In short
- The NHLBI says sleep apnea can affect children of any age, including babies, and is most common between ages 2 and 8.
- In children, obstructive sleep apnea is often caused by large tonsils or adenoids, and obesity is another common cause, according to the NHLBI.
- Children are judged on a stricter scale than adults: a 2016 European Respiratory Society task force said children with an AHI above 5, or 1 to 5 with related health problems, appear to benefit from treatment.
- The 2019 tonsillectomy guideline in Otolaryngology-Head and Neck Surgery recommends tonsillectomy for children whose obstructive sleep apnea is confirmed by an overnight sleep study.
- In the 2023 PATS trial of 459 children with snoring and mild breathing problems, surgery didn't improve executive function or attention at 12 months, but behavior, symptoms and quality of life improved more than with watchful waiting.
- A 2009 meta-analysis found children's standardized height and weight increased after tonsil and adenoid surgery, in studies that mostly enrolled children with sleep-disordered breathing.
Sleep apnea in children is when a child's breathing repeatedly narrows or stops during sleep, often because large tonsils and adenoids block the airway. It can show up as loud snoring, restless nights and bedwetting, or as daytime behavior and attention problems that are easy to blame on something else. The good news is that it's usually treatable, often with surgery to remove the tonsils and adenoids, and the right first step is a conversation with your child's pediatrician.
What is sleep apnea in children?
Sleep apnea in children is a sleep disorder in which the airway closes or narrows over and over during the night. Cleveland Clinic describes three types. Obstructive sleep apnea, caused by a blockage in the airway, is the most common. Central sleep apnea, where the brain has trouble signaling the breathing muscles, is rare and usually affects newborns. The third, sometimes called complex sleep apnea, can develop in a child being treated for obstructive sleep apnea with CPAP. This article is about the obstructive type.
Each time breathing is disrupted, the brain rouses the child just enough to breathe again. Cleveland Clinic compares it to hearing your phone ring once in the night: you wake briefly and drift off again without noticing. Those brief interruptions break up a child's sleep, and Cleveland Clinic says the result can be a child who is more tired during the day.
How common is it, and at what age?
The NHLBI says sleep apnea can occur at any age, including in babies, and that among children it is most common between ages 2 and 8. Cleveland Clinic puts the peak slightly earlier, between ages 2 and 6, and says obstructive sleep apnea affects up to 1% to 5% of children.
Babies are a special case. HealthyChildren.org, the American Academy of Pediatrics' site for parents, describes periodic breathing of infancy: short pauses in breathing followed by a burst of fast "catch up" breaths, then normal breathing again. It's generally considered normal, and babies should outgrow it by 6 months. If you're unsure whether what you're seeing is normal, ask your pediatrician.
What are the signs of sleep apnea in a child?
The signs of sleep apnea in a child show up both at night and during the day. At night, the NHLBI lists snoring, mouth breathing, breathing that starts and stops, waking up often and bedwetting. Cleveland Clinic adds coughing or choking, tossing and turning, night sweats, and sleepwalking or sleep talking.
During the day, the NHLBI says you may notice:
- behavior problems, such as being overactive or aggressive
- trouble paying attention at school
- dry mouth or headaches in the morning
- sleepiness
Notice that the daytime list includes being overactive, not only sleepy, so a child with sleep apnea won't always look tired. Our article on sleep apnea and ADHD goes into that overlap. If your child mostly breathes through their mouth, mouth breathing in children covers the causes and what a doctor will check.
What causes it?
In children, obstructive sleep apnea is often caused by enlarged tonsils or adenoids, according to the NHLBI, which also names obesity as a common cause. It lists Down syndrome, cleft palate or other differences in the face or skull, neuromuscular disorders, tobacco smoke and premature birth as other risk factors. Cleveland Clinic adds allergies, asthma, acid reflux and a family history of sleep apnea.
Big tonsils alone don't settle it, though. HealthyChildren.org points out that not every child with large tonsils and adenoids has sleep apnea, which is one reason doctors rely on a sleep study rather than a look in the mouth.
Why does it matter for growth, behavior and bedwetting?
Research: moderate (what this means)Untreated sleep apnea can affect a child's learning, growth and heart health. The NHLBI says it can lead to problems with learning and memory, and may raise the risk of impaired growth, poor school performance, high blood pressure, heart failure or pulmonary hypertension. The 2019 tonsillectomy guideline published in Otolaryngology-Head and Neck Surgery asks clinicians to check children with sleep-disordered breathing and large tonsils for conditions that may improve after surgery: growth problems, poor school performance, bedwetting, asthma and behavior problems.
Two studies give a sense of the size of these links.
