What Is Sleep Apnea in Children?
Obstructive sleep apnea (OSA) in children means the airway partly or fully closes during sleep, so breathing is interrupted many times a night. The most common cause is enlarged tonsils and adenoids. Obesity can also contribute.[1]
It helps to know that this is common enough to take seriously and uncommon enough not to panic. The American Academy of Pediatrics technical report found prevalence ranging from 0% to 5.7% across studies.[2] Most children who snore do not have OSA. Most children who do have it can be treated.
This page explains the signs, how the diagnosis is made, what the treatment guidelines say, and where dental care fits. It is meant to help you prepare for a conversation with your child's pediatrician. It is not a way to diagnose your child at home.
Signs Parents Notice
Symptoms differ from child to child. The American Academy of Pediatrics lists frequent snoring, trouble breathing at night, daytime sleepiness, trouble paying attention, and behavior problems.[4] The American Academy of Pediatric Dentistry adds mouth breathing, loud snoring three or more nights a week, morning headaches, and bedwetting.[3]
At Night
Look for these signs while your child sleeps.
During the Day
Look for these signs during the day.
Why Behavior Can Be a Clue
Sleep that is broken up does not restore a child the way normal sleep does. The pediatric dentistry policy notes that children with untreated OSA may be wrongly diagnosed with ADHD, and that in school-age children signs may include poor school performance, aggressive behavior, or developmental delay.[3]
This does not mean every child with focus problems has sleep apnea. It means sleep is worth asking about before or alongside other evaluations.
How Sleep Apnea Is Diagnosed
The AAP clinical practice guideline (2012) recommends that all children be screened for snoring. It says polysomnography, an overnight sleep study, should be done in children who snore and have signs of OSA. If polysomnography is not available, alternative tests or referral to a specialist may be considered.[1]
A physician makes the diagnosis. Your pediatrician may refer you to an ear, nose, and throat doctor (otolaryngologist), a pediatric pulmonologist, or a sleep medicine physician.[3][4] Questionnaires and exams can suggest risk, but the technical report found that most screening tests have low sensitivity and specificity, which is why the sleep study matters.[2]
Dentists cannot diagnose sleep apnea. A dentist may notice things during a routine visit that raise concern, such as mouth breathing, large tonsils, a narrow palate, or a crowded bite, and can refer you to a medical provider.
First-Line Treatment: Tonsils, Adenoids, and Other Medical Care
For children with enlarged tonsils and adenoids, adenotonsillectomy is recommended as first-line treatment.[1] In the technical report, some children still had residual OSA after surgery, from 13% to 29% in low-risk groups, and a higher share in children with obesity. Children should be re-evaluated after surgery to see whether more treatment is needed.[1][2]
The guideline also covers other options. Weight loss is recommended for children who are overweight or obese. Intranasal steroids are an option for mild OSA when surgery is not suitable or for mild OSA that remains after surgery. Continuous positive airway pressure (CPAP) is recommended when surgery is not done or OSA persists afterward.[1]
You can also read our overview of obstructive sleep apnea, which is written mainly for adults.
The Dentist's Role in Screening
The American Academy of Pediatric Dentistry policy on OSA encourages dental professionals to screen for risk at each visit, using history and examination, and to refer any child suspected of having OSA to an appropriate medical provider such as an otolaryngologist, sleep medicine physician, or pulmonologist. The policy says validated pediatric questionnaires are not sensitive enough to detect the presence or severity of OSA.[3]
A review of dental sleep medicine in children agrees that dentists are well placed to recognize at-risk children and provide medical referrals.[10]
Pediatric dentistry and orthodontics are both ADA-recognized dental specialties.[11] Dental sleep medicine is not one. If your child's dentist raises a concern, ask what they saw and whether they recommend a medical evaluation first. For help finding dental care for children with airway concerns, see pediatric airway dentist near me and our pediatric dentistry page.
