Snoring is usually associated with adults, but even infants and toddlers can be prone to snoring. A new study suggests that snorers among this age group are more likely to develop behavioral problems by the age of seven.
The study, published online and in the journal Pediatrics, says that later in life behavioral issues such as hyperactivity and inattention, emotional problems such as anxiety and depression, conduct problems such as rule-breaking and aggressiveness and problems with peer relationship may be linked to snoring in infants and toddlers.
Researchers assessed more than 11,000 children in England and followed their progress for six years beginning when they were about 6 months old.
Parents were asked about snoring, mouth breathing and witnessed apnea -- when a child takes abnormally long pauses in breathing during sleep -- at various points throughout infancy and childhood. Taken together, those symptoms are called sleep-disordered breathing.
Parents also filled out questionnaires about their child's behavior at the ages of 4 and 7.
What they found was that the children with the worst snoring and sleep disturbed breathing were almost twice as likely to have behavioral problems by the age of seven than kids whose breathing was normal. Kids were considered to have behavioral issues if their parent's ratings were in the top 10 percent, relative to kids their age, for problem behaviors.
"Parents should pay close attention to their child's sleep, and if you think something is going on you should consult a pediatrician or a sleep specialist," said study author Karen Bonuck, a professor of family and social medicine at Albert Einstein College of Medicine of Yeshiva University in New York City.
The study did not show that snoring or sleep disturbed breathing actually caused the behavioral issues, only that there could be an association between the two. There may be several reasons for this. Just like in adults, a bad night’s sleep can affect how well children function through-out the day. By interfering with the quality of rest, sleep-disordered breathing leaves kids overtired. That may contribute to behavioral issues, such as being easily distracted, hyperactivity and irritability.
Other studies have shown that sleep -disordered breathing can cause a lack of oxygen to the brain, carbon monoxide buildup and abnormal gas exchanges. These can contribute to long-term health issues for children.
"We are sleeping to restore our brains, and sleep-disordered breathing interferes with that process," Bonuck explained. "For kids, these are critical periods in brain development."
Heidi Connolly, division chief for pediatric sleep medicine at University of Rochester Medical Center in New York, said the study adds to a growing body of research showing that snoring, mouth breathing and sleep apnea in children should be taken seriously.
"These findings echo many of the other studies that show having sleep apnea and symptoms of snoring are bad for neurodevelopmental outcomes in children," Connolly said.
While snoring is a symptom of sleep apnea, it can have other causes, such as nasal allergies. Other studies suggest that even snoring alone, without apnea, can cause kids to do worse developmentally, she added.
"We need to think of that in primary care settings, and screen children for snoring," she said. "Kids who snore need to be evaluated and treated promptly, as you would any other medical condition."
Snoring occurs when the palate and the base of the tongue vibrate against each other. In sleep apnea, the airway is blocked. When kids try to breathe, negative pressure squeezes the airway shut, Connolly explained. That causes kids to wake up partially to take a breath.
Obesity is a major risk factor for sleep apnea in children, but normal-weight kids can get it, too.
"If your child is snoring on a nightly basis, not just when they are exposed to tobacco smoke or they have a cold or they just hung out with the neighbors' cat that they're allergic to, those children need to be evaluated for sleep apnea," Connolly said.
Treatments can include removing the tonsils and adenoids; topical nasal steroids or other anti-inflammatory medications; weight loss; and continuous positive airway pressure (CPAP) devices.
If you notice that your infant or toddler is snoring, or doesn’t seem to be sleeping normally, talk to your pediatrician about it. Not only because of this study, but staying on top of this health issue is an important step to helping your child rest well and develop well.