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DocSpot: Snoring in children

Dear Dr Margaret
Your section on snoring does not mention children who snore. My 5-year-old daughter snores every night, really loudly. I am wondering what can be done?

Thank you for this question – we welcome suggestions about what to add to the site, and we will add a section on snoring in children shortly. Meanwhile, here is some information to be going on with.
 
Of course, 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.
 
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, this 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, behaviour 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 like a sword-swallower. Presumably these sleeping positions help the tongue to fall away from the back of the throat.
 
Having the tonsils and adenoids out might seems to be the answer to snoring, but this is not an easy decision. First, it is a surgical operation and so carries risks. Secondly, the tonsils and adenoids usually shrink after the age of 7 or 8 as the child’s immune system matures. However, removing the tonsils and adenoids could be the best option if your daughter has any of the signs of OSAS; if you think this might be the case, you need to discuss it with your doctor.
 
Otherwise, there are couple of things you can do. First, think about your daughter’s weight. If she is fat, now is the time to encourage healthy eating and exercise (which may involve cutting down on time spent watching TV). Secondly, if there are smokers in the house, they should stop; www.quit.org.uk is a really helpful, practical website for people who want to quit smoking.
 

Sources of information

Goldstein NA, Pugazhendhi V, Rao SM et al. Clinical assessment of pediatric obstructive sleep apnea. Pediatrics 2004;114:33–43.
Kennedy JD, Waters KA. Investigation and treatment of upper-airway obstruction: childhood sleep disorders. Medical Journal of Australia 2005;182:419–23.
Lu LR, Peat JK, Sullivan CE. Snoring in preschool children. Chest 2003;124:587–93

Last updated; Wednesday, April 5th 2017


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