From the Guidelines
I strongly recommend starting with an ENT (Ear, Nose, and Throat) evaluation for your 9-year-old who snores. An ENT specialist can examine your child's airway, including the adenoids and tonsils, which are common causes of snoring in children, as suggested by the American Academy of Pediatrics in 2012 1. Enlarged adenoids or tonsils can obstruct breathing during sleep, and the ENT can determine if these need to be addressed. After this initial assessment, the ENT may then refer your child for a sleep study if they suspect sleep apnea or other sleep-related breathing disorders.
According to the clinical practice guideline for polysomnography for sleep-disordered breathing prior to tonsillectomy in children, published in Otolaryngology--head and neck surgery in 2011 1, sleep apnea in children can affect growth, behavior, and learning, so it's essential to address it. Signs that would make a sleep study more urgent include pauses in breathing during sleep, gasping or choking sounds, excessive daytime sleepiness, behavioral issues, or poor school performance.
The ENT evaluation is typically a good first step because it may identify a clear anatomical cause that can be addressed directly, potentially avoiding the need for a sleep study, which is more involved and may be more stressful for your child. Additionally, the American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends that clinicians should refer children with sleep-disordered breathing for polysomnography if they exhibit certain complex medical conditions or if the need for surgery is uncertain 1.
In this case, since the child is 9 years old and snores, an ENT evaluation is a reasonable first step to assess the airway and determine the need for further testing or treatment, as recommended by the Pediatrics study in 2012 1. Starting with an ENT evaluation can help identify potential anatomical causes of snoring and sleep apnea, and guide further management, including the potential need for a sleep study.
From the Research
Evaluation and Management of Pediatric Obstructive Sleep Apnea
- A 9-year-old child who snores may require evaluation for obstructive sleep apnea (OSA) 2, 3, 4, 5.
- The most common cause of pediatric OSA is adenotonsillar hypertrophy, and adenotonsillectomy is the first-line treatment for pediatric OSA 2, 4, 5.
- However, OSA can persist in some patients after adenotonsillectomy, and further evaluation and management may be necessary 3.
Sleep Study or ENT Evaluation
- A sleep study, such as polysomnography, may be necessary to diagnose and assess the severity of OSA in a child who snores 2, 3.
- An ENT evaluation may also be necessary to assess the size and condition of the adenoids and tonsils, as well as to evaluate for other potential causes of OSA 2, 5.
- The decision to refer a child for a sleep study or ENT evaluation should be based on the individual child's symptoms and medical history 3, 5.
Treatment Options
- Adenotonsillectomy is a common and effective treatment for pediatric OSA, especially in cases where adenotonsillar hypertrophy is present 2, 4, 5.
- Other treatment options, such as continuous positive airway pressure (CPAP) therapy or oral appliances, may be considered in cases where adenotonsillectomy is not effective or not possible 3, 4.
- The choice of treatment should be based on the individual child's needs and medical history, and should be made in consultation with a qualified healthcare professional 3, 5.