My child snores: when to see an ENT specialist (childhood sleep apnoea)

Occasional snoring is common in children, especially with a cold. What deserves attention is habitual snoring, almost every night, and pauses in breathing, because they can point to obstructive sleep apnoea. At Institut Mèdic Especialitzat La Ràpita (IME), Dr Vanessa Zerpa’s ENT clinic sees children and adults from Montsià and the Terres de l’Ebre area; you can book on +34 697 38 07 86, by WhatsApp or through Doctoralia via our contact page.

Is it normal for a child to snore?

Snoring is the noise air makes as it passes through a narrowed airway during sleep. Most children snore lightly and only now and then, during colds, and the noise goes away when they recover. However, according to the Spanish Association of Primary Care Paediatrics (AEPap), roughly one child in ten snores habitually, every day (AEPap, 2010).

The American Academy of Pediatrics recommends asking about snoring at every check-up for children and teenagers, because it is the starting point for detecting sleep apnoea (Marcus et al., 2012).

Why does my child snore?

The most common reason is that airflow is restricted by enlarged adenoids or tonsils, or by the shape of the mouth and jaw. Snoring is also linked to colds, allergies (rhinitis and asthma), reflux in babies and exposure to second-hand smoke (AEPap, 2010).

What is childhood sleep apnoea?

It is the most significant form of sleep-disordered breathing: during the night the airway partly or completely closes and the child has to work hard to breathe. AEPap estimates that around 20% of children who snore have obstructive sleep apnoea-hypopnoea (AEPap, 2010).

Warning signs: when to seek advice

See your paediatrician or an ENT specialist if your child snores often and you also notice any of these signs (AEPap, 2010):

At night

• Seems to struggle to breathe.
• Stops breathing for a few seconds while straining to breathe.
• Sweats a lot or sleeps in unusual positions.
• Often has nightmares, night terrors or sleepwalking.

During the day

• Finds it very hard to get up, is sleepy or, on the contrary, very restless.
• Problems with attention, behaviour or school performance.
• Over the age of 4, still needs a daily nap or wets the bed.
• Morning headaches or poor appetite.

The European Respiratory Society task force also stresses checking for consequences such as poor growth, bedwetting or neurological or cardiovascular effects, because they influence the decision to treat (Kaditis et al., 2016).

How is it diagnosed?

1. History and examination: the doctor asks about sleep and behaviour and examines the nose, mouth and throat. Families are sometimes asked to video the child while asleep (AEPap, 2010).
2. ENT examination: to assess the size of the tonsils and adenoids. At IME, the ENT clinic has flexible endoscopy to examine the nose and throat.
3. Sleep study (polysomnography): records breathing, oxygen levels and sleep overnight, and is painless. The American guideline recommends it for children who snore and have symptoms or signs of apnoea (Marcus et al., 2012), and the European statement considers it the preferred way to measure severity (Kaditis et al., 2016). If your child needs one, we will tell you where it can be done.

How is it treated?

Treatment depends on the cause and severity:

• Treating contributing causes, such as infective or allergic rhinitis or reflux, may be enough for some children (AEPap, 2010).
• Nasal corticosteroids: the American guideline considers them an option for mild apnoea when surgery is not possible, or for mild symptoms remaining after surgery (Marcus et al., 2012).
• Adenotonsillectomy (removal of the adenoids and tonsils): the first-line treatment when apnoea is caused by enlarged tonsils and adenoids (Marcus et al., 2012). In the CHAT trial of 464 children aged 5–9, early surgery did not improve attention test scores compared with watchful waiting, but it did improve symptoms, behaviour, quality of life and sleep-study results, which normalised in 79% of operated children versus 46% in the waiting group (Marcus et al., 2013).
• Weight loss if the child is overweight, and CPAP (a positive airway pressure device) if surgery is not performed or apnoea persists (Marcus et al., 2012).
• Some children benefit from an orthodontic assessment (AEPap, 2010).

After any treatment the child should be reassessed, because symptoms can persist or return (Kaditis et al., 2016; Marcus et al., 2012).

Paediatric ENT at IME in La Ràpita

Dr Vanessa Zerpa is an ENT specialist with a particular focus on paediatric ENT and specific training in snoring and sleep apnoea. She sees children and adults at IME, Av. del Dr. Ferran, 73, 43540 La Ràpita, where families also come from Amposta, Tortosa, Deltebre, Alcanar, Sant Jaume d’Enveja, Ulldecona and Vinaròs. See her professional profile.

For the appointment, it really helps to bring a short video of your child asleep, any previous reports, and a note of how many nights a week they snore.

Frequently asked questions

From what age should snoring be a concern?

Children can snore from a few months old. What matters is not age, but whether snoring is habitual or comes with pauses, effortful breathing or daytime symptoms.

Does removing the tonsils always cure sleep apnoea?

Not always. In the CHAT trial, the sleep study normalised in 79% of children who had surgery (Marcus et al., 2013), which is why children are reassessed after the operation.

My child only snores with a cold. Should I book?

If the snoring goes away once the cold clears and there are no other signs, it is usually mild. Mention it at the next check-up with the paediatrician.

Do you also see adults who snore?

Yes. IME’s ENT clinic sees both children and adults.