By 96five Contributors Wednesday 31 Jan 2018
Dr David McIntosh
This article has been supplied and reproduced with permission from the Great Health Guide, a 96five community contributor.
Seeing a child having a snore may seem quite cute and sometimes even funny. But what if I told you that snoring in kids is linked to behaviour problems. Such behavioural problems similar to ADHD can sometimes be caused simply because the child is sleep deprived due to snoring. Other behavioural problems that can be linked to snoring include teeth grinding, sleep-talking & bed wetting. But there is hope so please read on. But first a story…
Angel is a 6-year-old girl who is anything but her namesake. She is tired and often cranky, tends to burst into tears from the simplest of things, has very poor attention and the behaviour problems are such that her parents have been advised by the school to see a paediatrician in case she has Attention Deficit Hyperactive Disorder (ADHD). The parents realise that something is not right with their Angel and start researching a bit and seeking advice from a range of professionals.
The paediatrician confirms she is disruptive and meets the criteria for ADHD. The audiologist confirms she can hear OK. The optician confirms her vision is fine. The naturopath suggests it might be a sensitivity to wheat and dairy and faced with the alternative option of medication, the family give this a go but unfortunately, she is only getting worse.
25-50% of children with a diagnosis of ADHD have sleep-disordered breathing.
They see the dentist for her 6-month check-up and the dentist notices that Angel is struggling to breathe in the chair. Her mum says she has been like that for a while and tends to walk around with her mouth open ‘catching flies’. The dentist proceeds to look at her teeth and notices some wear and tear suggestive of teeth grinding. Mum confirms she does this too. The dentist keeps probing – it turns out the child has a habit of snoring and is quite restless at night. The dentist takes a second look – this time past the teeth and looks at the back of the throat and notices the tonsils are large.
If a child snores there may be times when she even stops breathing.
Mum confirms this has been noted by others and was told that kids with big tonsils just grow into them and because there have been no infections, they won’t be taken out by the specialists. Having said that, nobody has organised for Angel to see the specialists in tonsil problems, the ENT surgeons. The dentist offers a referral to see one, which mum accepts.
At the consultation the ENT specialist considers things in more detail. Not only does Angel snore, but there are times when she may even stop breathing. She wakes up tired, wets the bed often, grinds her teeth, sleep talks and has issues with her concentration and focus. The examination confirms the ears are fine, the nose is blocked at the back by large adenoids. The tonsils are so big that they are touching each other. Further discussion reveals that she will have episodes of choking on food and tends to avoid meat and prefers soft foods in general.
The ENT specialist advises mum that Angel has Sleep Disordered Breathing with probable sleep apnoea due to obstructing adenoids and tonsils. She advises mum that research shows 25-50% of children with a diagnosis of ADHD actually have a sleep problem and sleep disordered breathing is the most common. Furthermore, she explains to mum that teeth grinding, sleep-talking and bed wetting will stop, in a high proportion of cases once the airway obstruction is fixed.
She advises that the best way to correct this is with surgery. It is fortunate that Angel does not get tonsillitis as the tonsils are already way too swollen and waiting for such infections. Mum is relieved and hesitant at the same time and asks about whether Angel will just grow into them. The ENT specialist explains there was a study of 11000 children, including those that had sleep disordered breathing and had nothing done to fix it at the time, did often stop having their breathing problems. However, their behaviour problems persisted. In another recent study of a couple of thousand kids showed that in the group that had surgery early versus the group that had no treatment, having surgery resulted in more substantial improvements and better long-term outcomes.
Teeth grinding, sleep-talking & bed wetting will likely stop once the airway obstruction is fixed.
Realising her child was suffering terribly, mum decided to proceed with surgery to remove the tonsils and adenoids. Angel had a rough recovery, as the specialist explained would happen, but once it all settled down, mum was dumbfounded by the changes. Angel was far more co-operative at school, had more energy and everyone commented on how she seemed to be a new child.
As the specialist had advised, the symptoms of ADHD may just be reflective of her being exhausted and tired and with the good nights of sleep that came with being able to breathe well, she was able to function better during the day. Even her eating and swallowing was better. She wouldn’t eat broccoli but hey, don’t expect miracles.