Sleep Apnea (Child)

Sleep apnea is also called obstructive apnea. It's a condition where there are long pauses between breaths during sleep. It usually first appears in preschool-age children (2 to 5 years). This is the most common type of apnea in children over 2 years old. Pauses in breathing may be brief. Or they may last more than 10 seconds. During this time the child continues to make efforts to breathe. This can occur in otherwise healthy children from 2 years old through the teen years.

Sleep apnea can have a number of potential causes. They include:

  • Obesity

  • Enlarged tonsils or adenoids

  • Medicine side effects

  • Anatomic abnormalities

  • Metabolic or genetic disorders

Many symptoms of sleep apnea can be recognized. You may also see the breathing pauses directly. Other common symptoms include:

  • Snoring

  • Morning headaches

  • Extra sleepiness

  • Restless sleep

  • Night sweats

  • Blockage in the nose

  • Irritability

  • Behavioral problems

  • Bedwetting

Snoring is the most common symptom. But not all children who snore will have sleep apnea. Other symptoms vary by age.

At night the younger child may have labored, noisy breathing, restless movements, sweating, bedwetting and unusual sleep positions. During the day, the child may be hyperactive, and have poor attention and behavioral problems. Sleep apnea can lower the amount of growth hormone made. This can affect your child's growth. Untreated sleep apnea can cause lung conditions and cardiovascular problems such as high blood pressure.

At night the older child may have noisy breathing, gasping, sweating, and mouth breathing. During the day, the child may have trouble getting out of bed, frequent napping, irritability, and poor concentration and attention. Their grades at school may suffer.

The diagnosis can be hard to make from the parent’s description alone. The child may need special sleep studies to know for sure that this is the problem. Your child's healthcare provider may refer you to an ear, nose, and throat doctor (ENT or otolaryngologist) or a sleep specialist (pulmonologist) for such studies.

If your child has nasal allergies, anti-inflammatory or decongestant medicines may help. If enlarged tonsils and adenoids are the cause and symptoms are severe, surgery may be advised. In rare cases, a child will be prescribed a special machine (CPAP or BiPAP) to use when they sleep. The machine helps keep the airways open to prevent further episodes of sleep apnea.

Home care

  • Children 1 year and older:  Have your child sleep in a slightly upright position. This is to help make breathing easier. If possible, raise the head of the bed slightly. Or raise your older child’s head and upper body up with extra pillows. Talk with your healthcare provider about how far to raise your child's head.

  • Babies younger than 12 months: Never use pillows or put your baby to sleep on their stomach or side. Babies younger than 12 months should sleep on a flat surface on their back. Don't use car seats, strollers, swings, baby carriers, and baby slings for sleep. If your baby falls asleep in one of these, move them a flat, firm surface as soon as you can. This is so their airway won't be blocked while they sleep.

  • Keep your child away from cigarette smoke or other indoor pollutants. These will irritate the throat lining and make the condition worse. Don't let anyone smoke near your child or in your home or car.

  • Treat nasal allergies as advised by your child's healthcare provider.

  • If your child is overweight, discuss a weight-loss program with your child's provider.

Follow-up care

Follow up with your child's healthcare provider, or as advised, for your child’s next scheduled exam. If an X-ray or CT scan was done, you'll be told if there is a change in the reading, especially if it affects treatment.

Call 911

Call 911 if any of these occur:

  • Trouble breathing

  • Any episodes where your child appears to be limp, or their skin looks pale or has a blue color (often around the mouth)

  • Confusion or feeling dizzy

  • Very drowsy or trouble waking up

  • Fainting or loss of consciousness

  • Trouble talking

  • Rapid heart rate

  • Seizure

  • Stiff neck

When to get medical advice

Call your child's healthcare provider right away if any of these occur:

  • Observed pause in breathing that lasts more than 20 seconds

  • Not responding normally (behavioral changes) in school or at home

  • Bluish color during periods of normal breathing

  • Behavioral changes

  • Fast breathing:

    • Birth to 6 weeks: over 60 breaths/min

    • 6 weeks to 2 years: over 45 breaths/min

    • 3 to 6 years: over 35 breaths/min

    • 7 to 10 years: over 30 breaths/min

    • Older than 10 years: over 25 breaths/min

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