Aside from the brief periods of time when your child has a cold, which may block the nasal passage ways, snoring that occurs frequently is abnormal and should be evaluated.
Primary snoring happens when something is blocking the air from passing through the back of your child’s throat, causing a vibration. And it can cause your child to sleep poorly, which can lead to decreased focus and concentration, lowered IQ scores, behavioral issues and even hyperactivity.
Primary snoring can be caused by many different things, but in kids the most common causes are: enlarged tonsils and adenoids, blocked nasal breathing from enlarged turbinates (the inner lining of the nasal path), allergies, or a deviated septum. It can also be due to narrowing of the airway based on how your child’s airway is shaped, or from weight gain. About 10-20% of kids snore on a regular basis.
So what can be done?
Depending on a child’s age, sometimes “watchful waiting” is recommended, especially for older children, because a child’s tonsils and adenoids get larger until age six or seven years of age and then slowly get smaller over time.
Some children who snore as a result of a nasal obstruction like allergies may benefit from a nasal steroid, an antihistamine, or even salt water nasal rinses. Some more recent studies show that monteleukast (a leukotriene inhibitor medication like Singulair) can reduce adenoid size while also treating allergies.
For up to 10% of children who snore (or 2-4% of all children in the U.S.), the snoring can be a sign of a more serious problem, like obstructive sleep apnea. This is an important differentiation to make, because sleep apnea can cause pauses in breathing or periods of decreased airflow in and out, which can subsequently contribute to drops in oxygen or arousals during sleep. And it can have long-term consequences if left untreated, like problems at school, delayed growth, high blood pressure, and even heart failure in some rare cases.
The good news is that studies have shown that learning, heart and lung problems related to a child’s snoring or obstructive sleep apnea are reversible.
But how do you tell the difference between primary snoring and sleep apnea?
First, I’d like to be clear that primary snoring, regardless of the presence of apnea or not, is a cause for more investigation. But obstructive sleep apnea is the more concerning of the two conditions. Here are some warning signs that may indicate your child has obstructive sleep apnea:
- Gasping or snorting along with snoring, and pauses in breathing
- Sleeping in abnormal positions
- Snoring loudly and often
- Sweating heavily during sleep
- Sleeping restlessly
- Difficulty waking in the morning, even after a long time in bed
- Hyperactivity, trouble with concentration, possible ADHD diagnosis
Participating in a sleep study in a pediatric sleep laboratory is the only way to definitively determine whether or not your child has sleep apnea. While some sleep apnea can be managed with medications and lifestyle changes, other children may need surgery – often tonsil and adenoid removal – to fix the problem. Others may require positive airway pressure to fully treat obstructive sleep apnea.
It is also important to note that there is a strong link between obstructive sleep apnea and certain medical conditions like Down syndrome, obesity, craniofacial abnormalities, diseases like mucopolysaccharidoses (a genetic disorder), and children with low tone.
Because of the strong connection with Down syndrome, the American Academy of Pediatrics recommends that every child with the condition have a sleep study between 3 and 5 years of age, regardless of symptoms. It is important to have this procedure done at a pediatric facility because they will use pediatric scoring and measure parameters like carbon dioxide levels to evaluate your child, which is most accurate.
The bottom line is that if you have any concerns about your child’s snoring, or if he or she has regular snoring beyond a brief cold, you should discuss this with your pediatrician because it is not normal and can have long-term consequences if left untreated. He or she may refer your child to a pediatric otolaryngologist or a pediatric sleep center for further evaluation.
Editor’s note: Information included in this blog post was originally published in the spring edition of Young & Healthy.