Parents often notice that their young children may snore quite loudly at night. Snoring itself is not particularly harmful to the child but it may be a sign of underlying obstructive sleep apnoea (OSA), especially if the snoring is associated with frequent pauses in breathing, waking episodes at night or increased effort made by the child to breathe at night. Sometimes, bedwetting at night may be a more subtle sign that the child is suffering from an element of OSA. Other discreet signs of OSA to watch out for include changes in the child’s behaviour and attention deficits, which may also be noticed by the child’s teachers at school.

OSA in children is a different entity from OSA in adults. In a normal and otherwise healthy child, OSA is commonly caused by large tonsils and adenoids at the back of the nose and throat, which are made up of lymphoid tissue (part of the immune system). Reassuringly though, surgical removal of the tonsils and adenoids to treat OSA in children does not affect the child’s immune system. In many children, the tonsil and adenoid tissue begins to shrink by itself around the age of 7 so that by the time they reach puberty or young adulthood, most of them will no longer have large tonsils or adenoids. Sleep studies are usually reserved for children with other health issues or underlying syndromes or if the diagnosis of OSA remains unclear.

Sometimes, nasal issues like allergic rhinitis (sensitive lining of the nose which may cause sneezing, itching, blocked nose, runny nose as a reaction to e.g. house dust mite) may lead to snoring in children.  Nasal allergy may cause swelling and enlargement of the soft tissue inside the nose. In children, we always try medication to treat first and only consider surgery if absolutely necessary.