Research & Publications

Your Child Snores. Should You Be Concerned?

Date Posted: Sunday, August 3rd, 2014 by Alan Berger

Most parents are not even slightly concerned when hearing a child snore. Unfortunately, despite the “cute” factor, snoring may indicate medical problems and contribute to developmental issues.

Causes of Childhood Snoring

Unlike snoring in adults, snoring in children usually is not caused by traditional “obstructive sleep apnea” which is often related to obesity. Childhood snoring is most commonly caused by one of three things:

• Small anatomy: Some children may have smaller than normal jaw structures or airways. In many cases, children grow out of it, but this doesn’t preclude the need for medical attention
• Poor muscle-nerve integration: In some cases the muscles and nerves controlling neck, mouth and breathing muscles are not working together and don’t open the airway. As the child matures these systems may begin to work together.
• Enlarged tonsils and adenoids: Tonsils and adenoids are structures at the back of the throat which are a part of the immune system. In some cases they are naturally larger than normal but in many cases, they have become larger due to allergies or repeated respiratory infections. Enlarged tonsils and adenoids may block the airway and lead to snoring.

Snoring in Kids Can Have Medical and Developmental Consequences

Even though snoring may not appear to be harmful, it can cause medical and developmental consequences. It may indicate sleep apnea which occurs in about three percent of children ages 1 to 9 or it may indicate upper airway resistance syndrome. Either condition should be evaluated by a sleep specialist.

Apnea causes momentary lapses in breathing which cause oxygen levels to drop and carbon dioxide levels to rise. The child wakes because of snoring and decreased oxygen levels. Sleep apnea in children can be caused by childhood obesity but it may be caused by poor muscle tone in the neck that may be hereditary. And, as mentioned, it is also caused by allergies which result in nasal membrane swelling and enlarged tonsils. Children who are exposed to smoking also have a higher risk of apnea.

Upper airway resistance syndrome does not usually cause decreases in oxygen intake or increases in carbon dioxide intake but the snoring may wake the child up due to loudness or because of the effort required to breath. This may cause restless sleeping and result in a lack of quality sleep. If the brain is unable to complete the normal sleep cycle due to intermittent waking, it cannot properly rest and restore itself.

Problems day and night

Siblings who sleep with a child with apnea may complain as the child may frequently suddenly toss and turn or kick. Many children with sleep apnea are also bed-wetters as the loss of regulation in the sleep cycle makes them unwilling or unable to get out of bed to urinate. Those with nasal allergies and respiratory related sleep apnea may also become “mouth breathers” which can contribute to the development of dental cavities due to extra bacterial growth in the mouth.

Children with sleep disturbances caused by snoring can have difficulty concentrating during the day. The brain has not gone through the normal sleep cycle and the quality of sleep has been poor. Because the brain is fatigued, the child may act out and appear as if they are hyperactive.

Cognitive learning may also be affected if the brain has not received enough oxygen or the sleep has continuously been interrupted. A study conducted at the University of Louisville showed that children with poor grades were more likely to have sleep apnea than other children. In cases where the sleep apnea was treated, grades improved. Some evidence has also shown that long-term sleep apnea may cause irreversible loss in IQ measurements, meaning that childhood sleep apnea may cause lifelong disability.

As in adults, episodic wakening and low oxygen levels can also create strain on the heart and lead to high blood pressure and the effects are cumulative if the child has a family history of heart disease. Other lasting effects are similar to those in adults as well including the link to sleep apnea and obesity. Poor sleepers often eat more and exercise less due to the body’s search for energy and lack of ability to act.

Treatment of Snoring in Kids

Unlike adults, the most common fix for sleep apnea in kids is to remove enlarged tonsils and adenoids that are causing the problem. Tonsillectomies and adenectomies will need to be performed by an ear, nose and throat specialist. It is a surgical procedure but it is effective in most cases.

In cases where sleep apnea is not caused by enlarged tonsils or adenoids, orthodontic measures may correct jaw positioning but other case may warrant consideration of CPAP or BIPAP measures, particularly if obesity is involved.

If a parent notices snoring and observes that this is accompanied by bed-wetting, hyperactivity, school performance or other complaints such as nightmares or morning headaches, the child’s pediatrician should be advised so that an appropriate sleep disorder evaluation can be performed.

Sources

(1) American Academy of Pediatrics: Snoring Linked to Behavior Problems in Children http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Snoring-Linked-to-Behavior-Problems-in-Children.aspx (3/5/2012)

(2) National Sleep Foundation: Snoring in Children http://sleepfoundation.org/sleep-news/snoring-children (December 2009)

(3) UCLA health, Sleep Disorders Center: My Child Snores http://sleepcenter.ucla.edu/body.cfm?id=51 (2014)

(4) American Sleep Apnea Association: Children’s Sleep Apnea http://www.sleepapnea.org/treat/childrens-sleep-apnea.html (2014)

(5) American Academy of Physiological Medicine and Dentistry: Child Growth and Development http://www.aapmd.org/medical-problems/child-growth-and-development.html (2012)

Author:
Alan S. Berger, M.D.