Sleep apnea in children: recognize it, treat it

What is sleep apnea?

L’Sleep Apnea is defined by a partial or total upper airway obstruction of the child, at night, during his sleep. Result: for a few seconds, several times a night, there is an interruption in breathing.

L’Sleep Apnea touch between 2 and 5% of children.

What are the symptoms of sleep apnea in children?

A distinction is made between symptoms present during the day and those occurring at night. “We always think of snoring, but a child may not snore and suffer from sleep apnea,” says Dr. Madiha Ellafi, an allergist pulmonologist. This is why the combination of one or more diurnal and nocturnal factors should alert parents and lead them to consult a doctor for verification. »

Daytime symptoms

“Here are the signs that can evoke a Sleep Apnea and to which we must be attentive when we are parents »says the allergist pulmonologist.

Your child has trouble getting up the morning. He is grumpy and still tired.

• He complains of headaches upon waking.

• He is hyperactive, he can’t concentrate.

• He is muti-dys (dysorthographic, dyslexic, dyscalculic).

• He has concentration disordersattention, memorization at school.

• He has a failure to thrive.

• He is aggressive with his brothers and sisters, his classmates.

Nighttime symptoms

• Your child suffers from snoring.

• He has a agitated sleep.

• He sleep with open mouth.

• He sweats a lot.

• He suffers from parasomnias (sleepwalking, night terrors, nightmares).

• He gets up at night to drink.

What causes sleep apnea?

“The causes of sleep apnea in children are numerous”, warns Dr. Ellafi.

allergy

“The primary cause ofSleep Apnea in small children is respiratory allergy, explains Dr. Ellafi, and especially to mites. It is one of the first allergens that infants encounter. It can also be a food allergy with an intolerance to cow’s milk proteins. »

The increase in volume of the adenoids and tonsils

If it is normal, in case of infection, to see the tonsils grow, the latter, once the disease is cured, must regain their size. ” In case of’Sleep Apnea, the tonsils remain large between two infections because they are overstimulated by several factors, says the allergist pulmonologist. Whether it’s allergies, indoor and outdoor pollution, but also genetics, morphology. »

Overweight

This is not the most cause. Frequent. However, “overweight is a growing risk factorwarns Dr. Ellafi, especially with ‘coca babies’. » You should know that the gain of a few extra pounds in children, also affects a few extra grams in the tongue and can cause, at night, an obstruction of the airways because it is soft and goes backwards.

The warning signs

There is a typology of children who may be suspected of a syndrome ofSleep Apnea. How to recognize them? Dr. Ellafi describes them as follows: “It is a child with an adenoid face, that is to say elongated, always or often having his mouth open (he breathes through his mouth), fine nostrils, pale skin and dark circles. »

Who to consult?

If the parents suspect a Sleep Apnea in their child, they must first consult their pediatrician or their attending physician. The latter can refer them to an ENT doctor, a pulmonologist, an allergist.

For a long time, the only treatment was surgery. “Today, the approach is multi-disciplinary with long-term management with the aim of freeing the airways and allowing the child to have a restorative sleep »specifies the allergist pulmonologist.

The treatment depends on the history of the child after questioning about his history. “An ENT assessment with a nasofibroscopy is essential”, says Dr. Ellafi. This examination makes it possible to see if the nasal mucosa is of the allergic type or not, to distinguish the turbinates, the vegetations and to appreciate the entire volume of the tonsils.

• If the child is breathing with reflux, the treatment will be that of gastroesophageal reflux. It will be accompanied by food hygiene advice: “a bottle, in the evening, will be discouraged from the moment the infant has switched to solid food, i.e. between the age of 4 and 6 months”specifies the allergist pulmonologist.

• The pacifier should also be avoided.

• A dust mite bedding is recommended.

• A musculo-fascial rehabilitation (tongue physiotherapy) by a physiotherapist or speech therapist may be necessary to restore proper functioning of the tongue.

• A orthodontic treatment can be considered, generally from 7 – 8 years old, “when the first permanent teeth appeared”, says the doctor. Before it’s too early when there are only baby teeth.

• A adenoidectomy or a tonsillectomy in case of enlarged tonsils may be necessary. “This is the case when their congestion is greater than 50%. Below this, we recommend daily nasal cleaning to unclog the airways”explains Dr. Ellafi.

• The non-invasive continuous positive airway pressure ventilation (PPC) is recommended in case of severe apnea. “There is a great benefit to equipping children, warns the allergist pulmonologist. From the first nights, an effectiveness is observed. All you have to do is provide the necessary explanations to the child and ask him to keep his mouth closed so that there are no air leaks. »

Diagnose and treatSleep Apnea early in the child, above all allows the child to find a good sleep. This limits the risk that the latter is too severe in adulthood and that it leads to complications. “This is why it is recommended that children who have suffered from apnea be vigilant as they grow up and not hesitate to consult in the event of a return of symptoms”advises Dr. Ellafi.

Organizations to help

• French Sleep Apnea and Orthotics Association: 23 rue Vernet, 75008 Paris.

• Sleep Apnea Alliance: 8 rue Tronson du Coudray, 75008 Paris.

• Respiratory Health France: 115 rue Saint-Dominique, 75007 Paris.

An app for children

“A Marmotte Sleep” was created by Dr Madiha Ellaffi. This smartphone application de-dramatizes the disease thanks to its playful universe. This application offers therapeutic education for children, as well as maxillofacial rehabilitation exercises.

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