My Child Snores. Is Something Wrong?

It’s already 10 p.m. at night and the house is fast asleep. Now, what happens when the loud, gurgling sounds at night that you’re familiar with your partner making actually turn out to be sounds being emitted from your precious little child? It could be simple snoring, or it could be something a little bit more worrisome.
 
Snoring is actually one clinical entity along a spectrum of diagnosis of what physicians refer to as sleep disordered breathing. Put simply, at night our breathing patterns differ from when we are awake because our body is in a relaxed state. There can arise moments of obstruction in our airway, which results in disordered breathing such as snoring. More than not it is just that stuttering sound that keeps bed partners awake. But in some cases it could be more concerning, and that term is known as obstructive sleep apnea (OSA).
 

OSA in Children

Obstructive sleep apnea can occur in children, and with relative frequency. Like their adult counterparts, various issues can cause OSA in children. However, the most common source are the tonsils and the adenoids. Adenotonsillectomy, or removal of the adenoid and tonsillar tissue, is actually one of the most common surgical procedures performed on children in the United States. Sleep disordered breathing is the main indication for doing so.
 
Children with sleep disordered breathing usually suffer from symptoms related to breathing difficulty during sleep. Many parents describe their child as having breathing pauses at night and intermittent gasping for breaths. Some children are described as mouth breathers — children who do so can sometimes be identified by having dry lips as they simply keep their mouth open throughout the evening.


Apart from breathing abnormalities, there are other signs parents can be on the lookout for. Although we all know that bed wetting is common in certain age groups, children with OSA can have more episodes than their counterparts without OSA. In terms of daytime symptoms, children can be relatively hyperactive and some may carry a diagnosis of attention deficit hyperactivity disorder, or ADHD. This is in stark contrast to adults with OSA, as that patient population typically complain of significant daytime sleepiness.
 

Tonsils and Adenoids

Tonsils and adenoids are lymphoid tissue, so many times early on they have a key role in assisting in warding off infections. But as we grow older their role doing this lessens. The tonsils, which many of us have seen in the back of our mouth, can enlarge and shrink depending on inflammation (i.e. having a cold, tonsillitis). Many parents will state that their child’s breathing at night can sometimes worsen when they are sick; this enlargement of the tonsils is sometimes the main reason why.
 
The adenoids are also lymphoid tissue, but they lie in the back of the nasal cavity. We all have one adenoid pad in the central back part of the nose. These adenoids too can grow and obstruct the nasal airway just as the tonsils can, causing patients to feel like they have a blocked nose or to snore when sleeping.
 

Should I Have It Checked Out?

If the symptoms previously described occur, it is important to contact your physician to evaluate whether or not there is a need for treatment. Sometimes allergies can play a role and adequate medical treatment of allergic rhinitis can improve symptoms. In other instances, surgical management may be more appropriate. This can sometimes include removing the tonsils or adenoids, or both together. It is important to consult a surgeon to decide if that is a reasonable option.
 
In some patients, a sleep test, or polysomnogram (PSG), may give both the parent and physician some insight into what is truly going on while the patient is sleeping, and it is what we call the gold standard in diagnosing OSA. The results can tell parents if the child stops breathing at night or if he/she has any issues with oxygen levels that drop. The results can give parents more information before proceeding with the best treatment plan.
 
Snoring for the most part is what we’re all familiar with, that loud rattling sound that can keep your bed mate up at night. But, in rare instances it may indicate something that could have an easy treatment plan to help you and your child achieve better sleep and better energy.

 
Assist. Prof. Dr. Dhave Setabutr is a U.S. board-certified specialist in otolaryngology and
pediatric otolaryngology (Ear, Nose, Throat) at Bumrungrad International Hospital