Child snoring: when to worry and what to tell the pediatrician

What’s going on

Lots of children snore now and then, especially with a cold or allergies. That kind of snoring usually fades when the stuffiness does.

Regular snoring is different. It can be a sign of obstructive sleep apnea, where a child’s airway partly or fully closes during sleep. The American Academy of Sleep Medicine (AASM) says it affects about 3% to 5% of otherwise healthy children.

In children, it’s often caused by large tonsils and adenoids, the NHLBI says. Adenoids are tissue at the back of the nose. The AASM says it’s often found between ages 3 and 6, when tonsils and adenoids are large for the size of the throat.

Why it matters

Children have smaller lungs and less oxygen in reserve than adults. Even a short pause in breathing can lower a child’s oxygen level, the AASM explains.

Children also show it differently. Instead of being sleepy, younger children with sleep apnea may be inattentive or hyperactive. Untreated, it’s linked to learning, behavior and growth problems.

What the pediatrician guidance says

In 2012, the American Academy of Pediatrics (AAP) published guidance for pediatricians. It says:

1. Every child and teen should be screened for snoring. You don’t have to wait to be asked. Bring it up.
2. A child who snores and has other signs of sleep apnea should have an overnight sleep study (polysomnography). If one isn’t available, the pediatrician may use another test or refer to a specialist.
3. Removing the tonsils and adenoids is the first-line treatment when they’re enlarged.
4. CPAP is an option if surgery isn’t done, or if sleep apnea continues afterward.
5. Weight loss is recommended alongside other treatment for children with overweight or obesity.
6. Nasal steroid sprays are an option for some children with mild sleep apnea.

The pediatrician will decide what fits your child. Your job is to notice and report.

Signs to raise with the pediatrician

Write down what you see for a week or two, and take a short phone video of your child’s breathing during sleep.

At night

• Snoring most nights, not only with a cold
• Pauses in breathing, snorts or gasps
• Working hard to breathe: the chest or ribs pull inward with each breath
• Mouth breathing
• Restless sleep, tossing and turning, or waking often
• Sleeping in odd positions, such as sitting up or with the neck stretched back
• Heavy sweating in sleep
• Bedwetting

During the day

• Trouble paying attention, or overactive or aggressive behavior
• Morning headaches or a dry mouth
• Daytime sleepiness, more often in older children and teens
• Frequent colds or throat infections, or trouble swallowing because of large tonsils

These come from the AASM and NHLBI lists. Children with Down syndrome, a cleft palate or other differences in the face or skull, or neuromuscular conditions have a higher risk. So do children exposed to tobacco smoke or born early.

If your child ever turns blue, or struggles to breathe while awake, get urgent medical care.

Tonsils, adenoids and mouth breathing

Large tonsils and adenoids narrow the airway at the back of the mouth and nose. Children with sleep apnea often breathe through the mouth, the AASM notes.

The pediatrician can look in your child’s mouth and nose. They may refer you to an ear, nose and throat doctor. After tonsil and adenoid surgery, the AAP advises checking whether symptoms are gone, because some children still have sleep apnea afterward.

What a dentist may notice

Dentists see a child’s mouth regularly, so they may spot things worth mentioning to the pediatrician. None of these means your child has sleep apnea. They’re reasons to ask.

• A narrow upper jaw or high palate. A dental sleep medicine review links a narrow palate and mouth breathing in children with sleep apnea, though the research is still developing.
• Grinding. A 2024 review found an association between teeth grinding and sleep-related breathing problems in children. The evidence was low quality, and grinding has many causes.
• Crowded teeth. A dentist may mention crowding too. But a small 2022 review of low-quality studies found no link between crowding and sleep-disordered breathing symptoms in children. On its own, it isn’t a reason to worry about sleep apnea.

If your dentist raises any of these alongside snoring, tell your pediatrician. The pediatrician is the one who decides whether your child needs a sleep study.

What not to do

• Don’t buy an anti-snoring device for a child. Over-the-counter snoring mouthpieces aren’t meant for anyone under 18.
• Don’t tape a child’s mouth. A child who snores may have a blocked nose or sleep apnea, and taping is risky when the nose can’t carry enough air.
• Don’t wait it out if the signs above fit. Sleep apnea in children often goes undiagnosed for years, the AASM says, and it’s treatable.

Start with the pediatrician. They can screen, examine and, if needed, order a sleep study.