Why Does My Child Snore? Causes, Symptoms and Treatment

Does your child snore regularly at night? Although occasional snoring is often harmless, persistent or loud snoring may be a sign of an underlying sleep-related breathing disorder.

One of the most common causes of snoring in children is enlargement of the adenoids or tonsils. However, allergies, nasal obstruction and several other factors can also contribute.

It is important to recognise when snoring is simply temporary and when further assessment by an ENT specialist may be necessary.

Why do children snore?

Snoring occurs when the upper airway becomes narrowed during sleep, causing the surrounding soft tissues to vibrate as air passes through.

Common contributing factors in children include:

• Enlarged adenoids: These can obstruct nasal breathing, leading to mouth breathing and snoring.

• Enlarged tonsils: Large tonsils may narrow the airway at the level of the throat during sleep.

• Allergic rhinitis: Swelling of the nasal lining can cause persistent nasal obstruction.

• Upper respiratory tract infections: Colds can temporarily increase snoring due to nasal congestion.

• Being overweight or obese: Excess weight can increase the risk of obstructive sleep apnoea.

Not every child with enlarged tonsils snores, and snoring does not necessarily mean that a child has sleep apnoea.

When could snoring indicate sleep apnoea?

Obstructive sleep apnoea (OSA) is a sleep-related breathing disorder in which the upper airway repeatedly becomes partially or completely obstructed during sleep.

Parents may notice:

• Loud snoring on most nights.

• Pauses in breathing, sometimes followed by gasping or snorting.

• Restless sleep, frequent movements or unusual sleeping positions.

• Sleeping with the head tilted backwards to make breathing easier.

• Excessive sweating or persistent mouth breathing during sleep.

Regular snoring alone does not confirm sleep apnoea, but it may indicate the need for further investigation.

Can snoring affect a child's behaviour during the day?

Poor sleep quality can affect a child's daytime behaviour, concentration and general wellbeing.

Possible warning signs include:

• Morning tiredness or difficulty waking up.

• Problems with attention and concentration.

• Irritability, restlessness or hyperactive behaviour.

• Reduced school performance.

• In some cases, bedwetting or impaired growth.

Unlike adults, children with obstructive sleep apnoea do not always appear excessively sleepy during the day.

Instead, they may seem unusually active, restless or have difficulty concentrating.

How is childhood snoring investigated?

An ENT assessment usually includes examination of the nose, throat, tonsils and upper airway.

Where appropriate, nasal endoscopy may be performed to assess the size of the adenoids and identify possible causes of nasal obstruction.

Parents may find it helpful to record a short video of their child's breathing during sleep, particularly if they notice pauses in breathing, gasping or unusual breathing patterns.

In selected cases, an overnight sleep study (polysomnography) may be recommended to confirm obstructive sleep apnoea and assess its severity.

A sleep study is particularly important when the diagnosis or severity is uncertain, when symptoms do not match the examination findings, or when certain medical conditions or risk factors are present, including obesity.

How is snoring in children treated?

Treatment depends on the underlying cause, the severity of symptoms and the child's overall health.

For mild symptoms, observation and treatment of nasal obstruction or allergic rhinitis may be sufficient.

When significantly enlarged adenoids or tonsils contribute to obstructive sleep apnoea, surgical treatment may be recommended.

Adenoidectomy and/or tonsillectomy can significantly improve breathing and sleep quality in appropriately selected children.

However, not every child who snores requires surgery.

The decision should be based on individual assessment, including symptoms, examination findings and sleep study results when indicated.

Some children may continue to experience sleep-related breathing difficulties after surgery, particularly if other risk factors are present. Follow-up assessment may therefore be necessary.

When should you seek medical advice?

An ENT assessment is recommended if your child:

• Snores regularly or loudly.

• Frequently breathes through their mouth.

• Has persistent nasal obstruction.

• Experiences restless or disturbed sleep.

• Appears to stop breathing or gasps during sleep.

• Develops daytime concentration or behavioural difficulties associated with poor sleep.

If your child experiences severe breathing difficulties, prolonged pauses in breathing or blue discolouration of the lips or skin, seek emergency medical assistance immediately.

Early assessment can help distinguish simple snoring from a sleep-related breathing disorder requiring treatment.

With an accurate diagnosis and appropriate management, many children can achieve quieter, more restful sleep and improved daytime wellbeing.

References

1. Mitchell RB et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngology–Head and Neck Surgery. 2019. DOI: 10.1177/0194599818801757

2. American Academy of Pediatrics. Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics. 2012. DOI: 10.1542/peds.2012-1671