SATURDAY, JANUARY 19 2013 04:51
If your child snores, tell your pediatrician. Snoring may be a symptom of an underlying condition that can have serious health consequences later in life.
Even though snoring in children is frequently trivialized and even joked about by family members, it can be a sign of a serious medical problem or condition.
Many parents will casually report that their son or daughter snores so loudly that they “sound like grandpa” or even “wake the entire house up.” But these casual reports just reinforce the need for practitioners to screen all children at routine visits for a history of snoring and especially those children with large tonsils on physical exam.
It is important that a report of snoring is not only when a child has seasonal allergies or is sick with a cold to be considered persistent. Almost 80 percent of children will snore when they are congested with a cold or allergies and this is predictable, normal and not pathologic.
When there is a report of persistent snoring even without congestion, then further testing and evaluation is important and indicated. This is because a child’s snoring can be an early sign of obstructive sleep apnea. OSA is a complicated condition but essentially, a child’s snoring is an audible sign that there may be multiple, short, 2-3 second episodes of apnea (stopped breathing) during sleep. All children continue breathing normally between these episodes, but their sleep is interrupted.
When snoring is a sign of OSA and remains untreated or unaddressed for years, it may lead to cardiac problems (primarily right heart enlargement), in early adulthood. But long before any heart problems potentially arise, snoring and OSA are frequently associated with some of the following symptoms and signs: gasping or snorting during sleep, prolonged nocturnal enuresis (bedwetting), chronic mouth breathing with sleep, daytime somnolence (sleepiness) even after a full night’s sleep, and even behavioral and attention problems.
If your child has persistent snoring with or without some of these other signs, then after initial pediatric evaluation and exam, a referral to a pediatric ear-nose-throat specialist may be needed. A pediatric ENT can use a flexible endoscope to check for hypertrophy — enlargement — of a child’s adenoids and tonsils. Enlargement of tonsils and adenoids is the most common cause of persistent snoring in children.
So, once snoring has been confirmed by both a practitioner and specialist to be a sign of OSA, what is the next step(treatment)? Rarely, when the swelling of the tonsils and adenoids is mild, intranasal steroids at bedtime used for 4-6 weeks can decrease swelling and minimize snoring. But the majority of the time, the gold standard and definitive treatment for OSA is surgery to remove the tonsils and adenoids.
In summary, because of the proven available treatment and clear significant health consequences of OSA, it is important for parents to always mention their child’s persistent snoring at any pediatric office visit.
Jennifer Rich, MD is a board-certified pediatrician and is an associate professor of pediatrics at Albert Einstein College of Medicine, of which she is an alumna. She continued her pediatrics residency at the same institution and went on to serve as chief resident at the Children’s Hospital at Montefiore. Rich has a special interest in the prevention and treatment of childhood obesity, medical education and biomedical ethics. She is a physician at Peconic Pediatrics in Riverhead.
