Snoring in Babies and Toddlers

As parents, we often find ourselves amused by the gentle snores coming from our little ones. While snoring is commonly associated with adults, it's important to recognise that snoring in babies and toddlers is not normal and can have significant implications for their health and development. In this blog, I'll explore the signs to watch and listen for, delve into the impact of snoring on children's health and learning, and discuss the link between obstructive sleep apnea (OSA) and attention deficit hyperactivity disorder (ADHD).

Some common misconceptions I've heard floating around about snoring in children, some of which are discussed in more detail later in this blog:

• Snoring in toddlers is always a sign of a health problem: While snoring can be associated with health issues, such as enlarged tonsils or adenoids, not all snoring in toddlers is a cause for concern. Snoring can be a result of temporary congestion, allergies, or even sleeping in an awkward position. However, persistent and loud snoring accompanied by other symptoms might indicate an underlying problem that requires medical attention.

• Snoring in toddlers is harmless: Although not all snoring in toddlers is problematic, it is essential to pay attention to persistent or severe snoring. Chronic snoring can affect a child's quality of sleep, leading to daytime sleepiness, poor concentration, and behavioural issues. In some cases, it can indicate obstructive sleep apnea, a sleep disorder that causes pauses in breathing during sleep.

• All toddlers will outgrow snoring: While some children do outgrow snoring as they grow older, it is not true for every child. Snoring can persist into childhood and beyond, particularly if it is caused by anatomical factors like enlarged tonsils or adenoids. It is important to monitor persistent snoring and consult a healthcare professional if necessary.

• Snoring is only a concern if it causes sleep disturbances: Snoring itself can be a problem, even if it doesn't cause noticeable sleep disturbances. Chronic snoring can lead to disrupted sleep patterns and inadequate oxygen intake, potentially impacting a child's growth, development, and overall well-being. Therefore, it is crucial to address snoring in toddlers, even if they don't show obvious signs of sleep disruption.

• Surgery is the only solution for snoring in toddlers: While surgery can be a viable option for certain cases of snoring in toddlers, it is not always the first course of action. Lifestyle changes, such as maintaining a consistent sleep schedule, improving sleep environment, and managing allergies or congestion, can help alleviate snoring. 

Snoring may seem harmless, but it can be a red flag indicating an underlying issue. Babies and toddlers typically have narrower airways than adults, making them more prone to experiencing breathing difficulties during sleep. Persistent snoring in young children can be a sign of OSA, a sleep disorder characterised by repeated partial or complete blockage of the upper airway during sleep. OSA disrupts normal breathing patterns, leading to brief pauses in breathing and decreased oxygen levels.

If your child exhibits any of the following, it's important to consult with a paediatrician:

• Loud and frequent snoring: Snoring that is loud, occurs regularly, and is accompanied by other symptoms warrants attention.
• Other abnormal noises - gasps, snorts, choking, pauses.
• Restless sweaty or disturbed sleep: Notice if your child tosses and turns frequently, experiences abrupt awakenings, or sleeps in unusual positions.
• Mouth breathing: Constantly breathing through the mouth instead of the nose can be a sign of airway obstruction.
• Pauses in breathing: Observe if your child momentarily stops breathing during sleep.
• Waking headaches in children old enough to communicate this (may indicate sleep hypercapnia).
• Daytime sleepiness: Child over 3 years old still needing a nap on a regular basis, excessive fatigue, irritability, and difficulty concentrating during the day may indicate poor sleep quality due to OSA.
• ADHD symptoms
• Bed wetting past the age of 7

The consequences of untreated OSA in children can extend beyond the realm of sleep. The following are some of the potential health and learning issues associated with snoring and OSA:

• Cognitive impairment: Inadequate sleep due to OSA can affect a child's cognitive development, leading to difficulties in attention, memory, and problem-solving skills.
• Behavioural problems: OSA has been linked to increased levels of hyperactivity, impulsivity, and aggressiveness in children.
• Growth and development issues: Poor sleep quality can disrupt the release of growth hormones, potentially affecting a child's physical growth and development.
• Cardiovascular complications: OSA has been associated with high blood pressure and other cardiovascular problems in children.
• Poor academic performance: Sleep disturbances can hinder a child's ability to concentrate and learn, leading to decreased academic performance.

Recent studies have indicated a significant association between OSA and ADHD in children. Research suggests that up to 25% of children diagnosed with ADHD may also have OSA. The exact nature of this relationship is still being investigated, but several theories have emerged:

1. Sleep disruption: The fragmented sleep caused by OSA can mimic the symptoms of ADHD, such as inattention, hyperactivity, and impulsivity.
2. Oxygen deprivation: Reduced oxygen levels during sleep due to OSA may affect the brain's functioning and contribute to ADHD symptoms.
3. Shared risk factors: OSA and ADHD share common risk factors such as obesity, craniofacial abnormalities, and family history of sleep disorders.

To underscore the significance of the link between OSA and ADHD, consider the following statistics:

• Approximately 1-4% of children suffer from OSA, making it a prevalent condition in paediatric populations.
• Up to 60-90% of children diagnosed with ADHD may experience symptoms of sleep-disordered breathing, including snoring.
• Treating OSA in children with ADHD has shown improvements in both sleep quality and ADHD symptoms.

While snoring may seem like a harmless part of childhood, it's crucial to recognise that persistent snoring in babies and toddlers is not normal and may indicate an underlying sleep disorder, such as OSA. The impact of snoring on a child's health and learning should not be underestimated, with potential consequences ranging from cognitive impairment to behavioural problems and poor academic performance. Furthermore, the link between OSA and ADHD emphasises the need for early identification and treatment to mitigate the long-term effects on a child's well-being. 

In my role as a sleep consultant, I have encountered a large number of children who snore - they are poor sleepers and the parents are exhausted but unaware their child's snoring is the reason for their poor sleep. In referring them to an ENT specialist, enlarged tonsils and/or adenoids are often discovered and once this has been remedied, the vast majority of these children almost immediately start sleeping better once recovered from the procedure! 

If any of this resonates with you or sounds familiar and you have a baby or toddler, have a chat to your GP to discuss whether a referral to an ENT (Ear, Nose and Throat) specialist is necessary.  Getting on top of obstructive sleep apnea early can be incredibly helpful for your child's development, so don't hesitate to visit your GP and push for a referral if you feel something isn't right!