Paediatric Sleep Conditions
Sleep is essential for your child’s health and development, but sleep issues are surprisingly common.
This page explains what you need to know about snoring and obstructive sleep apnoea (OSA) in children, including how to recognise problems and the options for treatment.
If you’re a GP seeking clinical information, you can read Dr Phillips’ detailed clinical notes here.
Snoring in children
Snoring is a sound created by vibrations in your child’s airway while they sleep. It’s quite common, affecting about 15–20% of children.
What causes snoring?
Snoring usually happens when tissues in the throat relax and partially block the airway during sleep. This is common when your child has enlarged tonsils or adenoids, allergies, nasal congestion, or a cold.
When snoring might be a concern
While occasional snoring can be normal, regular or loud snoring can be a sign of sleep-disordered breathing or obstructive sleep apnoea.
If your child snores frequently, especially if you notice pauses in breathing or they appear to struggle to breathe, it’s important to get an assessment from an ENT specialist.
Obstructive Sleep Apnoea (OSA)
What is OSA?
Obstructive sleep apnoea (OSA) is a condition where your child’s breathing repeatedly pauses or becomes very shallow during sleep because the airway becomes blocked.
How common is it
OSA affects approximately 5% of children most commonly between the ages of 2-8 years old. Snoring and OSA are more prevalent in children who are overweight, were born prematurely, have certain genetic conditions like Down syndrome of have facial features that narrow the airway.
Common symptoms of OSA
OSA in children can show up as:
Night time symptoms
- Loud, regular snoring (at least three nights a week)
- Pauses in breathing or gasping during sleep
- Breathing difficulty that makes parents worry
- Restless or sweaty sleep
- Bedwetting (nocturnal enuresis)
Daytime symptoms
- Daytime mouth breathing
- Morning headaches and daytime tiredness
- Difficulty concentrating, hyperactivity, or behavioural changes
- Daytime sleepiness or difficulty / irritable waking
Why OSA matters
If untreated, OSA can significantly affect your child’s health, behaviour, and development. It can lead to poor sleep quality, learning difficulties, behavioural issues, and even affect their growth.
How we investigate sleep problems
If you suspect your child has OSA Dr Phillips will take a detailed history and perform a thorough examination including:
- Checking tonsil and adenoid size
- Looking for signs of a narrow jaw or high palate
- Assessing nasal breathing
In some cases, a flexible camera (nasendoscopy) is used to evaluate the airway.
The gold standard test for diagnosis is overnight sleep study (polysomnography or PSG) however this is normally not recommended in children unless they are <2 years old, have neurologic or genetic conditions or have persistent symptoms post adenotonsillectomy.
When to see an ENT specialist
Your child might benefit from an ENT assessment if:
- They snore loudly and regularly
- You notice pauses or difficulty breathing during sleep
- They cannot breathe through their nose easily / mostly mouth breath
- They’re constantly tired or have behavioural issues, including struggling at school
- They have ongoing symptoms even after initial treatments, like nasal sprays
Treatment options for paediatric sleep apnoea
There are several ways to manage paediatric sleep issues, depending on their cause and severity. In very mild cases treatment usually starts with less invasive options, progressing to surgery if necessary.
Non-surgical treatments
Nasal steroid sprays may be trialled in children with nasal obstruction or allergy
Weight loss: If your child is overweight, healthy weight loss can greatly improve OSA symptoms
Orthodontics such as palate expanders may help children with narrow upper jaws
CPAP (Continuous Positive Airway Pressure) uses gentle air pressure through a mask to keep the airway open during sleep and is a common treatment for adults. It is rarely used in children and normally reserved for cases of central sleep apnoea under the supervision of a respiratory paediatrician
Surgical treatments
Adenotonsillectomy (removal of tonsils and adenoids)
This is the first-line treatment in most cases of moderate-to-severe OSA, or those with persistent symptoms, especially if the child is over 2 years and has enlarged tonsils/adenoids
- Standard tonsillectomy removes the entire tonsil
- Intracapsular tonsillotomy (using Coblation) removes most of the tonsil but leaves the capsule, which may lead to less pain and bleeding. However, there is a small (around 3-5%) risk of tonsillar regrowth which may require further surgery in future
What happens after treatment?
What if it persists after surgery?
OSA can persist in up to 10-20 % of children post-surgery. This is more likely in children who:
- Had severe OSA before surgery
- Are overweight
- Have underlying genetic or neurological conditions
In such cases, further evaluation may include:
- Sleep study (PSG) – to confirm presence of persistent OSA
- Drug-Induced Sleep Endoscopy (DISE)
A specialised test performed under anaesthetic that helps identify exactly where and how your child’s airway collapses during sleep, guiding more targeted treatment
- During which additional procedures may be performed depending on the site of collapse including:
- Lingual tonsillectomy
Sometimes tonsil tissue at the base of the tongue can block the airway. Removing this can significantly improve breathing. - Supraglottoplasty
A procedure that treats floppy tissue above the voice box, sometimes needed in laryngomalacia.
- Lingual tonsillectomy
When to seek help
It’s important to consult an ENT specialist if your child:
- Regularly snores loudly or shows difficulty breathing at night
- Often wakes up tired or is frequently sleepy during the day
- Has behavioural issues or trouble concentrating
- Has not improved despite initial treatments (e.g., nasal sprays, allergy treatment)
Early intervention often leads to the best outcomes, helping your child achieve restful sleep, better health, and improved overall development.
FAQs
Is snoring always a sign of sleep apnoea?
No, but regular loud snoring can be a warning sign, especially if accompanied by gasping, apnoeas or behavioural issues.
Will my child outgrow it?
Some children may improve over time, particularly if they were very young or have mild symptoms. However, many children with moderate or severe OSA benefit significantly from treatment.
Is sleep apnoea dangerous?
Untreated OSA can lead to problems with behaviour, learning, growth, and even heart strain. Early diagnosis and treatment can greatly improve quality of life and health outcomes.
What is DISE and when is it needed?
Drug-Induced Sleep Endoscopy allows specialists to examine your child’s airway while they’re asleep, helping to pinpoint areas of obstruction when OSA persists after surgery.
Procedures Dr Phillips performs
Dr Phillips offers the following treatments for paediatric sleep issues:
Book a consultation
Concerned about your child’s breathing at night or snoring? Dr Nicholas Phillips welcomes paediatric consultations at his Gold Coast clinic.
