My Child Snores Loudly: When Should I Worry?

Have you noticed your child snoring? We see many children with snoring problems at our ENT clinics in Singapore. As a paediatric ENT doctor in Singapore, we know that many children snore occasionally, with about 10% of children snoring on most nights. So why do some children snore whilst others don’t? Snoring occurs during sleep when the child is breathing in and there is some blockage of air passing through the back of the mouth. The opening and closing of the air passage causes vibration of the tissues at the back of the throat. The loudness of the child’s snoring is affected by how much air is passing through and how fast the throat tissue is vibrating. Simple or primary snoring means that the child’s snoring is not associated with more serious problems such as obstructive sleep apnoea syndrome (OSAS), frequent arousals/awakenings from sleep, or inability of the lungs to breathe in sufficient oxygen.

But is snoring in your child normal? Loud and regular nightly snoring is actually often abnormal in otherwise healthy children. Sometimes it is a sign of a respiratory infection (a bad cold or flu), a stuffy nose or allergy (sensitivity of the lining of the nose to different things around us). But in other cases of snoring children, it may be a symptom of sleep apnea.

The American Academy of Pediatrics recommends that all children should be screened for snoring and that a diagnosis be undertaken to check if a child is experiencing normal primary snoring or obstructive sleep apnoea syndrome (OSAS), which is far more worrying.

About 1-3% of children not only snore, but also suffer from breathing difficulties during their sleep. When snoring is also accompanied by gasps or pauses in breathing, the child may have OSAS. Other worrying signs which may mean that the snoring child is suffering from undiagnosed sleep apnoea, include restless sleep movements, frequent waking up at night (nocturnal waking episodes), strange sleep positions like sleeping with their bottoms stuck upwards in the air and their faces twisted upwards with mouth open to breathe. Some children who snore, also present with recurrent problems of bedwetting at night (enuresis).

Children’s muscles usually relax during sleep but they can become so relaxed that the airway is narrowed or obstructed, so not enough air can pass through their airway during sleep. This interferes with breathing, leading to a pause in the child’s breathing that can last only a few seconds or even as long as a minute. The brain is then alerted and signals the body to make an effort to start breathing again. This effort at the child attempting to breathe results in the child gasping or snorting, waking up and starting to breathe again. Because of these repeated arousals to breathe, the child may not get enough quality sleep and is likely to be sleepy or overtired during the day. In the daytime, children who suffer from OSAS haven’t been able to sleep well and may present with daytime sleepiness or behavioural problems, which may be noticed at school. This may eventually affect their ability to perform well at school.

Some studies have found that children who snored loudly were twice as likely to have learning problems. Following a night of poor sleep, children are more likely to be hyperactive and have difficulty paying attention. These are also signs of attention-deficit/hyperactivity disorder (ADHD). Sleep apnoea may also be associated with delayed growth and cardiovascular problems in children.

At night, children with sleep apnea may:

• Snore loudly and regularly
• Have pauses, gasps, grunting and snorts and may actually stop breathing. The snorts or gasps may wake them up and disrupt their sleep repeatedly throughout the night.
• Be restless or sleep in abnormal positions with their head in unusual positions.
• Sweat heavily during sleep.

In the daytime, children with sleep apnea may:

• Have behavioural, school and social problems
• Be rather difficult to wake up
• Suffer headaches during the daytime but especially in the morning
• Be irritable, cranky, agitated and aggressive
• Be so sleepy during the day that they doze off, fall asleep or daydream
• Speak with a nasal-sounding voice and breathe constantly through their mouth

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