Snoring isn't always "just snoring."

Many parents are surprised to learn that children can develop obstructive sleep apnea (OSA). In children with OSA, the airway repeatedly becomes partially or completely blocked during sleep, disrupting normal breathing and sleep.

While occasional snoring can happen when a child has a cold or congestion, regular loud snoring, pauses in breathing, gasping, mouth breathing, restless sleep, or unusual daytime behavior can be signs that something deserves further evaluation.

The American Academy of Pediatrics recommends that children be screened for snoring and that children with symptoms or signs of obstructive sleep apnea receive appropriate evaluation, with a sleep study (polysomnography) being the standard diagnostic test when indicated.

What Is Sleep Apnea in Children?

Obstructive sleep apnea occurs when a child's upper airway becomes blocked repeatedly while they are sleeping.

The child may continue trying to breathe despite the obstruction, causing disrupted sleep and changes in oxygen and carbon dioxide levels.

Unlike adults, children don't always appear obviously sleepy during the day. Instead, disrupted sleep may show up as behavioral, attention, learning, or mood changes.

Research has associated untreated childhood OSA with behavioral and neurocognitive concerns, as well as other health consequences.

What Are the Signs Parents Should Watch For?

Some children with sleep-disordered breathing may have:

At night

• Loud or frequent snoring
• Pauses in breathing
• Gasping or choking sounds
• Mouth breathing
• Restless sleep
• Frequent position changes
• Sweating during sleep
• Sleeping with the neck extended
• Bedwetting in some children
• Difficulty staying asleep

During the day

The signs can be less obvious.

Parents may notice:

• Difficulty concentrating
• Irritability
• Hyperactivity
• Morning headaches
• Difficulty waking up
• Daytime tiredness
• Changes in school performance
• Mood or behavioral changes

Not every child with these symptoms has sleep apnea, which is why proper medical evaluation is important rather than trying to diagnose the condition based on symptoms alone.

Why Does Sleep Apnea Happen in Children?

There can be several causes. Enlarged tonsils and adenoids are common contributors, but nasal obstruction, facial and jaw development, and other health factors can also play a role.

Because there isn't one cause, children with suspected sleep apnea should be appropriately evaluated by their healthcare provider.

How Is Childhood Sleep Apnea Treated?

Treatment depends on the cause and severity of the problem.

Tonsils and Adenoids

For children with OSA and enlarged tonsils/adenoids, adenotonsillectomy (removal of the tonsils and adenoids) is a commonly recommended first-line treatment.

Research has shown improvement in sleep-related symptoms and quality of life following adenotonsillectomy in many children with OSA.

However, surgery does not guarantee that sleep apnea will completely disappear in every child. Some children have persistent OSA and require additional evaluation or treatment.

Other Treatments

Depending on the child, treatment may include:

• Medical management for nasal or mild obstructive symptoms
• CPAP therapy
• Weight management when appropriate
• Treatment of underlying nasal or airway problems
• Further evaluation by sleep medicine or ENT specialists

For some children, more than one approach may be needed.

Where Does Orthodontics Fit In?

An orthodontist can evaluate your child's teeth, jaw development, palate, bite, and dental arches. In some children, these findings may be relevant when considering airway and breathing concerns.

However, orthodontics does not replace medical evaluation or treatment for sleep apnea.

If Dr. Nizam identifies concerns during an orthodontic examination, she may recommend that parents discuss them with their child's physician, pediatrician, ENT, or sleep specialist.

What About Mouth Breathing?

Mouth breathing is worth paying attention to—but it does not automatically mean your child has sleep apnea.

A child may breathe through their mouth because of nasal congestion, allergies, enlarged adenoids, nasal obstruction or other factors.

If your child routinely sleeps with their mouth open, snores, or seems to have difficulty breathing through their nose, it's worth discussing with their healthcare provider.

An orthodontic assessment can also help evaluate the child's developing teeth, palate and bite.

What Should Parents Do?

If your child regularly snores, mouth breathes, gasps during sleep, or seems unusually restless while sleeping, don't simply assume they'll grow out of it.

Start by talking with your child's healthcare provider. A sleep study may be recommended if sleep apnea is suspected.

An orthodontic evaluation can also be helpful in understanding your child's developing teeth, jaws, palate, and bite.

The Bottom Line

Children can have sleep apnea, and recognizing the signs early is important.

At Impressions Orthodontics in Calgary, Dr. Nadia Nizam can assess your child's orthodontic development and discuss whether any dental or jaw-related concerns may warrant further evaluation.

Concerned about your child's development or sleep? We're here to help you understand what to do next.