What’s it all about?
Snoring and children is not a healthy combination. And although many parents just pass snoring off as ‘one of those things’ in their child, the truth is that any snoring or noisy breathing during sleep always needs investigating.
Obstructive sleep apnoea (OSA) is a medical condition where the breathing muscles become partly blocked during sleep. Instead of being a clear passage for the air to enter the nose and upper airway, partial or total blockage happens. This is most frequently because the tonsils and adenoids are enlarged.
Though it’s stating the obvious, a child’s face is quite small. There’s a lot going on in that small space. Even a slight inflammation or enlargement of lymphoid tissue in the confined space at the back of the nose and throat can interrupt airflow.
During sleep, the muscles in the face and airway relax. This means the tiny airways are not open like they are when the child is awake. Position also plays a part where inflamed tonsils and adenoids are more likely to cause obstruction when the child is lying down.
Snoring in kids is fairly common – around 15-20% will snore. Reassuringly, not all kids who snore have OSA – around 2-3% of children are affected.
There are a range of symptoms which children with OSA may show. But it’s important to know that not every child with these symptoms will be affected by OSA.
There is a range of possible causes but the most likely is enlargement of the tonsils – at the back of the throat, and the adenoids which are positioned at the back of the nose. Small bone type structures in the nose called the turbinates can also be a factor.
In the early years, the tonsils and adenoids grow very quickly. When there is an infection or recurrent infection, the tonsils and adenoids are also inflamed causing more obstruction.
OSA is not always caused by enlarged tonsils and adenoids. Just as in adults, there can be other reasons for noisy breathing.
The most effective cure is removal of the tonsils and adenoids, this is commonly called having the ‘T’s and A’s removed’. Removing the tonsils and adenoids cures around 80-90% of OSA in children. If there are no complications and the child recovers well, symptoms of OSA usually settle after 6-8 weeks.
Occasionally, the adenoids grow back which means they need to be removed again. Sometimes, more specialised surgery is needed for children with more complex issues.
If the OSA is caused by the child being overweight or obese, a weight reduction program may be recommended. This can require a referral to a dietician with expertise in children.
If an allergy is suspected to be the cause of OSA, medications can help. Anti-histamines, anti-inflammatory intra-nasal sprays, and tablets are the most common option.
For children with special medical conditions causing their OSA, a CPAP machine (Continuous Positive Airways Pressure) machine may be required. These are similar to the ones used for adults who snore, but smaller and less powerful so they suit a child’s anatomy.
The first step is to take your child for a GP assessment. Depending on their findings, they may refer your child to a paediatrician or an ear, nose and throat specialist. Sometimes, overnight monitoring in hospital or a sleep study is recommended.
As your baby develops into a toddler, they become increasingly aware of the world around them.
While this can be an exciting time for your toddler, it can also be challenging and frustrating for you both, as they begin to exert their independence and insist on doing things on their own.
The Guide to Toddlers is the perfect place to learn all of the skills and behaviours of your toddler and gentle and effective ways to communicate with them.
Many parents have reduced sleep. The Safe Sleep Space website has a variety of resources and supports to provide tips and advice on how to assist your baby with sleep. You can also book a phone consultation to speak with a Sleep Consultant.
Written by Jane Barry, Child Health Nurse and Midwife.