Abnormal Breathing In Children: Snoring, Mouth-Breathing And Blocked Nose

Does your child snore loudly or persistently breathe through his/her nose? Does your child have problems breathing through his/her nose pretty often? In fact, if your child is snoring equally as loud or even louder than Dad is, then their breathing is most definitely abnormal. Most children should sleep peacefully and quite quietly, at least most of the night. So if you have noticed noisy breathing, snoring, strange mucus-trapped noises in his/her nose, choking, gasping, snorting, and even teeth-grinding, then this is a form of abnormal difficulty in breathing when your child is asleep i.e. Your child is struggling to breathe in adequate levels of oxygen when they sleep but they have difficulty doing so, leading to all the unusual noises and movements you may have observed in them.

As a paediatric ENT doctor in Singapore, we see many children with breathing difficulties and/or noisy breathing conditions. It may be normal for children to snore sometimes, typically when they are unwell with a bout of the flu or the common cold but definitely abnormal if your child is snoring nearly every night! Snoring occurs during sleep when the child is breathing in and there is some obtruction of air flowing through the back of the mouth. The opening and closing of the air passage causes vibration of the floppy soft tissues at the back of the child’s throat. How loud your child’s snoring is, depends on how little air is passing through the narrow airway and how quickly the throat tissue is vibrating.

The American Academy Of Pediatrics Recommends That All Children Should Be Screened For Snoring And That A Diagnosis Be Undertaken To Check If A Child Is Experiencing Normal Primary Snoring Or Obstructive Sleep Apnoea Syndrome (Osas), Which Is Far More Worrying.

The main concern is that the snoring child may be suffering from underlying obstructive sleep apnoea syndrome (OSAS), a serious health condition which, if left untreated, may affect the child’s general health and wellbeing, including their cognitive development and behavioural state. Good quality sleep at night is important in children but some children, even if they seem to be getting their 9-10 hours’ duration of sleep at night, may not actually be getting proper deep sleep to allow their brains to release important chemicals, such as growth hormone. Some children with disturbed abnormal breathing when they asleep, may also start to wet the bed even after they have already been toilet-trained, as bed-wetting may be a sign of stress during sleep due to the underlying airway obstruction and breathing difficulty.

So what happens during an abnormal episode of sleep apnea or difficulty breathing when asleep? There may be a sudden pause in the child’s breathing that can last only a few seconds or even as long as a minute. The brain is then alerted and signals the body to make an effort to start breathing again. This effort at the child trying to breathe, results in the child gasping or snorting, even waking themselves up just to be able to start breathing again. As these repeated arousal events to breathe adequately may occur multiple times during the night, the child may end up getting poor quality sleep, leading to daytime tiredness or behavioural problems, which may be noticed at school. This may eventually affect their ability to perform well at school.
Some children may go on to have learning problems, or are more likely to be hyperactive, with difficulty paying attention, even displaying signs of attention-deficit/hyperactivity disorder (ADHD). Obstructive sleep apnoea may also be associated with delayed growth and cardiovascular problems in children.

Look carefully at the way your child breathes during the daytime and also when asleep at night: Do they consistently breathe with their mouth open? Mouth-breathing over a prolonged period is abnormal, and may affect the shape and length of the child’s facial bones, leading to the formation of the “adenoid face” (Figure 1). The “adenoid face” is the classic appearance of a mouth-breathing child who now has a long facial structure, slack-jawed appearance and protruding teeth. They may also have a narrow nose, shortened upper lip appearance and teeth misalignment or malocclusion issues (“overbite”). We often receive referrals from our dentist colleagues who worry about their paediatric patients who mouth-breathe, as this leads to reduced saliva in their mouths higher risk of tooth decay and can affect normal teeth development.

In Singapore, children who persistently snore loudly, breathe noisily or breathe through their opened mouths, usually also often suffer from underlying blocked runny noses. The soft tissues inside their nose may be swollen and enlarged as they have underlying allergy and sinus issues which need to be properly treated to prevent the above sleep and breathing complications. In the very young child, the tonsils and adenoids are commonly enlarged as they form part of the immune system to play an important role in fighting infection. But sometimes, the tonsil and adenoid soft tissue, made up of reactive lymph gland tissue, may enlarge way too much, and then they end up blocking the child’s narrow airway to lead to snoring, mouth-breathing and strange mucus-trapping sounds with the child often making throat-clearing noises, coughing or sniffing constantly.

So what danger signs of sleep apnea in children should you be watching out for in your own child? Dr Annabelle Leong has a few tips for you:

At Night, Children With Sleep Apnea May:

• Snore loudly and regularly
• Have pauses, gasps, grunting and snorts and may actually stop breathing. The snorts or gasps may wake them up and disrupt their sleep repeatedly throughout the night.
• Be restless or sleep in abnormal positions with their head in unusual positions.
• Sweat heavily during sleep.
• Grind their teeth repeatedly
• Breathe through their open mouths very often

In the Daytime, Children With Sleep Apnea May:

• Have behavioural, school and social problems
• Be rather difficult to wake up
• Suffer headaches during the daytime but especially in the morning
• Be irritable, cranky, agitated and aggressive
• Be so sleepy during the day that they doze off, fall asleep or daydream
• Speak with a nasal-sounding voice and breathe constantly through their mouth

So if your child is displaying any of the worrying symptoms and signs above, then you should bring your child to see a dedicated children’s ENT specialist to have their breathing problems properly checked out.