A child health nurse shares the warning signs to look out for in your child's snores.
Should I be worried?
Snoring is not uncommon in young children, around 15-20 percent snore, especially when they have a cold and their nose is stuffed up. But there’s a difference between snoring and sleep apnoea which happens when the child’s airways block the smooth flow of air into and out of their lungs. Sleep apnoea is always a problem and can have short and long-term effects on a child’s growth, development and behaviour.
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Snoring can be cute but it can also be a sign of something dangerous. Source: iStock
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What is obstructive sleep apnoea?
Obstructive sleep apnoea, also known as OSA, happens when the upper airway muscles relax during sleep, causing partial or complete obstruction of the upper airways. This means there is a flow-on effect to the levels of oxygen and carbon dioxide in the child’s body. As their oxygen level drops, the child wakes, takes a few breaths and then (hopefully) goes straight back to sleep.
Why would my toddler have sleep apnoea?
Some children are more at risk of OSA than others, though it has a lot to do with the size and shape of a child’s upper airways. Children who have a flat face or a very small jaw are more likely to have sleep apnoea. The shape, size and capacity of the airways to stay open all play a role.
Sometimes the structures in the airway above the vocal cords are lax. If the child has enlarged tonsils and/or adenoids, then there is less space for the air to flow smoothly. Recurrent viral infections can also increase the risk of sleep apnoea and so can long-term allergies and/or hay fever.
Children who live in households where the adults smoke or they are exposed to cigarette smoke are also more likely to have OSA.
Children who are overweight, much like adults with a ‘fat tongue’ are also at increased risk of OSA. And having recurrent viral infections with colds also places them at increased risk.
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Sleep apnoea can leave your child sleepy and cranky. Source: iStock
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Problems with snoring and Obstructive Sleep Apnoea
Because children with OSA wake more often, they tend to be tired a lot of the time. They never really get enough deep, restorative sleep which sustains their energy levels through the day. They are more prone to emotional meltdowns and moodiness so there’s more likelihood of tantrums.
If left untreated, OSA can also affect learning outcomes because the child struggles with their impulse control and concentration.
Children grow when they are sleeping. They release growth hormones, conserve energy and consolidate memories. Sleep apnoea has a direct impact on the stages of sleep. For children who don’t have enough opportunity to transition between sleep phases e.g., light sleep, deep sleep, rapid eye movement (REM) when dreaming happens, they are more likely to be irritable and cranky the next day.
Should I have my toddler’s snoring checked?
Any snoring needs to be medically investigated. Most often the cause of snoring is due to enlarged tonsils and/or adenoids. These are similar to the lymph nodes found in the rest of the body and play a role in immune function. When the body is fighting an infection, the tonsils and adenoids enlarge which causes a barrier to the flow of oxygen.
How would my child be tested?
A sleep study or polysomnography is a way to confirm if a child has sleep apnoea. Specialised equipment is attached to their head, legs and chest as a means of recording information and to measure a child’s behaviour when they are sleeping. Information is also gathered about the way they are breathing and their oxygen and carbon dioxide levels in relation to their stage of sleep.
Treatment for snoring in children
In around 80-90 percent of children, removal of the tonsils and adenoids cures sleep apnoea. Weight loss also helps for children who are overweight and/or obese. If allergies are the cause, medication can make a difference. In some children using a CPAP (Continuous Positive Airways Pressure) machine helps to keep the airways open and assist with breathing when they sleep.
Have your child’s snoring checked if:
- You are worried or just want reassurance that the noise your child makes when they are sleeping is normal. Take a video of them sleeping (with sound on) to take with you for the appointment.
- They snore loudly, have pauses in their breathing and seem to have difficulty breathing when they are sleeping.
- They sleep in an unusual position e.g., high up on pillows or need to sleep propped up.
- You feel that they are constantly tired and their behaviour is affected by sleep deprivation.
- They are breathing through their mouth when they are awake as well as when they are sleeping.
To ask your GP for a referral to an ENT (Ear, Nose and Throat) specialist if you are worried or need a specialist opinion.
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Written for Kidspot by Jane Barry, Midwife and Child Health Nurse.