Pediatric obstructive sleep apnea (OSA) has some distinct risk factors that aren’t as common in adults. One of these risk factors is enlarged or swollen adenoids, which can restrict the airway and make it hard for your child to breathe as they sleep.

Your child’s swollen adenoids may seem like solely an infection-related issue. But enlarged adenoids can also affect your child’s sleep and, ultimately, their development. Here’s how swollen adenoids can obstruct the airway and contribute to pediatric OSA.

What Are Adenoids?

The adenoids are tissue structures in the upper back part of your child’s throat, right behind their nose. Just like the tonsils, they’re part of the lymphatic system. These and other parts of the lymphatic system share responsibilities like clearing infections, trapping germs, and balancing fluids.

By the time a child turns 5, their adenoids begin to shrink. They often go away entirely as a child gets older, though some older children and adults still have them. However, since they often disappear in early childhood, swollen adenoids are more of a concern for children than adults.

How Swollen Adenoids Block Airflow

Just like the tonsils, adenoids can become swollen and enlarged as they fight infections. They may stay swollen long after an infection has cleared. Some children are born with naturally large adenoids without any infectious cause.

No matter why your child’s adenoids are enlarged, it’s possible for them to be so large that they restrict airflow and make it harder to breathe. Together with the tonsils, this is the main cause of sleep apnea in children. Enlarged tonsils in adults can cause sleep apnea, but in adults the major cause of sleep apnea is obesity.

Signs of Swollen Adenoids Affecting Sleep

Swollen adenoids are one of the main risk factors for pediatric OSA, especially in young children who still have their adenoids. It’s important to know the signs of pediatric OSA so you can tell your child’s pediatrician right away and start treatment as early as possible.

Your child might not notice anything different about their sleep or how a lack of quality sleep affects them during the day. But you, other parents or caretakers, or their teachers might notice signs that swollen adenoids are affecting their sleep. Pediatric OSA symptoms can be a little different from adult OSA symptoms.

Snoring

Snoring isn’t always indicative of sleep apnea, and not all small children with sleep apnea snore. However, if your child has enlarged adenoids, they may snore more than usual.

They may also sound like they’re coughing, choking, or gasping for air. Tell your child’s pediatrician if your child snores frequently at night.

Mouth Breathing

Enlarged adenoids may cause your child to breathe through their mouth more than their nose. Mouth breathing can also be a sign of pediatric OSA linked to enlarged adenoids, so it’s worth mentioning to their doctor during their next physical.

Mouth breathing from enlarged or swollen adenoids can happen both at night while your child sleeps and during the day while they’re awake. You might notice that they have trouble breathing through their nose if they try.

Restless Sleep

Restless sleep can be a key sign of swollen adenoids and OSA from swollen adenoids in children. You might notice that your child kicks their feet or moves around a lot at night, or that it seems like they didn’t sleep at night because of excessive daytime tiredness.

Keep in mind that restless sleep can have other causes, so you should talk to your child’s pediatrician to pinpoint the cause.

Breathing Pauses During Sleep

Pauses in breathing are a telltale sign of OSA in both adults and children. If you sleep near your child, listen for frequent breathing pauses. They may be followed by gasping for air, choking, or loud snores.

Daytime Attention or Behavior Problems

In many cases, the main signs of pediatric OSA occur during the daytime and are behavior related. Children experiencing OSA at night from enlarged adenoids might experience learning or behavioral issues including:

• Hyperactivity
• Not paying attention in school or at home
• Learning difficulties or low grades
• Impulsive or reckless behaviors
• Aggressive behavior

If your child spends most of the day at school or daycare, you might hear about learning and behavior concerns from a teacher or caregiver. Swollen adenoids are one of many possible causes, so it’s important to bring these concerns to your child’s pediatrician.

How Doctors Evaluate Swollen Adenoids

To evaluate your child’s swollen adenoids, your family pediatrician starts with a physical exam and medical history. They’ll look at your child’s mouth, throat, and ears. The adenoids are at the back of the throat, right behind the nose, and cannot be felt on examination.

A nasal endoscopy can allow your child’s doctor to take a closer look at the adenoids. This involves using a flexible lighted tube to see further into their throat. Imaging tests, such as an X-ray, can also provide a clearer view of the adenoids.

Your child’s pediatrician may suggest a sleep study (also called a polysomnogram) if your child has pediatric OSA symptoms. A polysomnogram is an overnight test that monitors factors like your child’s breathing, heart rate, and brain activity as they sleep. Combined with tests that evaluate the adenoids, polysomnography can paint a picture of your child’s sleep health.

Talk to Your Child’s Pediatrician

Enlarged adenoids can be a challenge while managing pediatric OSA. But with individualized treatment that targets the swollen adenoids and other factors contributing to sleep apnea, your child’s OSA can still improve.

Sleep is important for people of all ages, and children have a lot to gain from consistent, good-quality sleep. Restorative sleep supports mental and physical development and helps them retain the information they’ve learned during the day. When children don’t get the sleep they need, it can be detrimental to their immune system, school performance, and mental health.

Tell your child’s pediatrician if you notice any sleep disturbances or behavioral problems that might indicate sleep apnea or enlarged adenoids. In some cases, pediatricians recommend watchful waiting to see if the adenoids shrink or disappear on their own.

Your child’s pediatrician might recommend removing the enlarged adenoids and tonsils with a surgery called adenotonsillectomy. Other sleep apnea treatments, like oral devices for sleep apnea or positive airway pressure, may also be recommended to improve your child’s nighttime breathing.

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