Snoring in children: what's normal and when to see a doctor

Occasional snoring is common in children, especially with a cold or a stuffy nose, and usually isn't a concern. Loud snoring on most nights is different, particularly if it comes with pauses in breathing, gasping or daytime problems like sleepiness and poor attention. Those are signs of sleep-disordered breathing, and the right next step is your child's pediatrician.

Is snoring normal in children?

Some snoring is normal in children. Cleveland Clinic says nearly everyone snores at some point, including babies and young children, and that occasional snoring is usually nothing to worry about. In babies, it says snoring is common, rarely points to anything serious and is most often caused by a stuffy nose.

Babies also have a breathing pattern that can look alarming. The American Academy of Pediatrics (AAP) describes periodic breathing of infancy, where a baby pauses briefly, breathes quickly to catch up and then returns to normal. It considers this generally normal and says babies should outgrow it by around six months.

What matters is how often and how loudly a child snores, and what else is going on.

How common is snoring in children?

Regular snoring affects a sizeable minority of kids. A 2008 systematic review of pediatric sleep-disordered breathing put the overall rate of parent-reported snoring at about 7.5% in its meta-analysis, with 1.5% to 6% of children described as "always" snoring and 1% to 4% diagnosed with obstructive sleep apnea. The authors noted that studies define snoring and sleep apnea in different ways, so these figures are estimates. A cohort study that followed about 1,000 children in southern Thailand found habitual snoring in 13% at age 5 and 10.9% at age 8.5.

The NHLBI says sleep apnea can happen at any age, including in babies, but is most common in children between ages 2 and 8.

The AAP takes snoring seriously enough that its 2012 clinical practice guideline recommends screening all children and teenagers for it.

Why does snoring matter in a child?

Snoring matters in a child because it sits on a spectrum that runs to sleep apnea. Researchers describe pediatric sleep-disordered breathing as a continuum that runs from primary snoring to obstructive sleep apnea. MedlinePlus explains that in sleep apnea the throat muscles relax during sleep, the tissues close in on an airway that is already narrow, often because of large tonsils or adenoids, and breathing stops for a moment. Snoring itself is air squeezing through that narrowed or blocked airway. It lists high blood pressure, heart or lung problems and slow growth and development among the possible complications of untreated pediatric sleep apnea. Our guide to snoring vs. sleep apnea explains the difference in adults.

The NHLBI says untreated sleep apnea in children can lead to problems with learning and memory, and may raise the risk of impaired growth, poor school performance and high blood pressure.

What causes snoring in children?

Large tonsils and adenoids are a common cause. The NHLBI says obstructive sleep apnea in children is often caused by large tonsils or adenoids, and MedlinePlus says a narrow throat in children is often due to large tonsils or adenoids that partly block the airflow. The AAP notes that the adenoid sits in the space between the nose and throat, and can only be seen with an x-ray or special mirror.

Weight plays a part too. The NHLBI calls obesity a common cause of sleep apnea in children, and the AAP's technical report found obesity to be an independent risk factor. In the Thai cohort, children who became obese or stayed obese between ages 5 and 8.5 were far more likely to start snoring than children who didn't.

The NHLBI lists other factors that raise a child's risk of sleep apnea:

• Down syndrome
• Cleft palate or other differences in the face or skull
• Neuromuscular disorders
• Tobacco smoke
• Premature birth

Colds and allergies can cause temporary snoring by blocking the nose, and our guide to why your nose gets stuffy at night explains why it often feels worse at bedtime. If your child breathes through their mouth a lot, our guide to mouth breathing in children covers the common causes.

What are the warning signs?

The warning signs of sleep apnea in a snoring child show up at night and during the day, according to the NHLBI. At night, look for snoring, mouth breathing, breathing that stops and starts, waking up often and bedwetting. During the day, look for behavior problems such as being overactive or aggressive, trouble paying attention at school, a dry mouth or headache in the morning, and sleepiness.

MedlinePlus calls loud snoring a telltale symptom of sleep apnea, though it notes that not every child who snores has it. It adds long silent pauses in breathing followed by snorts, choking and gasps, restless sleep and sweating to the list of night-time signs. The AAP says that if you notice frequent snoring, breathing problems at night, daytime sleepiness, difficulty paying attention or behavior problems, you should let your pediatrician know right away.

When is it an emergency?

A snoring child's breathing is an emergency in a few specific cases. The AAP 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 symptoms of illness.

How do doctors check a snoring child?

The AAP guideline recommends a sleep study, called polysomnography, for children who snore and have symptoms or signs of sleep apnea. During the study, sensors track breathing, oxygen levels and brain waves overnight in a sleep lab. The NHLBI says the doctor will also look in your child's nose and mouth for large tonsils or anything else blocking the airway, and may measure blood oxygen overnight.

MedlinePlus says the doctor will also take a medical history and may ask about daytime sleepiness, how well your child sleeps and bedtime habits, so what you notice at night matters. The AAP's technical report found that most screening tests had low sensitivity and specificity, meaning they can miss sleep apnea or flag it when it isn't there.

How is snoring in children treated?

Snoring in children is treated according to the cause. The AAP guideline recommends removing the tonsils and adenoids as the first-line treatment for children whose sleep apnea is linked to enlarged tonsils and adenoids. It recommends CPAP if surgery isn't done or the problem continues afterward, weight loss alongside other treatment for children who are overweight, and steroid nasal sprays as an option for some milder cases.

Surgery doesn't always settle things. The AAP's advice for parents says tonsil and adenoid removal is the most common and effective treatment but isn't always successful, so a follow-up visit matters. Its guideline recommends checking children again after surgery to see whether they need more treatment, with a repeat sleep test for those at higher risk or with ongoing symptoms. In the studies reviewed for the AAP's technical report, sleep apnea persisted after surgery in 13% to 29% of children in low-risk groups, and in up to 73% when obese children were included and stricter sleep study criteria were used.

Depending on the cause, the NHLBI says a child's doctor may also suggest an asthma medicine called montelukast, oral devices or orthodontic treatment, or exercises for the mouth and facial muscles. It notes that montelukast can cause behavior and mood side effects, so contact the doctor straight away if you notice changes.

Not every snoring child needs surgery. In the Childhood Adenotonsillectomy Trial, 464 children aged 5 to 9 with sleep apnea were assigned either to early surgery or to watchful waiting with supportive care. After seven months, sleep study results had returned to normal in 46% of the watchful waiting group and 79% of the surgery group. Surgery led to bigger gains in symptoms, behavior and quality of life, but attention and executive function scores improved by a similar amount in both groups. Whether to wait or treat depends on your child, and that call belongs with their doctor. The NHLBI also advises keeping children with sleep apnea away from secondhand smoke.

Can mouth tape or nasal strips help a child?

This site doesn't recommend mouth tape for children. A child who snores most nights needs a doctor's assessment, because the cause may be enlarged tonsils or sleep apnea that tape can't address and could hide. Our guide to mouth tape for kids explains why, and nasal strips for kids covers what to ask a pediatrician before using any strip on a child.

Read next

• Mouth tape for kids
• Mouth breathing in children
• How to sleep with a stuffy nose

* 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.