On behavior, a 2012 study in Pediatrics used the Avon Longitudinal Study of Parents and Children. Parents reported on snoring, mouth breathing and witnessed pauses in breathing from 6 months onward, and rated behavior at age 4 (9,140 children) and age 7 (8,098 children). Children in the groups with breathing symptoms had roughly 20% to 100% higher odds of behavior problems after the researchers accounted for 15 other factors. Even children whose symptoms peaked before 18 months and then went away had 40% to 50% higher odds of behavior problems at 7. This was an observational study based on parent reports, so it shows a link rather than proof of cause, but the authors concluded that symptoms may need attention as early as the first year of life.
On growth, a 2009 systematic review and meta-analysis in Archives of Disease in Childhood pooled observational studies of otherwise healthy children before and after tonsil and adenoid surgery, most of which enrolled children because of sleep-disordered breathing. Standardized height (10 studies, 363 children) and weight (11 studies, 390 children) both increased significantly after surgery, as did IGF-1, a growth-related hormone. The authors suggested doctors consider sleep-disordered breathing from large tonsils and adenoids when a child isn't growing as expected.
How is it diagnosed?
Sleep apnea in children is diagnosed with an overnight sleep study, called polysomnography. The American Academy of Pediatrics' 2012 guideline says all children should be screened for snoring, and that those who snore and have symptoms or signs of sleep apnea should have a sleep study. HealthyChildren.org explains that the study usually takes place in a specialized sleep lab, with sensors that track breathing, oxygen and brain waves while staff watch your child sleep. The NHLBI adds that the doctor will look in the nose and mouth for large tonsils or other blockages and may measure blood oxygen overnight with pulse oximetry.
The 2019 tonsillectomy guideline goes further about who needs a sleep study before surgery. It says clinicians should refer a child for one if they are under 2, or have obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease or mucopolysaccharidoses. For other children, it advocates a sleep study when the need for surgery is uncertain or the exam doesn't match how severe the symptoms sound.
Why a child's results are read differently
A child's sleep study is read on a stricter scale than an adult's. The apnea-hypopnea index (AHI) counts how many times per hour breathing stops or becomes shallow. Cleveland Clinic says an AHI of 5 to 14 counts as mild sleep apnea in adults, which we explain in mild sleep apnea. In children, smaller numbers matter. A 2016 European Respiratory Society task force on children aged 2 to 18 said that children with an AHI above 5, children with an AHI of 1 to 5 who also have related health problems or factors that predict the problem will last, and children with complex conditions such as Down syndrome all appear to benefit from treatment.
How is it treated?
Treatment depends on the cause, and for most children with large tonsils and adenoids, surgery comes first. Here's how the main guidance and the newest trial line up.
| Source | Who it covers | Key point |
|---|---|---|
| AAP guideline, Pediatrics, 2012 | Children and teens with uncomplicated sleep apnea | Adenotonsillectomy is first-line when tonsils and adenoids are enlarged; CPAP if surgery isn't done or apnea persists |
| ERS task force, European Respiratory Journal, 2016 | Children aged 2 to 18 | Treat step by step and re-evaluate after each step to catch remaining problems |
| AAO-HNS Foundation guideline, Otolaryngology-Head and Neck Surgery, 2019 | Children aged 1 to 18 considered for tonsillectomy | Recommend tonsillectomy when a sleep study confirms obstructive sleep apnea; warn families it may persist or come back |
| PATS trial, JAMA, 2023 | 459 children aged 3 to 12 with snoring and an AHI under 3 | Surgery didn't improve executive function or attention, but improved behavior, symptoms, quality of life and blood pressure |
Tonsil and adenoid surgery
Removing the tonsils and adenoids, called adenotonsillectomy, is the most common and effective treatment, according to HealthyChildren.org, which also stresses booking a follow-up visit because the operation doesn't always work. The 2019 guideline asks surgeons to tell families that breathing problems may persist or recur and need more treatment. It also recommends overnight monitoring in hospital after surgery for children under 3 or with severe sleep apnea (an AHI of 10 or more, a lowest oxygen level below 80%, or both), and says codeine must not be given after tonsillectomy to children under 12.
What about snoring with only mild breathing problems?
The Pediatric Adenotonsillectomy Trial for Snoring (PATS), published in JAMA in 2023, tested surgery in a group doctors had long been unsure about: children who snore regularly but don't have frequent breathing pauses. It enrolled 459 children aged 3 to 12 at seven US academic sleep centers and randomly assigned them to early surgery or watchful waiting with supportive care for 12 months.
Surgery didn't significantly improve the two main measures, executive function and attention. It did improve behavior, sleepiness, symptoms and quality of life more than waiting, and it lowered blood pressure percentiles. Only 1.3% of children in the surgery group progressed to an AHI above 3, compared with 13.2% in the waiting group. Six children (2.7%) had a serious adverse event linked to surgery. For a child with snoring and mild breathing problems, that means weighing gains in behavior and quality of life against the risks of surgery, a decision to make with your child's doctor.
