Snoring, though it may bring to mind Fred Flintstone or a well-loved adult, is not just a problem in adults. In fact, about 10 percent of children more than occasionally produce that noisy, labored breathing of sleep we call snoring. Very simply put, snoring is the result of air travelling down partially blocked or inadequate passageways on its way to the lungs. Situations that cause airway blockage can result in snoring. Colds do, for example, by causing swelling and more than the usual mucus production, as do allergies, either seasonal or year-round.
Yet snoring is also a symptom seen in 1 to 2 percent of children with a more serious problem called Obstructive Sleep Apnea (OSA). For them, airway blockage can get to the point of completely preventing air movement. After a pause in breathing, called apnea, (during which no oxygen is supplied to the body), these sleepers awaken to take a deliberate breath, often with a noisy gasp. The most common causes of this more serious type of obstruction are tonsils and adenoids (the latter are lymph tissue, like tonsils, found further back in the throat) that are too big relative to the size of the rest of the child's upper airway. Other risk factors are obesity, neuromuscular diseases like Cerebal Palsy or Muscular Dystrophy, and syndromes associated with a small mid-face or jaw or low tone, as in Down syndrome.
The upper airway system has a complicated anatomy. More than 30 pairs of muscles work to provide the many functions of this part of the body: swallowing, talking, and breathing, among others. Normally, the factors that cause the airways to collapse (to swallow or talk, for example) and those that keep the airway open are in balance. Certain upper airway problems like large tonsils and adenoids upset this balance, but, while awake, muscles can compensate for this with increased tone. When asleep, though, muscle tone involuntarily decreases, and without this compensation, airways collapse. Over the course of one night, a sufferer from OSA can snore, become apneic and awaken many times, interrupting the normal sleep cycle and producing daytime drowsiness.
Other problems that have been linked to OSA are diminished school performance, developmental delay, eneuresis (day or night wetting) and sluggish growth. Though seen in many ages, two- to six-year-olds are most often affected, due to the relatively large tonsil and adenoid size in this age group.
How can OSA be distinguished from less serious snoring? It often isn't possible to tell in the awake child, though very large tonsils and adenoids can cause mouth-breathing or a nasal-sounding voice. The most helpful clues are the night-time ones. A pattern of snoring, labored breathing, apnea then arousal with a gasp or choking effort is alarming. Sometimes these children are restless sleepers or sleep in unusual positions—sitting up or with necks arched backwards.
Many times the causes of snoring in children are straightforward and easily remedied. Teaching children to clear their blocked noses by blowing one nostril at a time into a tissue before bed helps during a cold. Treating seasonal allergies can help, as may eliminating feather pillows or stuffed animals if allergies to them are suspected. But, if these issues don't apply and a child exhibits some of the symptoms seen with OSA mentioned above, this should be brought up for discussion with a pediatrician or healthcare provider.