Children can often snore. Any parent will tell you this.

This is particularly true when they have a blocked nose due to a cold. There are other types of snoring however which last longer than a few days and are less benign. When a child’s breathing at night becomes laboured to the point at which the parents are concerned - it usually means there is significant airway obstruction. In rare cases this is due to developmental problems at the connection between the nose and the throat but in the vast majority of children the problem is due to large tonsils and adenoids.

When awake, muscle tone in the soft palate together with the upright position of the child keeps the airway open, but when asleep, the muscles relax and the soft palate flops backwards towards the back wall of the throat. This is perfectly natural. If however large tonsils and adenoids are present, there is very little room in the airway at the best of times, and so when the palate flops, the airway closes. This results in loud snoring followed by no sound – this is the point when the airway closes. At this point as no breathing is taking place the child's sensors detect the change and start waking the child up again. This in turn causes muscle tone to return and this lifts the soft palate forward thus restoring the airway. Parents who have witnessed this in their children describe the point at which the snoring stops very well. The chest continues to try to suck in air, but as the airway is blocked, no air reaches the lungs until the child starts to wake. We call this Obstructive Apnoea.

This can happen many times over the course of a nights sleep and can give rise to several problems.

One of the commonest is recurrent waking and crying during the night. There can also be an association with bad dreams or ‘night terrors’.Children may still be lively during the day but there are often reports from school or nursery of children with this condition falling asleep in story telling or other quiet activities.

Also of concern is the stress this places on the heart which has to continue forcing blood around the lungs against a negative pressure in the chest caused by the attempts to breathe against a blocked airway. The long term consequences of this are detrimental to the cardiovascular system.

The functioning IQ of the affected child is also worse than their potential should allow as they tend to have difficulty concentrating during the day. Studies have shown children with obstructive sleep apnoea have poor concentration and memory as well as lower IQs than those children without the condition. Obstructive Sleep Apnoea can also worsen daytime behaviour.

The sleeping position of children with large obstructing adenoids and tonsils is also informative. They tend to lie with their necks extended so that their heads are thrown back. This arching backwards is a conditioned response to the airway obstruction that occurs when the neck is flexed. If the child sleeps on his or her front they may try to still sleep with the neck arched or simply with their knees curled up and bottom in the air. This is also an attempt to keep the neck extended so as to improve the airway.

In order to correct Ostructive Sleep Apnoea the airway must be improved and this is usually very easy. Removing the adenoids and tonsils will restore a normal airway and immediately correct the problem. The operation takes under 30 minutes and usually requires one night in hospital.

If you would like to arrange a consultation with Mr Banerjee to look into this condition further please contact us.

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