When to Worry About Your Child's Snoring

Child sleeping with mouth open

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Almost everyone has awoken in the night at least once to snorts, groans, or snores coming from the other side of the bed. But in these cases, a swift kick or shove of your partner typically quiets the freight train so you can roll over and go back to sleep.

When you hear those sounds coming from your child’s room, however, it’s a different story. And while occasional snoring isn’t typically cause for concern in little ones, heavy or labored breathing on a regular basis may be a sign of something else going on—namely pediatric obstructive sleep apnea. Here, learn when you may need to worry about your child’s snoring, plus everything you need to know about pediatric obstructive sleep apnea.

When Snoring Is Cause for Concern

Young children can be noisy sleepers—moaning, crying, groaning, and rolling in their sleep. But what about snoring? “Light snoring can be normal and is not always cause for concern,” says Rachel Mitchell, CEO of My Sweet Sleeper, a maternity and sleep consulting company.

“When children, especially young children and infants, snore regularly and heavily and it is coupled with other symptoms, such as sleeping with their mouth open and not seeming rested after sleeping through the night, it should definitely be brought up with their pediatrician to rule out sleep apnea,” notes Mitchell. “Similarly, if the child seems to have sudden gasps for air and sounds like they are struggling to breathe, this would be cause for concern.” 

Occasional snoring that doesn’t happen all night every night is probably OK and could be the result of something as simple as a cold or allergies. It’s when snoring becomes frequent and rhythmic and begins to sound like an adult’s snoring that you may want to visit the pediatrician.

Pediatric Obstructive Sleep Apnea

Once you’ve decided to see a doctor about your child’s snoring, the first cause they may suspect is pediatric obstructive sleep apnea (OSA). Here’s everything you need to know about the condition.

Signs of Sleep Apnea

The most common symptom of OSA in kids is habitual snoring, says Michelle Caraballo, MD, pediatric pulmonologist and sleep medicine specialist at Children’s Health and an assistant professor of pediatrics at UT Southwestern Medical Center. “These are usually kids who snore on a regular basis, not just when they're sick, congested, or allergies are flaring,” she explains.

Other symptoms that you may notice while your child is asleep include mouth breathing, pauses in breathing, labored breathing, gasping for air, or frequent nighttime awakenings. You’ll see the effects when your child is awake, too.

“Daytime manifestations of disrupted sleep in children may include behavior problems, inattention or hyperactivity (ADHD symptoms), learning difficulties, or daytime sleepiness,” says Dr. Caraballo. “Though notably, daytime sleepiness is a much less common symptom [of OSA] in children compared to adults.”

Possible Causes

In the majority of cases, OSA in children is caused by enlarged tonsils and adenoids. Adenoids are patches of soft lymph tissue that sit in the throat behind the nose and may obstruct the upper airway. Even though this is the most common cause of sleep apnea, it is not always a perfect correlation. “There are children with OSA with small tonsils and adenoids, and conversely there are children with very enlarged tonsils and adenoids, with no symptoms suggestive of OSA," says Dr. Caraballo.

While the tonsils and adenoids blocking the airway are the physical cause of the snoring and other symptoms, there are a few risk factors that can increase the likelihood of OSA occurring. These include obesity, lymphoid hyperplasia (when there are more cells than normal in your lymph nodes), craniofacial abnormalities (birth defects of the face and head), and neuromuscular dysfunction.

How Its Diagnosed

A sleep study is used to diagnose OSA in children. “This is a one-night test done in a sleep lab where several parameters are monitored such as oxygen levels, carbon dioxide levels, airflow through the nose, heart rate, brain waves, and body movements,” explains Dr. Caraballo. From there, healthcare providers will use all of the data to determine different statistics of your child’s sleep that are used in making the diagnosis.

The most important statistic is the apnea/hypopnea index (AHI), which is a measure of the average number of times per hour your child stops breathing (apnea) or breathes shallowly (hypopnea). Anything over one event an hour is considered abnormal in children up to 13 years old and would yield a diagnosis of OSA.

If you’re worried that the sleep study will be scary for your child, Dr. Caraballo says there is nothing to fret about. “I reassure parents that though there are many cables and monitors, there are no needles involved or anything painful to the child.”

Treating Obstructive Sleep Apnea in Kids

There are a few different ways that healthcare providers will treat OSA, depending on the case. “As enlarged tonsils and adenoids is the most common cause of OSA in children, the recommended first-line treatment is the surgical removal of the tonsils and adenoids, which is done by an otolaryngologist, or ENT physician,” Dr. Caraballo explains. “In otherwise healthy children who are not obese, this surgery cures sleep apnea much of the time.”

Surgery is recommended for kids with severe OSA or those who have an AHI over nine events per hour. For those with mild to moderate OSA, or an AHI between one and nine, “watchful waiting” for up to six months is sometimes suggested. During those six months, healthcare professionals recommend using lifestyle strategies to target any underlying problems, such as obesity, that may be contributing to OSA.

In kids who have other factors contributing to their OSA, are not good surgical candidates, or continue to have symptoms after surgery, the next recommended treatment is continuous positive airway pressure (CPAP). With this treatment, the child wears a soft mask over their nose and/or mouth to sleep, which is connected to a box via a tube. “The box delivers air concentrated at a higher flow rate to basically stent open the airway wherever the obstruction occurs,” Dr. Caraballo explains.

While CPAP is an attractive option for some families since it is neither medication nor surgery, it does present some challenges in children. “The younger and smaller they are, it can be challenging to find a mask that fits well without significant leak and tolerance, which can be a barrier,” notes Dr. Caraballo. “Children who need CPAP should be followed by a sleep specialist who can help with desensitization strategies to ensure successful use and effectiveness of therapy.”

A Word From Verywell

Snoring in children is not always a cause for concern. But when snoring becomes regular and heavy and it is clear that the child isn’t getting restful sleep, it's best to visit your pediatrician. Pediatric obstructive sleep apnea may be causing your child’s snoring, a diagnosis that can be confirmed with a sleep study and treated with surgery or other interventions. While some snoring and other sleep noises are often totally normal, don’t hesitate to contact your pediatrician or healthcare provider if you have concerns.

1 Source
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  1. Gouthro K, Slowik JM. Pediatric obstructive sleep apnea. In: StatPearls. StatPearls Publishing.