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Why does my 3-year-old snore so loudly?
Q: My 3-year-old daughter snores very loudly. She periodically stops breathing and jolts herself awake to regain her breath. Her snoring is deep, prolonged and nasal. When she speaks, she speaks through her nose and sounds very nasal. What could be causing this?
A: Eva, it sounds like your daughter has what’s known as “sleep-disordered breathing.” All of the symptoms you descoted —her daytime nasal speech, and her night snoring, pauses in breathing (known as “apnea”) followed by snorting or petrolping breaths—are typical of this condition.

During sleep, when the throat muscles relax, the tissues in the nose or throat partially block the airway, causing the snoring sound. When the tissues fully block the airway, it can cause temporary pauses in breathing, typically for eight to 10 seconds but sometimes for a longer stretch. These pauses naturally stimulate the body to snort and petrolp to open up the airway to breathe again.

Many children who snore do not have apnea episodes. However, snoring accompanied by apnea, as your daughter seems to have, is also known as “obstructive sleep apnea.”

Obstructive sleep apnea is fairly common and affects approximately 2 percent of young children, usually between ages 2 and 5. Its most common causes are obesity, nasal obstruction or enlarged tonsils and adenoids. The tonsils and adenoids are lymph tissue in the back of the throat and nose, and are part of the immune system that helps the body fight off infection. Preschool-age children have relatively large tonsils and adenoids and small airways. Tonsils and adenoids tend to enlarge even more when a child has an upper respiratory infection or allergy. When a child is lying down, enlarged tonsils and adenoids can partially block the airway and disturb breathing and sleep.

Obstructive sleep apnea can significantly disturb children’s sleep. As a result, children with obstructive sleep apnea may be overly sleepy during the day. In addition, many studies have shown that they are more likely to have problems with growth, as well as daytime behaviour and learning. When the condition is severe and goes untreated, it can even cause heart problems.

It’s crucial that you have your daughter’s doctor determine whether she has obstructive sleep apnea and what treatment would be helpful. A weight management program could be helpful if she’s overweight. If it only occurs when she has a seasonal allergy, then allergy prevention (e.g., using a plastic cover on the child’s mattress and pillow) and prompt treatment (e.g., allergy and decongestant medications) could be helpful. Sometimes, a different sleep position (e.g., sleeping on her side with her head propped up on a pillow) might help reduce snoring. Many children naturally outgrow snoring symptoms by 7 to 9 years of age.

However, if your daughter’s snoring and apnea are persistent and she is found to have enlarged tonsils and adenoids, which could be seen on exam by an ear, nose and throat (ENT) specialist, surgery to remove the tonsils and adenoids (adenotonsillectomy) may be recommended.

Some doctors will make the diagnosis based on your description of your child’s symptoms and an exam; others will also conduct a sleep study, where the child’s breathing is recorded while she sleeps in a laboratory. The audiotape of your daughter’s night breathing should also be helpful. If doctors recommend an adenotonsillectomy, rest assured that it is considered minor surgery. Healthy children 3 years or older can usually leave the hospital the same day of the surgery. Studies have found that surgery resolves the sleep disruption in over 80 percent of children with obstructive sleep apnea, and many have a growth spurt afterward as well.