The mechanics of snoring are no different in children. Inhaled air becomes partially obstructed which causes excess soft tissue in the upper airway to flap and make noise.
But how do you know if your child’s snores are normal or not?
We all snore occasionally, particularly if we are unwell. But 10% of children will snore on most nights. This is not normal and could be a sign of something more serious [1].
1-3% of children even experience obstructive sleep apnea (or OSA for short) [2]. This is where airway blockage leads to breathing pauses – a condition that has health implications beyond sleep.
Side note: what is the difference between snoring and sleep apnea?
Normal snoring (a.k.a. “habitual” snoring or “primary” snoring) does not involve breathing stoppage. This is usually benign. When a child has sleep apnea, their breathing stops for at least 10 seconds, generally followed by a big gasp or choke. Those with OSA often snore loudly, but importantly, not all loud snorers have sleep apnea.
Children need lots of healthy sleep for good physical, mental and emotional development. OSA disrupts sleep, therefore sleep deprivation is the biggest concern for children with sleep disordered breathing.
Studies have also linked the sleep fragmentation experienced with sleep apnea to ADHD [3]. Even without an ADHD diagnosis, sleep deprivation can affect children’s behaviour, focus and overall development.
The various reasons for snoring are the same in children as for adults. Sleeping position, being overweight and allergies can all be implicated in your child’s snoring.
To understand why your child snores, try to explore their triggers:
Unlike in adults, the tonsils and adenoids are frequently cited as causes of snoring and sleep apnea. This is because the adenoids are regions of soft tissue that (usually) disappear after puberty. Further, tonsils reach their peak mass between 5-7 years – well before a child’s airway has reached its peak size. These are therefore key obstruction triggers in childhood snoring and sleep apnea.
There are some key signs that can suggest that your child’s snoring is a cause for concern.
5 sleeping flags are:
It can be hard for you to identify these sleeping flags in your child; beyond a certain age, parents don’t usually share a room with their child.
Therefore, it is important to also keep watch for these 5 flags whilst your child is awake:
If they are ticking many of these boxes, it is a good idea to seek advice and further investigation from a specialist.
Before a medical consultation, it is recommended that you start a sleep journal. This can help a specialist glean some insight into your child’s snoring. Focus on the 10 sleeping and waking flags above.
The logistics of listening to your child’s entire night of sleep are difficult if they are at the age where you aren’t sharing a room. This is where SnoreLab can be helpful.
Side note: is SnoreLab suitable for children; will my child’s privacy be protected?
Your child’s privacy is not at risk when using SnoreLab. We do not collect audio recordings and therefore cannot share or listen to any audio picked up by the app. We do collect some anonymised, non-audio data on the session – this cannot identify you personally and is nothing more than some numbers on a screen.
Yes, children have sleep studies too. A sleep study is a way of looking at how your child’s body behaves when they are asleep. This is the reliable way to understand their sleep disordered breathing.
The process is almost identical to adult sleep studies.
On the day of the sleep study, parents are encouraged to help make the process as normal as possible. This means sticking to normal routines, both before and after arriving at the hospital. If an afternoon nap is part of your child’s routine, then don’t deny them it.
To help make the hospital feel as comfortable and homely as possible, bring things from home that help your child to relax and sleep – whether it’s a toy, a blanket, a book or a film to watch before bed.
Your child will be “wired up” before the study starts. This involves attaching an array of monitors which can take up to an hour to set up. The key ones are:
Importantly, none of these attachments are painful and they should be attached in such a way to avoid any discomfort. Your child should have no problem sleeping with them on.
The technicians attaching these monitors are well-trained in dealing with children and allaying any fears and anxieties they may have. You as a parent can also play your part here too.
Paediatric sleep studies almost always have two beds set up – one for the child and one for the parent. Your presence should help your child relax and get the sleep needed to make the necessary measurements. People say that typically the child sleeps better than the parent!
Similar to adult studies, the session finishes around 6am. Results are analysed by specialists and will be communicated to you at a later date.
As with anyone’s snoring, what is the “best treatment” depends on the cause. Almost all snoring remedies apart from mouthpieces – if well matched to the cause – are suitable for children.
Surgery is recommended more for children than it is for adults. This is because children’s snoring is more likely to have a clear physical obstruction that can be corrected with surgery – namely by removing the adenoids and tonsils. Indeed, these procedures are performed more than a quarter of a million times per year in the USA alone [4]. It is generally very safe with only minor risks associated.
Such surgical interventions are usually very successful. Some research indicates that children’s stunted mental capabilities, often attributed to the sleep disturbance that accompanies sleep apnea, reverses completely 3 to 10 months after surgical removal of the adenoids [5].
Surgery is not always an option. If a child is diagnosed with OSA which cannot be managed with surgery or other measures, CPAP can also be used. Whilst CPAP can be quite a drastic change for a child to get used to, if presented and handled well by both the medical professionals and the parents, it can be extremely effective [6].
Further, it is speculated that another potential measure is doing nothing! Children develop and grow quickly so certain conditions can resolve themselves. Recent studies have shown that the non-intervention commonly referred to in the medical world as “watchful waiting” saw almost half of sleep apnea cases reversed within 7 months [7].
Snoring has similar causes in both adults and children and can therefore be managed in the same ways.
Occasional snoring is normal and harmless for children. However, extra attention should be paid if your child snores 4 nights or more per week, and snores frequently through the night [1].
Assess your child’s snoring with the following process:
