Specialties · Paediatric ENT
The child who snores, mouth breathes and is always unwell
Snoring every night, sleeping with the mouth open and waking up tired is not normal sleep for a child. The most common causes are enlarged adenoids and tonsils, and allergic rhinitis. Assessment identifies what is obstructing airflow and guides treatment, which may be medical or surgical.
Medically reviewed by Prof. Aline Bittencourt, MD, PhD, CRM-MA 7562 · RQE 1832 Updated on
Why does a child snore?
Snoring happens when air meets a narrow passage and sets the tissues of the airway vibrating. In childhood, that narrowing is usually in one of these places:
- Enlarged adenoids. The adenoid sits at the back of the nose, behind the soft palate. When it grows, it blocks the passage from the nose to the throat.
- Enlarged tonsils. They sit in the throat, on both sides, and reduce the space through which air passes.
- Allergic rhinitis. Inflamed lining swells and blocks the nose, particularly at night.
- Less often, a deviated septum, polyps or alterations in facial structure.
More than one cause is frequently present at the same time, which is why treating a single factor does not always resolve matters.
Which signs warrant assessment?
- Snoring on most nights.
- Pauses in breathing during sleep, or noisy, laboured breathing.
- Sleeping with the mouth open, drooling on the pillow, sweating heavily during sleep.
- Restless sleep, unusual positions, waking several times.
- Waking tired, with difficulty getting up.
- Fatigue, irritability or inattention during the day.
- Bedwetting after the age at which it had stopped.
- A blocked nose all year round, nasal-sounding voice, recurrent ear infections.
The complaint that reaches the clinic is usually not the snoring. It is the teacher saying the child does not pay attention, or the family noticing that she falls ill every time the weather changes.
What does mouth breathing lead to in the long run?
Breathing through the mouth is an adaptation: the body finds air where it can. Sustained over years during the growth period, that adaptation has consequences described in the literature:
- Changes in facial growth and in the position of the teeth.
- Poorer sleep quality, with effects on daytime behaviour and attention.
- More frequent airway infections.
- In cases with apnoea, effects on growth and development.
How is assessment done at Clínica Rhinus?
The consultation brings together the sleep history, the record of infections, the growth pattern, and examination of the nose, mouth and ears. From there:
| Tool | What it answers |
|---|---|
| Nasal endoscopy | How large the adenoid is and how airflow is affected |
| Audiometry and tympanometry | Whether there is middle ear fluid and associated hearing loss |
| Sleep study | Whether there is sleep apnoea and how severe it is |
When is treatment medical and when is it surgical?
Medical treatment is the first step in most cases: control of rhinitis, nasal irrigation, topical medication and attention to environmental factors. Many children improve with this alone, and adenoids tend to regress with age.
Adenoid and tonsil surgery is considered where obstruction is significant and persistent, where sleep apnoea has been documented, where infections recur at high frequency, or where there is otitis media with effusion that will not settle.
There is no adenoid measurement that, on its own, indicates surgery. What weighs is the whole picture: how the child breathes, how she sleeps, how often she falls ill, and how her hearing is.
Sources: Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.
Frequently asked questions
Questions about paediatric ent
My child snores every night. Is that normal?
Occasional snoring during a cold is common. Snoring on almost every night, with pauses in breathing, restless sleep, sweating and an open mouth, is not. That pattern suggests obstruction of the airway during sleep and warrants assessment by an ENT specialist.
How do I know whether it is the adenoids?
The adenoid sits at the back of the nose and cannot be seen through the mouth. Suspicion comes from the combination of signs — chronic nasal obstruction, nasal-sounding voice, snoring, recurrent ear infections — and confirmation comes from nasal endoscopy or a specific X-ray, depending on the child's age and cooperation.
Does removing the tonsils weaken a child's immunity?
No. The tonsils form part of the defence system, but they are not its central component, and the body maintains protection through other routes. Surgery is indicated when they impair breathing during sleep or cause recurrent infections, and the decision is always individual.
From what age can a child see an ENT specialist?
At any age, including as a newborn. The complaints change with each stage: in a baby, an abnormal newborn hearing screening and a blocked nose; in a preschooler, snoring and ear infections; at school age, inattention and delayed speech.
Does mouth breathing change a child's face?
Mouth breathing sustained over years during the growth period is associated with changes in facial development and tooth position, with a longer face and altered bite. This is one of the reasons it is worth investigating early, alongside the dentist or orthodontist where appropriate.