Other treatments
The NHLBI lists other options depending on the cause, including CPAP, steroid nasal sprays such as budesonide, the asthma medicine montelukast, oral devices or orthodontic treatment, mouth and facial muscle exercises, and support with weight. It notes that long-term PAP treatment may affect the growth of a child's face, and that montelukast can cause behavior and mood side effects, so contact the provider straight away if you notice changes. Keeping your child away from secondhand smoke matters too, because the NHLBI says it can worsen sleep apnea. For an overview of how adult options compare, see sleep apnea treatment options, and for help with masks, getting used to CPAP.
Can mouth tape or nasal strips help?
Mouth tape is not a treatment for sleep apnea in children or adults. We don't recommend mouth tape for children. A child who breathes through their mouth at night usually does so because something, such as large adenoids or a blocked nose, is in the way, and taping over the symptom could hide a problem a doctor needs to find. Our guides to mouth tape for kids and nasal strips for kids explain what to ask your pediatrician before trying any sleep product on a child.
Check this first. Skip mouth tape and see a doctor if you snore loudly, wake up gasping, have been told you stop breathing in your sleep, or can't breathe comfortably through your nose. More on safety
When should you see a doctor?
See your child's pediatrician if your child snores most nights, gasps or pauses in their breathing, wets the bed, or has daytime sleepiness, attention or behavior problems. HealthyChildren.org says to let your pediatrician know right away about these signs. A short phone video of your child's breathing during sleep can help, and Cleveland Clinic notes that recordings where the provider can hear breathing can speed up diagnosis.
Call 911 or your local emergency number right away if your child's breathing stops for more than 20 seconds, their skin turns pale, bluish or grayish, or there's a change in muscle tone, a fever or other signs of illness, which is HealthyChildren.org's emergency advice.
If you're pregnant and snoring yourself, or your own nose is blocked most nights, raise that with your own clinician too. Our list of sleep apnea warning signs covers what to watch for in adults.
This article is general information, not medical advice. Talk to your child's doctor about their symptoms.
Read next
- Snoring in children: what's normal and when to see a doctor
- Mouth breathing in children
- Is mouth tape safe for children?
Common questions
What are the signs of sleep apnea in a child?
At night, the NHLBI lists snoring, mouth breathing, breathing that stops and starts, waking often and bedwetting. During the day, look for hyperactivity or aggression, trouble paying attention at school, morning headaches or dry mouth, and sleepiness. Cleveland Clinic adds restless sleep, coughing or choking, and night sweats.
What is the most common cause of sleep apnea in children?
The NHLBI says obstructive sleep apnea in children is often caused by enlarged tonsils or adenoids, and that obesity is also a common cause. Children with Down syndrome, cleft palate or other differences in the face or skull, neuromuscular disorders, or who were born early are also at higher risk. Exposure to tobacco smoke raises the risk too.
How is sleep apnea diagnosed in a child?
With an overnight sleep study, called polysomnography, usually in a sleep lab. The American Academy of Pediatrics recommends one for children who snore and have other signs of sleep apnea. The doctor will also check the nose and throat for large tonsils or anything else narrowing the airway.
Will my child grow out of sleep apnea?
Some children with mild sleep apnea do. Cleveland Clinic says tissue at the back of the throat can shrink with age, which opens the airway. In the PATS trial, though, 13.2% of children with mild symptoms who waited without surgery had worsened past an AHI of 3 within a year, so follow-up matters.
Does removing tonsils cure sleep apnea in children?
Often, but not always. Removing the tonsils and adenoids is the first-line treatment when they're enlarged. The 2019 tonsillectomy guideline says families should be told that breathing problems during sleep may persist or come back after surgery and may need more treatment.
Can a child use mouth tape for sleep apnea?
No. We don't recommend mouth tape for children. Mouth tape isn't a treatment for sleep apnea at any age, and a child's snoring or mouth breathing usually has a cause, such as large tonsils or a blocked nose, that needs a doctor to find it.
When is a child's breathing at night an emergency?
The American Academy of Pediatrics says to call 911 or your local emergency number right away if your child's breathing stops for more than 20 seconds, their skin turns pale, bluish or grayish, or there's a change in muscle tone, a fever or other signs of illness.
Sources
- Sleep apnea in children
- Obstructive Sleep Apnea in Children
- Sleep apnea in children: detection and treatment
- Diagnosis and management of childhood obstructive sleep apnea syndrome
- Clinical Practice Guideline: Tonsillectomy in Children (Update)
- Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management
- Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children: A Randomized Clinical Trial
- Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years
- Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis
- Sleep apnea
About this article
- Research
- 10 published sources, listed above.
- Evidence
- Moderate. How we rate it
- Last checked
- November 2, 2026
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* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.