Does your little baby snore? If so... read on! :)

Does your child snore?

14 March 2010 By Dr RAYMOND TAN SUAN-KUO
SLEEP apnea, generally considered a problem among middle-aged men, can be a problem for youngsters, too. The third Malaysian National Health and Morbidity Survey 2006 tells us that 20% of Malaysian children are obese. With the increasing rates of obesity in children, it’s likely there will also be an increase in sleep apnea. It is estimated that 5 to 10% of Malaysian children suffer from sleep apnea.

Sleep apnea is characterised by brief but numerous involuntary breathing pauses during sleep. These breathing pauses cause awakenings throughout the night, making it impossible for sleep apnea sufferers to enjoy a night of deep, restorative sleep.

People with sleep apnea often feel sleepy during the day and their concentration and daytime performance suffer. While being overweight or obese are risk factors for sleep apnea, being thin does not preclude a diagnosis.

The repercussions of sleep apnea and poor sleep for children are vast. When children do not get the sleep they need, they are at risk for health, performance, and safety problems; difficulties in school are often the result. However, sleep deprivation in children is often overlooked or attributed to attention-deficit or behaviour disorders.

Parents should be aware of night time and daytime symptoms of sleep apnea.

Night time symptoms include snoring, breathing pauses during sleep, restless sleep, mouth breathing, difficulty getting up in the morning, even after getting the proper amount of sleep.

Daytime symptoms include hyperactivity, inattention, behaviour problems, e.g. aggressive behaviour, problems at school, sleepiness and headaches

To help your child get a good night’s sleep, follow these tips:

·Establish a regular bedtime and wake up time. Parents and children should plan a daily schedule that includes the basic daily sleep requirements for particular age groups. This schedule should be maintained on the weekends, though students can be permitted to sleep in one or two hours on weekend mornings if necessary.

While individual sleep needs can vary, the amount of sleep suggested by sleep experts for particular age groups is:

18 months to three 3 years: 12-14 hours

Three to five years: 11-13 hours

Five to 12 years: 10-11 hours

Teens: 9.25 hours

·Create a bedtime routine. Bedtime routines are important, regardless of a child’s age. It should include at least 15 to 30 minutes of calm, soothing activities. Discourage television, exercise, computer and telephone use, and avoid caffeine (found in beverages, chocolate and other products).

·Achieve a balanced schedule. Identify and prioritise activities that allow for downtime and sufficient sleep time. Help students avoid an overloaded schedule that can lead to stress and difficulty coping, which contribute to poor health and sleep problems.

To help children maintain a healthy body weight, follow these tips:

·Be supportive. Children know if they are overweight and don’t need to be reminded or singled out.

·Plan family activities that involve exercise. Instead of watching TV, go hiking or biking, wash the car, or walk around the mall. Offer choices and let your children decide.

·Eat meals together as a family and eat at the table, not in front of the television. Eat slowly and enjoy the food.

·Don’t use food as a reward or punishment. Children should not be placed on restrictive diets unless done so by a doctor (for medical reasons). Children need food for growth, development and energy.

How to diagnose:

·Seek treatment from an ENT specialist

·Look for large tonsils and adenoids

·Child may have an “adenoids face” – a long face with flat cheeks, open-mouthed look with thick lower-lips, caused by years of mouthy breathing and little air entering the maxillary (cheeks) sinuses.

·Look for high blood pressure

·Look for poor growth (failure to thrive) and also, paradoxically, obesity.

·Look for heart problems, e.g. heart failure and lung problems

·May need a sleep study

How to treat:

1. Main treatment in children – Surgery: remove the enlarged tonsils and adenoids

2. Lose weight – Help children maintain a healthy body weight.

3. Nasal steroid sprays for nasal allergies

4. CPAP (Continuous Positive Airway Pressure) mask at night for children who still have OSA and are very symptomatic after surgery.

Which other groups of children are at high risk of developing OSA?

·Down’s Syndrome

·Children with craniofacial abnormalities e.g. Pierre Robin sequence, Treacher Collins Syndrome, Crouzon Syndrome.

■ Dr Raymond Tan Suan-Kuo is a consultant ENT surgeon and snoring specialist. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.