Orthodontic Options: What the Evidence Shows
Once a child has been evaluated by a physician, an orthodontist may become part of the team, especially if the child has a narrow upper jaw or a bite problem. The evidence is encouraging in some ways and limited in others.
Rapid Maxillary Expansion
Rapid maxillary expansion (RME) uses a palate expander to widen the upper jaw. A 2017 systematic review and meta-analysis of 17 studies covered 314 children (average age 7.6) who had narrow palates and OSA. On average, the apnea-hypopnea index (AHI) fell from 8.9 to 2.7 events per hour within three years, about a 70% reduction. However, only about 26% of the 90 children for whom it could be calculated were fully cured (AHI below 1). Improvement was larger in children who had already had their tonsils removed or had small tonsils (73% to 95%) than in children with large tonsils (61%).[5]
A 2023 meta-analysis reached a similar but more careful conclusion. RME reduced AHI after treatment, but the data came mainly from studies without control groups, and the body of evidence was rated low to very low. The authors said the treatment cannot be suggested as elective for OSA, and that it should be used only when there is an orthodontic indication.[7] An earlier meta-analysis also called for more studies with larger samples and standard reporting.[6]
The pediatric guideline authors reviewed the evidence in 2012 and found the data insufficient to recommend RME for OSA.[2] The American Association of Orthodontists white paper describes growing but low-level evidence that RME can lower AHI in properly diagnosed mixed-dentition children, notes that untreated control groups were generally not used, and says there is no indication that prophylactic expansion prevents OSA later.[8]
Other Appliances and Prevention
Some orthodontists use appliances that guide lower jaw growth forward in children with a set-back lower jaw. The same white paper says a few studies show a lower AHI with these appliances, but long-term stability has not been studied, and there is no clear indication that using them prevents OSA later.[8]
A 2024 review of the orthodontist's role concluded that evidence for growth modification to prevent OSA in children is weak, that tonsil and adenoid removal should come first, and that children with leftover OSA linked to jaw structure may be referred to an orthodontist afterward.[9]
What This Means for Your Child
Expansion may be reasonable when a child truly has a narrow upper jaw, and the sleep effect can be a possible extra benefit. It should not replace a medical evaluation, and it should not be sold as a cure. Ask for a repeat sleep study to see whether it worked. Our page on orthodontic treatment for sleep apnea and the evidence-first look at airway orthodontics explain more.
When to See an ENT or Pediatric Sleep Physician
Call your pediatrician first if you notice the signs above. Ask for a referral to an ENT or a pediatric sleep physician, especially in these situations.
- Your child snores loudly most nights, or you see pauses in breathing.
- Your child breathes through the mouth all day, wakes tired, or seems sleepy at school.
- Your child has new attention or behavior problems, or bedwetting after being dry.
- Your child had tonsil surgery and the snoring or other signs came back.
- A dentist or orthodontist has flagged a narrow palate, large tonsils, or airway concerns.
Questions to Ask Before Any Dental Treatment
If a dental provider suggests treatment for your child's airway, these questions can help.
- Has my child had a sleep study, and what did it show?
- Has an ENT checked my child's tonsils, adenoids, and nose?
- Is this treatment recommended because of my child's jaw and bite, or only for sleep?
- How will we find out whether it worked, and when?
- What are the risks, cost, and time in treatment? (Costs vary by location and case.)
Finding Dental Care for Your Child
Get the medical evaluation first. Once your child has a diagnosis and a plan from a physician, you can look for a pediatric dentist or an orthodontist who is comfortable working with your child's medical team. For a dentist who provides oral appliance therapy for teens or adults with a diagnosis, look for one with training in dental sleep medicine.
You can search for pediatric dentists and orthodontists in the MSD provider directory. When you call, ask the office how they screen for airway problems and how they work with your child's pediatrician. Browse our list of dentists who provide oral appliance therapy, grouped by state.
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