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Sleepy Child

A child's snore may sound cute, or even funny, but habitual snoring in children may contribute to problems ranging from bed-wetting to poor school performance. In fact, some children with sleep disorders associated with snoring are mistakenly diagnosed with attention deficit-hyperactivity disorder or ADHD, when what they really need is a good night's sleep.

All children snore when they have a cold, but habitual snoring in children is more common than you might think – about 8–12% snore most nights. It seems to be worst between the ages of 2 and 8 years and then usually starts to improve. It is more common in overweight children and in households where someone is a smoker. The usual reason is enlarged tonsils and adenoids. When the throat muscles relax during sleep, the tonsils and adenoids cause a slight narrowing (obstruction) of the air passage in the throat. This results in air turbulence, which you hear as snoring.

It is estimated that between 3% and 12% of preschool age children snore. The majority of these children are well, without other symptoms and have primary snoring. Other children that snore, about 2% by some estimates, have obstructive sleep apnea syndrome (OSAS), a condition that is being increasing recognized as leading to school and behaviour problems in children.

What causes snoring in children?

Snoring in children can result from three things. First, there is an anatomical component, such as a small jaw or a small airway that the child was born with. Secondly, there's the possibility that the muscles and the nerves controlling those muscles are not well integrated during sleep and therefore, do not open the airway enough. But the most common reason children snore is enlarged tonsils and adenoids.

Tonsils and adenoids are part of the body's immune system. You can see the tonsils at the back of the throat, one on each side. Adenoids are high in the throat behind the nose and the roof of the mouth, so you cannot see them. They filter germs and help to develop immunity to germs, especially in early childhood. Therefore tonsils and adenoids are at their largest in young children (probably as a reaction to colds and other minor infections).

Usually, the narrowing of the air passage by enlargement of the adenoids and tonsils does not really matter, but in a few children it is bad enough to cause a real breathing problem during sleep, which is known as OSAS or ‘obstructive sleep apnoea syndrome’. In OSAS, the child may seem to stop breathing during sleep momentarily. Because sleep is disturbed, there may be knock-on effects during the day (such as tiredness, behavior problems or lack of concentration). One clue is mouth breathing during the day. Another is an odd sleeping position. For example, some children with narrowing of the air passage at night will sleep hanging over the side of the bed so their head is almost upside down or with their neck stretched out. Presumably these sleeping positions help the tongue to fall away from the back of the throat.

Children who snore and do not have OSAS should be otherwise well, without daytime sleepiness and they should have normal sleep patterns. In contrast to normal primary snoring, children with OSAS usually have disrupted sleep with short 'pauses, snorts, or gasps' in their sleep. Children with OSAS may also have behavioural problems, a short attention span and problems at school.

Once it is determined that your child has obstructive sleep apnea syndrome, it will be time to discuss treatment options, which usually include removing enlarged adenoids and tonsils (adenotonsillectomy). Other treatments might include treating a child's allergies and helping overweight children lose weight. CPAP therapy with a nasal mask is another treatment option for children who can't have surgery or who continue to have obstructive sleep apnea after their adenoids and tonsils are removed.


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