In children and adults alike, the muscles at the back of the throat relax when we sleep. This airway sagging is completely normal. However, in children with large tonsils, adenoids or nasal congestion (eg due to allergies or infections), this sagging can be exacerbated, causing snoring.
The tonsils, medically known as the palatine tonsils, are two oval-shaped mounds of tissue on either side at the back of the throat (pharynx) — you can see them in the mirror if you open your mouth wide. Adenoids are small mounds of tissue at the back of the nose above the roof of the mouth, which are hidden from view. Both the adenoids and tonsils help fight off infection.
In young children, the tonsils and adenoids are naturally larger and don’t start to shrink until around age four or five. It is, therefore, normal to expect most children to snore for periods of time during nursery and the early primary school years. In most cases, they will grow out of it. There is no evidence that this has a negative effect on their development.
Severe cases of snoring can interrupt the normal breathing cycle of your child. When snoring is accompanied by breath holding (apnoea), where your child stops breathing for several seconds, it is called obstructive sleep apnoea (OSA).
In OSA, the levels of oxygen in their bloodstream drop due to their breath holding. Their brain consequently detects that their breathing has stopped and briefly wakes them up to open their airways again.
This cycle of breath holding and waking can significantly affect your child’s quality of sleep, leaving them sleepy, irritable and unable to concentrate during the day.
There is increasing evidence that, if left untreated, OSA can negatively affect a child’s quality of life, learning and performance at school. Extremely rarely, untreated OSA may lead to significant heart and lung problems ie pulmonary hypertension and heart failure.
Signs that your child has OSA include:
Risk factors for OSA in children largely revolve around medical problems that affect the growth of their skull and jaw, and/or children with low muscle tone. For example, children with Down syndrome are more likely to have OSA.
However, it is important to note that children with no other health problems can still develop OSA. If your child shows symptoms of snoring and disturbed sleep, it is, therefore, important to see a doctor to rule out OSA.
OSA in children is usually treated via surgery to remove the tonsils and adenoids. This is successful in over 90% of children who are otherwise healthy.
Traditionally, the tonsils and adenoids were removed by cutting them out. However, around five years ago, a newer technique called coblation was further refined and is now the preferred method for removing tonsils and adenoids in children. This is because coblation causes less bleeding and pain, which allows for a faster recovery.
Coblation uses an electrically powered device to ‘dissolve’ the tissue that the tonsils and adenoids are made of. Your child will be able to eat and drink normally after their procedure and will usually be ready to return to nursery or school after a week.
Professor Iain Bruce is a Consultant Ear, Nose and Throat Surgeon (ENT) at Spire Manchester Hospital and the Royal Manchester Children's Hospital. He specialises in all aspects of paediatric ENT, including children's ear disease and hearing loss, glue ear, implantable hearing devices (cochlear implants and bone anchored hearing aids), snoring, tonsillitis, neck lumps, nasal obstruction, drooling and tongue ties. Prof Bruce is also an active member of the research community and is Editor-in-Chief of the Cochlear Implants International journal.
Visit Professor Bruce's website: www.manchesterchildrensent.com
If you're concerned about symptoms you're experiencing or require further information on the subject, talk to a GP or see an expert consultant at your local Spire hospital.