When a Child Snores: What I Look For as a Sleep Dentist

Parents almost never bring a child to me because of snoring. They bring them because of crowded teeth, or a bite that looks wrong, or because the dentist at school noticed something. Then, somewhere in the conversation, I ask whether the child snores, and the answer is often yes, most nights, and it has been going on for years.

Nobody had mentioned it because snoring in a child sounds harmless. Sometimes it is. Often it is the most visible sign of a problem that is quietly shaping how that child grows, behaves and learns.

Snoring in children is not the same as snoring in adults

An adult who snores is usually tired. A child who is not sleeping properly frequently is not sleepy at all. They are wired.

This is the single most important thing for a parent to know. Disrupted sleep in children tends to show up as behavior rather than drowsiness: hyperactivity, difficulty concentrating, irritability, meltdowns in the late afternoon, trouble at school. Those symptoms overlap almost exactly with attention problems, and children have been assessed for attention disorders when the underlying issue was that they could not breathe properly at night.

The other differences matter too. A large share of deep sleep happens in the first part of the night, and growth hormone is released during it. Sleep that is fragmented night after night is not a trivial thing in a growing child.

What is normal and what is not

Occasional snoring with a cold is normal and nothing to act on.

Habitual snoring, meaning most nights when the child is otherwise well, is not normal. Roughly one child in ten snores habitually, and a smaller group, usually put at a few percent, has obstructive sleep apnea. That is common enough that it turns up in every classroom, and it is very treatable once somebody names it.

Worth raising with your pediatrician:

• Snoring on most nights when the child is healthy
• Pauses in breathing, gasping, or choking sounds
• Breathing through the mouth while asleep, or during the day
• Very restless sleep, odd sleeping positions, or a neck arched back
• Sweating heavily at night
• Bedwetting that returns after a child had been dry
• Waking unrefreshed, or being very hard to wake
• Morning headaches
• Behavior, attention or school problems with no obvious cause

None of these proves anything on its own. Several together are worth a conversation.

What I look for in the mouth

This is where a dentist sees things a parent cannot, because the face and the airway develop together and the mouth keeps a record of how a child has been breathing.

A narrow, high palate. The roof of the mouth is the floor of the nose. When a child breathes through the mouth for years, the palate often develops narrow and high, which leaves less room above it.

Crowded teeth or a crossbite. Crowding is not only about tooth size. It is frequently about the size and shape of the arch the teeth have to fit into.

Open mouth posture. Lips apart at rest, in the chair, in photographs, while watching television.

Dark circles under the eyes. Often a sign of chronic nasal congestion rather than tiredness.

Worn or flattened teeth. Grinding is common in children who are struggling to breathe at night, and one explanation is that the jaw is being pushed forward to reopen the airway.

A low resting tongue position, or a restrictive tongue tie, which changes where the tongue sits and how the palate is shaped.

None of these findings diagnoses anything. Together they tell me to ask about sleep, and that question is often the first time anyone has asked.

The most common causes

Enlarged tonsils and adenoids are by far the most common reason a child snores. They grow relative to the airway through the preschool years, which is why this so often starts between three and six. An ear, nose and throat specialist can assess them, and removing them resolves the problem for a great many children.

Allergies and chronic congestion. A blocked nose forces mouth breathing, and mouth breathing makes snoring worse. Treating allergies properly is unglamorous and frequently effective.

Weight, in older children, for the same mechanical reasons it matters in adults.

What to do, in order

1. Say it out loud to your pediatrician. Describe the snoring and anything from the list above. If it helps, record thirty seconds of your child sleeping on your phone. That recording is often more persuasive than a description.
2. Ask about an ear, nose and throat evaluation if tonsils and adenoids are a possibility.
3. A sleep study can be done in children, and the thresholds are different from adults. What counts as mild in an adult is treated in a child.
4. Treat the nose. Allergy management, and a plan for chronic congestion.
5. Ask your dentist to look at the arch and the bite. In the right cases, and at the right age, widening a narrow upper arch is a well established orthodontic treatment, and it happens to create more room above the palate. It is not a treatment for sleep apnea on its own, and anybody who tells you otherwise is overselling it.

Two things not to do

Do not wait for them to grow out of it. Some children do. The difficulty is that the years you would spend waiting are the years the face and airway are developing, and that is the window in which intervention is easiest.

Do not tape a child's mouth shut. Mouth taping has become popular with adults and it is not appropriate for children. If a child cannot breathe through the nose, the answer is to find out why, not to close the other route. I set out who should and should not go near tape in mouth taping and nasal breathing.

Why a dentist is often the one who spots it

Children see a dentist twice a year, usually more often than any other health professional once they are past infancy, and the signs live in the mouth. That is an accident of scheduling rather than expertise, but it means we get a lot of chances to notice.

If you want the adult version of this, including how habitual snoring is distinguished from something more serious, it is in snoring, when it is harmless and when it is a red flag. The broader connection between the mouth and sleep is in oral health and sleep, and what else the mouth reveals is in how your mouth reflects stress, sleep and inner health.

If you are working on your own sleep as well, the order I would tackle things in is in the sleep biohacking guide.

One last thing. If you read this and recognized your child, you have not missed anything irreversible. You have noticed, which is the part almost nobody does.