Sleep-related breathing disorders
Pediatric Obstructive Sleep Apnea
Children with sleep apnea often snore, breathe through their mouth and show behaviour or learning problems. Enlarged tonsils and adenoids are a common cause.
Overview
Obstructive sleep apnea in children looks different from adult OSA. Instead of obvious daytime sleepiness, children may be hyperactive, irritable or struggle to focus at school. Habitual snoring, mouth breathing and restless sleep are common clues.
The most common cause in young children is enlarged tonsils and adenoids. Obesity, allergies, craniofacial differences and conditions such as Down syndrome also increase risk.
Untreated pediatric OSA can affect behaviour, learning, growth and heart health. The American Academy of Pediatrics recommends that clinicians ask about snoring at routine visits, and treatment, often removal of the tonsils and adenoids, usually helps.
Studies reviewed for the American Academy of Pediatrics guideline found childhood OSA prevalence estimates ranging up to about 5.7%, varying with how it was defined.
Common symptoms
- Snoring most nights
- Pauses, gasps or labored breathing during sleep
- Mouth breathing
- Restless sleep or unusual sleeping positions such as a bent-back neck
- Bedwetting after a child had been dry
- Hyperactivity, inattention or behaviour problems
- Daytime sleepiness or difficulty waking
- Morning headaches
- Poor growth or weight gain in young children
Causes and risk factors
- Enlarged tonsils and adenoids
- Obesity
- Allergies and chronic nasal congestion
- Down syndrome
- Craniofacial differences such as a small jaw
- Neuromuscular conditions
- Premature birth or family history of OSA
How it is diagnosed
The AAP recommends screening children for snoring and, for a child who snores and has symptoms or signs of OSA, testing with an overnight in-lab polysomnogram, which remains the reference standard. Home testing is less validated in children.
Children are scored differently from adults. An obstructive AHI of more than 1 event per hour is generally considered abnormal in children, and higher values indicate more severe disease. Your child's clinician also examines the tonsils, nose and growth.
Treatment options
Adenotonsillectomy
Removing the tonsils and adenoids is the first-line treatment for children with enlarged tonsils and adenoids.
Nasal steroid sprays
May be used for mild OSA or residual symptoms after surgery.
CPAP
Used when surgery is not suitable or OSA persists after surgery.
Weight management
Important for children with obesity.
Orthodontic treatment
Rapid maxillary expansion may help selected children with a narrow upper jaw.
Follow-up testing
Children with obesity, severe OSA or ongoing symptoms after surgery may need a repeat sleep study.
What you can do yourself
- Keep a record of snoring, pauses and sleep positions, and record a short video to show the clinician
- Treat allergies and nasal congestion
- Keep a consistent bedtime routine
- Support healthy eating and activity
- Share school or behaviour concerns with your child's clinician
When to see a doctor
- Your child snores three or more nights a week
- You notice pauses, gasping or struggling to breathe during sleep
- Your child has new bedwetting, behaviour changes or trouble focusing
- Your child is not growing as expected
- Your child has Down syndrome, obesity or a craniofacial condition and snores
Frequently asked questions
Is it normal for my child to snore?
Occasional snoring during a cold is common. Snoring three or more nights a week is not considered normal and should be mentioned to your child's clinician, especially with pauses, gasping or daytime symptoms.
Can sleep apnea look like ADHD?
Yes. Disrupted sleep in children can cause hyperactivity, impulsivity and poor attention that resemble ADHD. Clinicians often ask about snoring when evaluating attention problems.
Will removing tonsils and adenoids cure it?
Adenotonsillectomy improves or resolves OSA in many children with enlarged tonsils and adenoids. Some children, particularly those with obesity or severe OSA, still have apnea afterward and need follow-up.
How is a sleep study done for a child?
Your child sleeps overnight in a lab with a parent present, and sensors are taped on to measure breathing, oxygen, brain waves and movement. It is painless, and labs that test children are used to helping them settle.
Sources
This page is general information, not a diagnosis or medical advice. Read our medical disclaimer.