Child Snoring: Causes, Signs of Sleep Apnoea and When to See a Doctor

01Common

How common is snoring in children?

Occasional snoring is very common, particularly during colds. Regular snoring, on three or more nights a week, is less common, and obstructive sleep apnoea affects a smaller number of children, most often between the ages of two and eight, when tonsils and adenoids are largest relative to the airway. The NHS notes that snoring in children is often linked to enlarged tonsils or adenoids.

02Causes

Common causes

• Enlarged tonsils and adenoids: the most common cause in young children.
• Colds and respiratory infections: temporary snoring.
• Allergies: nasal congestion from dust mites, pets or pollen.
• Nasal blockage from a deviated septum or polyps (less common).
• Obesity, especially in older children.
• Craniofacial differences, such as a small jaw.
• Conditions such as Down syndrome or neuromuscular disorders.

03OSA

Signs of obstructive sleep apnoea

• Loud snoring on most nights.
• Pauses in breathing, followed by gasps or snorts.
• Restless sleep and unusual sleeping positions, such as the neck extended.
• Heavy sweating during sleep.
• Mouth breathing day and night; see mouth breathing.
• Bedwetting after previously being dry.
• Morning headaches.
• Daytime sleepiness, irritability, hyperactivity or poor concentration.
• Poor growth or weight gain in some children.

04Three

A three-year-old who snores

At three, snoring is often linked to colds or large adenoids and tonsils. If your child snores only during colds and breathes quietly otherwise, it is usually not a concern. If they snore loudly most nights for several weeks, breathe through their mouth, or you notice pauses or gasps, speak to your doctor. Recording a short video of your child’s breathing during sleep can be very helpful for the doctor.

05Effects

Why sleep apnoea matters

• Broken sleep can affect behaviour, mood and attention.
• Some children with OSA are mistaken for having ADHD.
• Poor sleep can affect learning and school performance.
• Severe OSA can affect growth and, rarely, the heart.
• Treating OSA often improves sleep, behaviour and quality of life.

06Diagnosis

How it is diagnosed

A doctor will ask about snoring, sleep and daytime symptoms, and examine the nose, throat and tonsils. American Academy of Pediatrics guidance recommends a sleep study (polysomnography) for children who snore regularly with signs of OSA where possible, or referral to a sleep specialist or ear, nose and throat surgeon. Home sleep monitoring or overnight oximetry may be used in some settings.

07Treatment

Treatment options

• Watchful waiting: for mild cases, as some children improve as they grow.
• Nasal steroid sprays or allergy treatment for mild OSA or allergy-related snoring.
• Adenotonsillectomy: surgery to remove tonsils and adenoids, the main treatment for OSA caused by enlarged tonsils.
• Weight management for children with obesity.
• CPAP for children who still have OSA after surgery or are not suitable for it.
• Orthodontic treatment in some cases.

08Evidence

What the evidence shows

In the Childhood Adenotonsillectomy Trial, children aged five to nine with OSA were randomly assigned to early adenotonsillectomy or watchful waiting with supportive care. After seven months, the surgery group did not differ in attention and executive function tests, but showed greater improvements in behaviour, symptoms, quality of life and sleep study results. Nearly half of the children in the watchful waiting group also had normal sleep studies at follow-up. This helps doctors and families make shared decisions about surgery.

09Home

What you can do at home

• Treat colds with saline drops and keep the nose clear.
• Reduce exposure to allergens and smoke.
• Keep a regular bedtime routine.
• Note how often your child snores and record any pauses.
• Support healthy weight through activity and balanced meals.
• Large tonsils are discussed in swollen tonsils.

10Cases

Three common situations

• Toddler who snores only with colds: usually no treatment needed.
• Four-year-old with loud nightly snoring, pauses and daytime irritability: see a doctor about sleep apnoea.
• Child who snores and is struggling to concentrate at school: ask whether sleep may be affecting learning.

11Surgery

What to expect from adenotonsillectomy

Adenotonsillectomy is a common operation done under general anaesthetic, often as a day case or with one overnight stay. Children usually have a sore throat for about one to two weeks and need regular pain relief, plenty of fluids and normal food to help healing. There is a small risk of bleeding, most often in the first two weeks, which needs urgent attention. Most children sleep and breathe much better afterwards, though some still snore and need further assessment.

12Older

Snoring in older children and teenagers

In older children and teenagers, snoring may be linked to weight gain, allergies, nasal blockage or, less often, large tonsils. Daytime sleepiness, poor concentration and mood changes are worth discussing with a doctor. Snoring remedies for adults are not always suitable for children; see snoring remedies for general advice.

13Summary

Key points to remember

• Occasional snoring is common in children.
• Loud snoring most nights with pauses or gasps may be sleep apnoea.
• Enlarged tonsils and adenoids are the most common cause.
• Adenotonsillectomy is an effective treatment for many children with OSA.