Let’s be honest. Parents love it when their children have a good night’s sleep. I mean, we love it when WE have a good night’s sleep, too! However, when kids sleep poorly, the impact on their behavior, learning, and health can be significant. Many times, when a child snores, poor sleep occurs.
Men snore twice as much as women and there seems to be a trend for boys to snore more than girls. Regardless of age or sex, most people will snore at some point in their lives. Chronic snoring can be a problem which can be associated with health and learning problems in kids.
What is snoring?
Snoring is actually just a description of the sounds we hear where the tissues in the respiratory tract vibrate as air flows past them. The sounds usually happen when the air is sucked in and can come from the nose, mouth or lower in the throat.
Some people snore immediately when they fall asleep, others only later in the deeper part of sleep.
I am often amazed at how differently we all perceive snoring. Snoring can be very loud and harsh, or it can be soft. It is still noisy breathing!
As a pediatric Ear, Nose and Throat surgeon, I ask parents on a daily basis if their child snores. Sounds like a basic question. I have to interpret the answers of YES, NO or ONLY WITH A COLD.
The YES answers tend to be very clear! Some parents lean forward and loudly answer:
- Oh yes. It’s awful
- Yes, you can hear it down the hall
- Yes, like a truck driver (not sure why this is such a common response. Do all truck drivers snore?)
- Yes, and it scares me.
When a child snores to such a degree that parents quickly provide the above descriptions, I know I need to aggressively seek answers and solutions because it is impacting the family in a significant way.
The “NO” and “ONLY WITH A COLD” answers allow me to move to my next line of questioning because some of these answers are really a YES! In some cases, parents are deciding on the degree of snoring instead of the presence of snoring. The YES answer can be hidden under qualifying descriptions because, for some reason, parents do not want the answer to be yes.
- Not really
- Not as bad as the sibling.
- No, because I reposition them to help them breath better
- No, but there is a constant noise while my child sleeps
When I hear answers such as these, I know I need to proceed more slowly to figure out what is actually happening. Often, these kids come to my office with complaints of something else and I “learn” that snoring is also a symptom but not a primary concern for parents…yet.
What can cause snoring?
Snoring can be caused by swelling or narrowing in many places in the upper airway. To be clear, this area is usually defined as the breathing area from the nose to the vocal cords. Any problem that can narrow each area can lead to snoring; however, problems in the voice box are usually NOT snoring and may be a much more serious problem called stridor.
Obesity is a general cause of snoring, regardless of age and sleeping on your back may make you more likely to snore.
Additionally, things that make the muscles in the upper airway relax can cause snoring. Common examples that occur in adults include alcohol, sleeping pills, and aging, while in kids it can be related to problems with weak muscle tone.
For purposes of this blog, I intend to focus on the common problem that may need to be considered when a child snores.
1. Nose: colds, allergies, crooked nose, sinus infections, nasal polyps, abnormal development of the nasal passageway
2. Nasopharynx (space behind the nose): large adenoid, tumors
3. Mouth: large tonsils, large tongue, long uvula (hanging in back of throat), acid reflux, poor chin development
Primary Snoring vs. Sleep Apnea
Snoring is kids is very common with about 10% of kids snoring. The snoring can be simple, short-term and irritating. Or it can be the symptom of a more serious disorder.
When a child snores but continues to sleep well, physicians often just watch and wait. However, when parents report a disrupted sleep pattern with excessive tossing and turning or awakening in the night, an evaluation may be needed.
Light snoring often does not significantly block the airway. As the snoring gets heavier, more blockage often occurs. Most of us have heard of sleep apnea where breathing temporarily stops throughout the night. Because 2-4% of kids develop sleep apnea, you should contact your child’s physician as soon as possible if you feel this could be present.
Sleep apnea in adults may be diagnosed using different criteria than in kids. For the 1 millionth time, kids are not just little adults!
When apnea is not present, we call it primary snoring. However, kids have a grey area where the problem is not simple or severe. Just as with most medical problems, there is a spectrum or range in severity.
Young kids with sleep-disordered breathing may need aggressive management, even if they do not fully develop sleep apnea.
What are the potential consequences of snoring?
We know how crabby we can be after a poor night of sleep. Imagine kids of all ages trying to function while being sleep deprived. It ain’t pretty!
Types of problems that you may notice in your snoring child may include:
- Social: Difficulty with sibling sleeping in same room, embarrassment at sleepovers and summer camp
- Behavior changes: Moody, lack of attention, disruptive at home and school, often diagnosed with ADD
- Learning: lack of focus often allows kids to fall behind in school
- Bedwetting: previously potty trained kids can become bedwetters again
- Reduced growth: growth hormone is usually released at night, and poor sleep may slow growth
- Weight gain: possibly due to daytime fatigue and reduced physical activity, evidence starting to show poor sleep associated with insulin resistance and poor metabolism.
- Heart problems: sleep apnea increases the risk of high blood pressure, heart and lung problems.
Many of the symptoms associated with snoring and sleep disturbance are mimicked by young kids and teens who do not sleep well due to a variety of other issues.
The take-home message is that when your child snores, it may not be “just snoring”. Often these children have chronic nasal congestion and breathe through their mouths. It is important to find out the cause of chronic mouth breathing so your child can take advantage of all the functions of the nose.
Allergies are a major cause of swelling in the nose but it is important to determine if you actually have allergies or another problem. If the diagnosis is made, a variety of nasal allergy treatments are available.
Your child’s pediatrician may refer your child to an ENT surgeon for a more thorough history and physical examination. We need to ensure our kids get a good night’s sleep! I also recommend you discuss over the counter sleep aids. Melatonin dosing is often too high and has potential side effects.
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