Snoring

Snoring is the term used to describe noisy breathing during sleep. Many children will snore if they have a cold or blocked nose and this is common and expected to resolve. However there are some children who constantly snore and this article is aimed helping to decide how serious this is. Snoring sometimes starts as young as 18 months. Often in these young toddlers a wait and see approach is acceptable as many will improve as the airways increase in diameter. However if there is significant sleep apnoea (pausing noted due to obstruction) then sometimes intervention is needed. In older chldren it is rare to spontaneously improve after the age of seven or eight years.

What Causes Snoring ?

Our upper airways consist of the nasal passages, the mouth and the airways of the throat or pharynx. During sleep, these airways are relaxed which can make them smaller. Air being transferred across a narrow passage will become noisy. If there is a partial blockage of these airways the noise can be particularly loud. Some children will snore constantly, and this will affect their quality of sleep. One of the most common reasons is the presence of enlarged tonsils and adenoids which are partially obstructing the flow of air. A second cause of snoring is related to4314_image blocked nasal passages which can sometimes be due to allergies. This is termed allergic rhinitis or hay fever.

What are Tonsils and Adenoids?

Basically these are lumps of fleshy tissue that are a insignificant lymph nodes. The body has hundreds of lymph nodes that are scattered throughout and they are part of the immune system. Sometimes when faced with recurrent viruses these lymph nodes can swell to a size that can cause problems by partially blocking the airways. The adenoids live above and behind the palate and can block the air breathed in through the nasal passages if too big. The tonsils live at the back of the throat, and can compromise the airways at the back of the mouth. In some children the tonsils and adenoids will remain enlarged for years.

What about tonsillitis ?

This is a name given for infection of the tonsils which causes them to be enlarged and sometimes appear red and inflamed. See my article on tonsillits. Recurrent tonsillitis can occassionally be severe enough to warrant removal, and can result in large obstructing tonsils.

How Bad is snoring ?

One of the problems is that many parents do not feel this is a problem and will not tell their family doctor thinking it is normal, or cannot be treated. However snoring will adversely affect sleep quality, and this affects the child’s quality of life. Snoring in childhood can be divided into one of the following groups

  1. Occasional snorer – mainly with colds but when well has no breathing issues – wait and see approach needed here.
  2. Habitual snorer – nighttime noisy breathing, with increased effort noted with breathing, but no periods of apnoea
  3. Obstructive Sleep Apnoea – this is where there are pauses in breathing due to the extent of the obstruction in the airways. This child will snore loudly, pause and then appear to gasp as the body recognises a need to ‘get some air’. There will be considerable effort required to breath, which is recognised by sucking in of the chest.

Problems due to poor sleep quality

  • Difficulty waking in the morning and overtired during the day
  • Poor concentration and low energy levels
  • Lower performance at school and lower IQ on testing
  • Symptoms that can mimic ADHD

Other health issues related to disordered night time breathing

  • Strain on the heart
  • Facial structural changes
  • Chest wall changes
  • Poor growth
  • Bedwetting

My Child Snores. How Can I tell if it is significant ?

Generally if the snoring is persistent (6months or more) and results in symptoms suggestive of interrupted sleep and increased work of breathing, then he should be assessed by a suitably qualified ENT surgeon.

During Sleep – observe and even video the following:

  1. Snoring and witnessed apnoea
  2. Choking noises
  3. Increased work of breathing (signifcant chest movement)
  4. Restless sleep
  5. Sweating during sleep
  6. Neck is arched back during sleep (to keep the airway as open as possible)
  7. Dry mouth sore throat in the morning

During the day watch out for

  1. Difficulty eating breakfast and lumpy foods (suggestive of large swollen tonsils)
  2. Short temper and hyperactivity
  3. Sleepiness
  4. Difficulty in school – behaviour and grades.

Investigations and Treatment

In an ideal situation it would be good if children could be assessed at a proper paediatric sleep clinic. Unfortunately in most instances these are difficult to gain access to and are only located at major teaching hospitals. In most cases an ENT surgeon will take a history and examination similar to the above description and this will help with the decision to go ahead and remove the tonsils and adenoids. In Australia there is the option of either being placed on a public queue at a public hospital or seeing a private ENT surgeon which will involve a considerable expense.

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