Snoring in children refers to a series of pathophysiological changes caused by frequent upper airway obstruction during sleep, which disrupts the normal breathing and sleep structure of the sleep process.
The most typical manifestations of children’s snoring are: snoring during sleep, open-mouth breathing, repeated awakening during sleep, difficulty in breathing and excessive sweating. There are also bedwetting, hyperactivity, and other signs of misbehavior in children. Xiaoyun Tang, Department of Ophthalmology, Ear, Nose and Throat, Yuexiu District Children’s Hospital, Guangzhou
The author has been engaged in otorhinolaryngology for nearly 30 years and has treated many cases of snoring in children, most parents have misconceptions about snoring in children and ask many questions. Now we will answer the questions most often asked by parents to the specialist.
Is snoring a good sleep?
“Old people say that children who snore in bed are sleeping well and it doesn’t matter, right?” Many parents ask a similar question. In this regard, we should identify the situation before jumping to conclusions.
Occasional snoring (commonly known as snoring) in children’s sleep due to fatigue or upper respiratory tract infection does not have much effect on the body. In deep sleep, the muscles of the whole body are relaxed and the muscles of the pharynx are relaxed, so that the upper respiratory tract is narrower than usual and there is a slight snoring sound when breathing, but the ventilation is basically normal and there is no lack of oxygen, which does not matter.
Children with acute upper respiratory tract infections, such as acute rhinitis and tonsillitis, may also cause temporary narrowing of the airway, which can be restored to normal after treatment.
However, if snoring is frequent and affects sleep and breathing, it is a pathology and should be taken seriously by parents.
This is because snoring has an impact on cardiovascular system, growth and development, cognitive function of the nervous system and craniofacial development, etc. If left untreated, it can gradually worsen. Long-term poor sleep and lack of oxygen can lead to a variety of systemic diseases, such as cognitive defects, malformations of maxillofacial development (adenoid face), and also complications such as tonsillitis, sinusitis, otitis media, etc. In serious cases, it even leads to pulmonary heart disease and heart failure.
Therefore, children with mild snoring can be left untreated; in more serious cases, they should go to the hospital for further examination and proper treatment. For those who have upper respiratory tract infection, they can be treated with medication first, and if there is no improvement, surgery will be considered.
Three questions about surgery
1. Can a 3-year-old child undergo surgery?
After children reach school age, the enlarged adenoids and tonsils will gradually shrink. Therefore, if the snoring is not too serious or has not reached school age, we can suspend surgery and carry out appropriate medication, while observing, strengthening exercise, enhancing physical fitness and avoiding upper respiratory tract infection. If the snoring is more serious or the adenoids and tonsils are obviously enlarged, surgery should still be considered.
Many parents worry that their children are still too young to have surgery now. In this regard, parents can rest assured. If the child has severe snoring, airway obstruction and hypoxemia, and there are no other contraindications to surgery, surgery is possible.
Nowadays, most hospitals adopt endoscopic minimally invasive surgery to remove adenoids, which is effective and less invasive. Low-temperature plasma radiofrequency or microelectric knife can also be used to remove tonsils and adenoids, which is less bleeding, more effective and safer. In some cases of airway obstruction due to specific etiology, surgery can be performed at a younger age. We have done hypopharyngeal cyst surgery for babies who were only 6 hours old and posterior rhinoplasty for babies with posterior nostril atresia who were two days old.
2.How is the surgery done?
The main treatment for snoring in children is the surgical removal of adenoids and tonsils. The extent of removal depends on the condition. If the adenoids are obviously enlarged and obstruct the posterior nostril for more than 2/3, and the tonsils are obviously enlarged for more than grade III, the adenoids and tonsils should be removed at the same time. If the snoring is simple and the tonsil hypertrophy does not reach degree III, only the adenoids can be removed.
In the past, tonsillectomy surgery for children was performed without anesthesia. However, the anesthesia-free method has a greater impact on the physical and mental health of the child, and nowadays, it is mostly replaced by general anesthesia with tracheal intubation. Today’s anesthesia technology and drugs have been greatly improved, with a high safety factor, few adverse reactions, and no harm to the brain and the whole body.
3.Will the immunity be reduced if the tonsils are removed?
Although tonsils and adenoids are lymphatic tissues and have certain immune functions, the nasopharynx, oropharynx and other lymphatic tissues of the human body have certain compensatory capacity, therefore, the removal of tonsils does not cause a significant decrease in immunity.
Many adolescents who have undergone tonsillectomy have been observed to have no worse physical resistance than other people of the same age. On the contrary, because the original tonsils are often inflamed and sometimes complicated by other diseases, the body is more robust after the removal of tonsils than before.
The tonsils are after all an immune organ and should be preserved as much as possible until the point where they have to be cut. The indications for tonsillectomy are now much stricter than they were decades ago. It is also recommended that only the larger side of the tonsils be cut, or that only a partial tonsillectomy be performed. Whether this has advantages or disadvantages needs to be confirmed by more medical research.
Snoring in children, what is the cause?
1.Nose: chronic rhinitis (infectious, allergic), deviated nasal septum, nasal polyps, posterior nostril atresia and nasal masses are common.
2.Nasopharynx and oropharynx: the most common causes are tonsillar hypertrophy, adenoid hypertrophy, other causes are tongue hypertrophy, fat accumulation due to obesity, pharyngeal and nasopharyngeal swelling, palatopharyngeal flap surgery, etc.
3.Larynx: congenital laryngeal cartilage softening, laryngeal webbing, tracheal atresia, etc.
4. Craniofacial malformation: mid-facial (mid-facial) dysplasia (Down syndrome, chondrodysplasia), mandibular dysplasia, etc.
5. Others: neuromuscular diseases, application of sedative drug treatment, etc.
What is the difference between children’s snoring and adults’ snoring?
The main difference between children’s snoring and adults’ snoring is that the causes are different and the treatment is also different.
Most snoring in children is caused by adenoid hypertrophy and tonsillar hypertrophy. Adults, on the other hand, are mostly due to obesity, narrow bony structures of the jaw, muscle relaxation and narrow nasal airway.
The treatment for children’s snoring is mainly surgical removal of adenoids and tonsils, and proper treatment of upper respiratory tract inflammation. Adult snoring is mainly treated with different methods according to the obstruction site and severity, such as the application of ventilator or appropriate surgical treatment.
Children snore and are prone to infection
Most of the snoring children are stunted and have low body immunity, so they are especially prone to upper respiratory tract infections, most commonly rhinitis, sinusitis, tonsillitis, pharyngitis, tracheitis and pneumonia.
In addition, adenoid hypertrophy compresses the eustachian tube (which is the ventilation channel from the middle ear to the nasopharynx), causing the ventilation of the eustachian tube to become impaired, resulting in a decrease in air pressure in the middle ear, fluid leakage, and affected tympanic membrane vibration, leading to conductive deafness, which is clinically diagnosed as secretory or exudative otitis media. If infection occurs, it can also become purulent otitis media.