist who has experience with children to determine if your child has OSAS. The specialist will record your child’s sleep for at least one night in a laboratory with a test called Polysomnography (PSG). This is the only way to find out if your child has obstructive sleep apnea syndrome or primary snoring. During that night, the specialist will place sensors or electrodes on your child’s head and body to monitor sleep patterns. The specialist will also record brain waves, leg and arm movements, muscle activity, heartbeat, and breathing patterns. These monitors do not pose any danger to your child and are not painful. Most of the time (except maybe for teens) parents should stay with their children during the overnight testing and let the sleep lab staff know if the study night was typical of the child’s usual sleep and breathing. Aside from determining OSAS or primary snoring, the study shows how serious the OSAS is so the specialist can decide on the best treatment.

What are the treatment options?
1. Surgery
In many children, enlarged tonsils and adenoids are the cause of OSAS and your doctor will recommend removing them. This surgical procedure is called adenotonsillectomy (surgical removal of the tonsils and adenoids). Other more specialized surgery may be recommended if your child has a structural problem causing OSAS. Sometimes surgery can stop snoring even though it does not cure OSAS. A second PSG, a few months after surgery, may be needed to be sure the OSAS has been cured.

2. Other Treatments
Nasal continuous positive airway pressure (CPAP) is a small mask worn over the nose during sleep. The mask provides air pressure that keeps the throat from closing during sleep. This is very helpful for children when surgical treatment is not possible or desirable, or when surgery does not cure the OSAS.

3. Lifestyle Change
If your sleep specialist thinks that obesity may be contributing to your child’s OSAS, he or she may recommend weight loss by means of a combine diet, exercise, and behavioral program. Even if other treatments are used, weight loss in an overweight child with OSAS should always be a long term goal.
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