What Is Sleep Apnea in Toddlers?

When you think of sleep apnea, an image of a snoring older man may come to mind. But the sleep condition can crop up in toddlers too.

It’s estimated that up to 4 percent of all children experience sleep apnea, many of them between the ages of 2 and 8. 

Some children do grow out of it, as their tonsils and adenoids shrink with age. But often they don’t, which can lead to health and behavioral problems down the road. In fact, it’s estimated that about a quarter of all kids who are diagnosed with attention deficit hyperactivity disorder (ADHD) also show symptoms of sleep apnea.

What is sleep apnea in toddlers?

Sleep apnea is a sleep disorder where breathing repeatedly stops and starts during slumber. There are three main types:

• Obstructive sleep apnea, the most common form, which happens due to a blockage in the airway.
• Central sleep apnea, where the brain doesn't send proper signals to the muscles that control breathing.
• Complex sleep apnea syndrome, which is a combination of both. 

Obstructive sleep apnea is by far the most common type of sleep apnea in toddlers. While there’s also something called apnea of prematurity, where a newborn's breathing pauses for at least 20 seconds, that is something only seen in premature babies and it usually resolves on its own as the infant matures.

What are the signs of sleep apnea in toddlers and young children?

The signs of sleep apnea in toddlers are similar to the symptoms of sleep apnea seen in older children and include:

• Frequent snoring. Snoring alone isn’t necessarily cause for concern, since up to 12 percent of all children do. But it can be a sign of sleep apnea, which makes it important to bring up the next time you see the pediatrician.
• Problems breathing during the night. This might either be brief periods of not breathing — if you put your ear to your little one’s mouth or nose, you’ll notice no air or oxygen is moving through them into the lungs — or mouth breathing, due to the nasal passage being completely blocked by enlarged tonsils and adenoids.
• Restlessness during sleep. Since your toddler is constantly waking up, he may appear to “toss and turn” throughout the night. You may notice that your tot frequently moves around in his bed, or wakes up in very different positions than he was in when he went to sleep. Your child may also sleep in a strange position: for example, he arches his neck backwards to help open up his airway. 
• Daytime sleepiness. Your toddler may nap more or for longer than usual, or frequently fall asleep at preschool or while on car rides.
• Behavior problems. You may notice irritability, crankiness, hyperactivity or difficulty paying attention in your child.
• Frequent tonsil or ear infections.
• Night terrors (episodes of screaming and flailing while asleep) and sleep walking.

What causes sleep apnea in toddlers?

The most common causes of sleep apnea in toddlers are enlarged tonsils in the back or the throat and/or enlarged adenoids in the back of the nasal cavity.

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What Is Sleep Regression in Toddlers?

While your little one may have no trouble breathing when he's awake and active, during sleep, his muscle tone decreases, which makes his airway smaller. As a result, the tonsils and/or adenoids block the airway and make it harder for your child to breathe. When your child has a short breathing pause, he wakes up briefly. This increases his muscle tone and opens up his airway, but it also prevents him from getting a good night’s sleep.

Other causes of obstructive sleep apnea in toddlers include:

• Being overweight or obese

• Medical conditions such as Down syndrome or cerebral palsy

• Family history of obstructive sleep apnea

• Being born prematurely, or at a low birth weight

Treatment for sleep apnea in toddlers

It’s very important to treat sleep apnea in toddlers. If it’s ignored, it may cause poor growth and inadequate weight gain (“failure to thrive”), high blood pressure, trouble learning and behavior problems. Treatment for sleep apnea in toddlers includes:

• Tonsillectomy and adenoidectomy. If your toddler’s sleep apnea is due to large tonsils and adenoids, the most common treatment is to remove them. While many doctors want to wait until your little one turns 3 to perform this surgery, sometimes, if the sleep apnea is severe enough, there’s no choice. If that’s the case, your child will have to stay in the hospital overnight (rather than go home a couple hours after the procedure) for monitoring.
• Continuous positive airway pressure (CPAP). This requires your child to wear a mask while he sleeps. The mask delivers steady air pressure through your little one's nose and helps him breathe. This may be recommended if your little one’s sleep apnea doesn’t improve after having a T&A.
• Weight loss. If your child is overweight or obese, losing weight has been shown to improve sleep apnea. Your toddler may need to continue to use a CPAP in the meantime.
• Nasal corticosteroids. A prescription or OTC nasal spray may help treat mild cases of sleep apnea, especially if your child is very young and your doctor wants to take a watch-and-wait approach. The prescription drug montelukast has also been shown to be effective.

When to call the doctor

If you notice any of these symptoms of sleep apnea, talk to your pediatrician. They may want your child to do an overnight sleep study called a polysomnogram. These are usually done at hospitals or major medical centers. Several sensors will be attached to your toddler while he sleeps to monitor his breathing, oxygenation and brain waves.