Snoring, Mouth Breathing + More
Every day in clinic, parents ask about their baby or toddler's sleep.
This is such a big topic, because it depends so much on your baby - their overall health, nutrition + development, temperament, family approach to sleep. And while every baby's sleep can look different, it's important to know when to seek help. Here are some times you should talk with your healthcare team.
If Your Child Is:
Snoring more than 3 times a week (when they are NOT sick).
Many kids snore when they have congestion or colds, but if your child is snoring regularly each week when they're not sick, they may need an evaluation by an ENT for enlarged adenoid tissue or obstructive sleep apnea.
Usually breathing through their mouth during sleep.
Mouth breathing can mean different things at different ages. In newborns and infants, it can be related to oral ties or the oral anatomy preventing them from being able to maintain a proper resting position. In older toddlers, it can be related to enlarged adenoid tissue, oral anatomy, or obstructive sleep apnea. There are a lot of people who can be involved - ENT, lactation consultants, pediatric dentists, chiropractors, physical therapists, your pediatrician. I would talk with the person on your care team that you trust and make a plan for how to approach mouth breathing in your child — it can be easy to find a lot of different opinions, because the data on oral ties can be different than the ENT literature is different than parents' anecdotal experience. Try your best to trust your gut if something feels off, talk with your care team, and feel confident asking for opinions.
Gasping, pausing breathing, or having trouble breathing during sleep.
This can signal a problem with their sleep like sleep apnea.
Having very restless sleep (i.e. legs thrashing around, moving around a lot).
Low ferritin/iron deficiency anemia (typically in babies > 6 months old) can be a cause of poor nighttime sleep, restless leg syndrome and cause sleep disturbances.
Inconsolable when waking up at night.
If your infant is screaming when they wake or seems like they are in discomfort or pain, it's important to check for medical causes. Here's a quick checklist for infants: teething, gas, reflux, illness (fever, GI bugs, ear infections), or hair tourniquets, and for toddlers: teething, illness, nightmares or night terrors (read here for more).
What To Do
Take Notes. Think about what else has been going on with your baby.
Are they in the middle of a big developmental surge or growth spurt?
Have they been putting their hands in their mouth, drooling a lot, or tugging at their ears? (Teething, ear infections)
Are they going through other feeding issues? (Reflux, constipation, gas, breastfeeding challenges, formula change)
Have there been any family changes? (Separation anxiety, new sleep environment, recent transitions)
Temperament. Some babies are naturally more sensitive or reactive. Your baby's temperament is so important to consider when you're thinking about their sleep.
Fill Out This Questionnaire. This is a questionnaire that ENTs use to see how your child’s sleep is affecting their daily functioning. If you bring this with you when talking with your care team, you’ll have so much more data (more data always helps to support your observations!).
Take Videos. Taking a video of your child's sleep position, any sounds they are making (snoring, gasping, etc.), and anything else that you notice can help so much when you're talking with your care team. The more data points you have, the stronger foundation you have as you figure out next steps.
Find Someone To Talk To. It's so important to find a community in parenting, especially when it comes to sleep. And I know it can feel overwhelming with all that's out there, and everyone can have so many opinions. But other parents who have been through similar situations (and that you feel comfortable with) can help so much through shared experiences.
What To Expect
Imaging. You can ask your care team if they would consider a lateral neck x-ray to evaluate your child’s adenoid and tonsillar tissue. This can often show you if these tissues are enlarged, which can provide strong support for observations that you may have. Many ENTs will use this information plus your history (and questionnaire answers above) to work with you on determining if your child needs intervention or not.
Sleep Study. Your team may recommend a sleep study to get more detailed information on their sleep patterns, if there are apnea episodes, oxygenation during that time, etc.
Lab Tests. Talk with your care team about iron and ferritin if your child is having multiple wakings a night (i.e. every hour for a baby who is not a newborn), disrupted sleep, restless sleep, or with any questions or concerns at all.
Trial of Medication. If your child does have enlarged adenoids or tonsillar tissue, your team may recommend a short trial (often around 6 weeks or so) of a medication called Flonase (for kids > 2 years old). This can help to reduce the inflammation in those tissues and improve symptoms for many kids. It’s always nice to try and explore options before you consider surgery.
Surgery. If your team recommends surgery for your child’s adenoids and tonsils, it can be a lot to think about. Take a look at my ‘t+a’ highlight on Instagram for all of the details to consider and prep for if your family is working through this decision.
What To Remember
I know how hard it can be when you're exhausted, overwhelmed, or worried that something deeper might be going on with your child's sleep. I've been there with my kids, and I just want to make sure that you feel comfortable knowing what sleep issues might need more intervention. I know it feels like a lot, but you’re doing just great.