Snoring and Sleep Apnea in Children: When Snoring Is Concerning

Your child snores like a freight train. Maybe you've joked about it, or maybe you've wondered if it's normal. Here's what you need to know: while occasional snoring is common and usually harmless, regular, loud snoring can be a sign of obstructive sleep apnea—a condition that affects far more children than most parents realize.

Pediatric sleep apnea is both underdiagnosed and undertreated. When identified and treated, the improvement in children's behavior, attention, and quality of life can be dramatic. AAP

Normal Snoring vs. Concerning Snoring

Probably normal:

• Snoring only when congested (cold, allergies)
• Quiet, occasional snoring
• No other symptoms
• Child seems well-rested

Warrants attention:

• Snoring most nights (not just with illness)
• Loud snoring (can be heard outside the room)
• Pauses in breathing
• Gasping, choking, or snorting sounds
• Restless sleep
• Child seems tired despite adequate sleep time

What Is Pediatric Sleep Apnea?

Obstructive Sleep Apnea (OSA) occurs when the airway repeatedly becomes partially or completely blocked during sleep. NSF

What happens:
1. Child falls asleep, muscles relax
2. Airway narrows or collapses
3. Breathing becomes difficult or stops briefly
4. Body partially awakens to open airway
5. Pattern repeats throughout the night

The result:

• Fragmented sleep (even if child doesn't fully wake)
• Reduced oxygen levels
• Stress on heart and body
• Daytime symptoms

How Common Is It?

Statistics:

• 1-5% of children have sleep apnea
• Peak ages: 2-6 years (when tonsils/adenoids largest relative to airway)
• Often undiagnosed
• More common in children with obesity, Down syndrome, craniofacial differences

Signs and Symptoms

During sleep: AAP

• Loud, regular snoring
• Breathing pauses observed by parent
• Gasping or choking sounds
• Mouth breathing (even when not congested)
• Restless sleep, frequent position changes
• Unusual sleep positions (neck hyperextended)
• Sweating during sleep
• Bedwetting (in previously dry child)

During the day:

• Difficult to wake
• Morning headaches
• Daytime sleepiness or fatigue
• Behavior problems
• Hyperactivity or ADHD-like symptoms
• Attention and learning difficulties
• Irritability and mood changes
• Poor school performance

Physical signs:

• Enlarged tonsils
• Adenoid face (long face, open mouth, narrow palate)
• Breathing through mouth
• Frequent ear or throat infections

The ADHD Connection

Many children with untreated sleep apnea are misdiagnosed with ADHD. AAP

Why the confusion:

• Sleep deprivation in children often causes hyperactivity (not sleepiness)
• Attention problems result from poor sleep
• Impulsivity and behavior issues mirror ADHD

Important implication:
Any child being evaluated for ADHD should also be screened for sleep problems, including sleep apnea.

Risk Factors

Primary risk factors:

• Enlarged tonsils and/or adenoids (most common cause in children)
• Obesity
• Family history of sleep apnea
• Craniofacial abnormalities
• Down syndrome
• Neuromuscular conditions
• Premature birth

Diagnosis

First step: Talk to your pediatrician
Describe what you've observed. A detailed sleep history and physical exam are the starting point.

Sleep study (polysomnography):

• The definitive test for sleep apnea
• Overnight recording of breathing, oxygen, brain activity
• Done at a sleep lab or sometimes at home
• Safe and painless (though unfamiliar setting)
• Required before most treatments

What the study measures:

• How many times breathing stops or decreases
• Oxygen levels throughout the night
• Sleep quality and stages
• Body position and movements

Treatment Options

Tonsillectomy and adenoidectomy (T&A): AAP
The most common treatment for pediatric sleep apnea.

• Removes enlarged tonsils and adenoids
• Highly effective—cures or significantly improves 80%+ of cases
• Usually outpatient surgery
• Recovery: 1-2 weeks

Weight management:

• Important if obesity is contributing
• May resolve sleep apnea in some children
• Benefits overall health regardless

CPAP (Continuous Positive Airway Pressure):

• Used if surgery doesn't fully resolve the issue
• Or when surgery isn't appropriate
• Requires wearing mask during sleep
• Very effective but can be challenging for children to tolerate

Other options:

• Dental devices/orthodontic treatment (in some cases)
• Positional therapy
• Treatment of allergies and nasal congestion
• Additional surgeries in complex cases

What Happens If Left Untreated?

Untreated sleep apnea can lead to: NSF

Short-term:

• Behavior problems
• Learning difficulties
• Poor school performance
• Mood issues
• Frequent illness

Long-term:

• Cardiovascular problems
• Growth issues
• Metabolic problems
• Persistent neurocognitive effects

The good news:
Treatment is usually very effective, and many of these effects are reversible.

After Treatment: What to Expect

After T&A surgery:

• Recovery takes 1-2 weeks
• Throat pain is normal
• Sleep often improves within weeks
• Some children need follow-up sleep study to confirm resolution
• Rarely, apnea persists and needs additional treatment

Signs treatment is working:

• Snoring stops or dramatically decreases
• Child sleeps more peacefully
• Easier to wake in morning
• Behavior and attention improve
• More energy and better mood

What Other Parents Ask

Q: My child snores but seems fine during the day. Should I still be concerned?
A: Possibly. Some children compensate well during the day despite disrupted sleep. Regular snoring—especially if loud—warrants discussion with your pediatrician regardless of daytime symptoms. AAP

Q: Will my child outgrow sleep apnea?
A: Sometimes, if it's related to enlarged tonsils/adenoids that shrink with age. But don't assume it will resolve on its own—untreated sleep apnea causes problems now. Get evaluated.

Q: Is surgery really necessary?
A: For most children with sleep apnea due to enlarged tonsils/adenoids, surgery is the most effective treatment. The benefits usually far outweigh the risks of a common outpatient procedure.

Q: My child had tonsils removed but still snores. What now?
A: Some children have residual apnea after surgery, especially if they have other risk factors. Follow up with your doctor—additional evaluation may be needed. NSF

The Bottom Line

Snoring in children is not always normal. Regular, loud snoring—especially with breathing pauses, restless sleep, or daytime symptoms—may indicate sleep apnea. This treatable condition affects behavior, learning, and health when left unaddressed. Treatment is usually highly effective.

Key points:

• Regular snoring warrants evaluation
• Sleep apnea affects 1-5% of children
• Often misdiagnosed as ADHD
• Enlarged tonsils/adenoids are the most common cause
• Diagnosis requires a sleep study
• Tonsillectomy is highly effective for most children
• Treatment dramatically improves symptoms
• Don't assume children will outgrow it

Clara is here to help you understand when snoring needs attention.