Snoring, Tonsils and Adenoids: Call it what you want, but snoring is not good for you

Breathing is important. I spent a bunch of money learning stuff in medical school-- some of the content didn't stick with me, but this one did: Air in and out.  You don't do anything more important all day than breathe.  That means that something that messes with your breathing needs to be fixed.

This is a pretty controversial area for my profession.  We have lots of discussions about defining "primary snoring" versus "obstructive sleep apnea" how to diagnose it and what to do about it.  But I'm an in-the-trenches pediatrician and all of this seems to me to be a lot of detail and not much practicality.

The fact of the matter is, no study looking at kids who snore like freight trains has shown that snoring is good for them, no matter how you define it, work it up or treat it.  Snoring louder than your dad is not normal.  It messes up your breathing and that's bad.

To be complete,  obstructive sleep apnea is snoring with pauses in your breathing.  Primary snoring is something less than that.  Both are associated with behavior problems, learning issues, daytime sleepiness and changes in facial architecture, all of which your child would be better off without.  The biggest cause of snoring is big tonsils, but big adenoids probably play a role too.

If you snore, you can't get a good night's sleep.  The kids are restless while sleeping, and can stay in bed for hours without getting much real rest.  If you are a sleep-deprived little kid, you don't walk around asking for your cup of coffee... you run around, don't pay attention, have huge mood swings,  and in general, behave as if you have a behavior problem.  I've been able to "cure" more than just a few cases of ADHD by getting the child to get a good night's sleep.

And that doesn't even address the orthodontia.  Now that my braces are off, I'm all for preventing braces in the first place. When you mouth breathe, usually from enlarged adenoids, the pull of your muscles around the middle of your face is down.  That means that the pull on that bone, the maxilla, is down.  And if you pull that bone down, you make your palate high and arched instead of gently sloping.  It decreases the size of the nasal airway and that's bad since you really need to breathe through your nose.  I've heard the palate changes from big adenoids explained as the jaw being "too small"  and that means using a palate expander with the braces. 

The biggest cause of snoring is big tonsils.  Tonsils start to grow around ages 2-8 years and aren't usually a problem in really little kids, although I've had my fair share of kids who didn't read that part of this book and had big tonsils as infants.  Kids with big tonsils can also drool, have problems with textured foods (with gagging) and then have the behavior and energy disturbances I talked about earlier. The primary reason for tonsillectomy would be snoring loudly enough to disturb sleep...snoring like your dad consistently.  We don't do tonsillectomies for strep much- but when the tonsils mess up "air in and out" then the problems needs to be fixed.

Big adenoids cause kids to mouth breathe, constantly sound as if they are congested (the "recurrent sinus infections of childhood" may actually just be big adenoids), and change the shape of their face.  They may also contribute to recurrent ear infections in older kids, especially if they  aren't supposed to be getting more infections as they get older.  Kids with big adenoids breathe like Darth Vader. 

So, if your child snores loudly consistently or breathes through their mouth all the time, let me know and we'll chat about visiting a nice surgeon and maybe avoid the orthodontist.


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This child has what is described as "adenoid facies",

                                                                                      with a narrow midface and open lip posture.  He'll need braces :)