Babies and toddlers who snore or have other breathing problems when they sleep may develop more behavior problems, a study finds. The research was based on surveys filled out by parents of more than 11,000 children. The first survey was done when the children were 6 months old. Parents were asked whether their children snored, breathed through the mouth or had pauses during breathing (apnea) while asleep. The surveys were repeated 5 times, ending at age 69 months. The parents also were asked about children's behavior at ages 4 and 7. Behavior problems were twice as common at age 7 in children who had the worst sleep-disordered breathing. Hyperactivity was the most common problem. Others included attention issues, depression, aggression and conflicts with other children. The study does not show that breathing issues during sleep actually caused the behavior problems. But researchers said poor-quality sleep could make kids tired and more likely to misbehave. They said breathing problems also could reduce oxygen to the brain and affect brain development. The journal Pediatrics published the study. HealthDay News wrote about it March 5.

By Claire McCarthy, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Snoring in kids is bad -- we've been hearing that a lot recently. There has been lots of talk about how kids who snore are more likely to be sleepy during the day. We've heard that they may have health problems and behavior problems as well, such as attention-deficit hyperactivity disorder, or ADHD.

Most of the discussion has been about school-age children who snore. We haven't worried all that much about babies or toddlers who snore, figuring that there's a good chance they will grow out of it.

Now there's a study that suggests we do need to worry about babies and toddlers who snore.

Researchers from the Albert Einstein College of Medicine in New York did the study. They looked at surveys completed by the parents of more than 11,000 children in England. The parents filled out two different kinds of surveys. One survey was done when the children were 6, 18, 30, 42, 57 and 69 months old. Parents were asked whether their children had any snoring, mouth breathing or apnea (pauses in breathing) while they slept. These are symptoms of sleep-disordered breathing.

The other study was done when the same children were 4 and 7 years old. This time, parents answered questions about their children's behavior.

Researcher found that kids who had sleep-disordered breathing, especially if it started early, were much more likely to have behavior problems when they were 4. The difference was even more apparent when they were 7. Several behavior problems were noted. But hyperactivity was the most common.

This actually makes sense when you think about how a child is developing in those early years. The brain is growing and changing, setting pathways and patterns that can last for life. It's in those years that executive function develops. This is a name for the fundamental skills that control behavior and help kids to interact with others. Without enough sleep, or with sleep that isn't good sleep, that development can be harmed.

If what this study suggests is true, it would mean that we would need to intervene early when children have any breathing problems in sleep. In some cases, the treatment may be surgery.

What Changes Can I Make Now?

I think it will take a little time to fully understand this study and what it means. We can say now, though, that it's important to pay attention to your child's breathing during sleep. Let your doctor know if there are any problems.

Doctors are particularly concerned about snoring, especially if the child stops breathing during the snoring. However, mouth-breathing or any kind of noisy breathing may be a sign of a problem.

A video can be worth a thousand words. These days, with so many smart phones having video cameras, it can be easy for parents to show their doctor what they see and hear.

Some children may need a sleep study, or polysomnogram. In these studies, the child is hooked up to machines that measure exactly what is going on with their breathing and their bodies while they sleep. These studies can be extraordinarily helpful in sorting out whether there is a real problem or not.

What Can I Expect Looking to the Future?

This study is intriguing and important, but we need more information. The study relied entirely on the answers parents gave on questionnaires. There was no way to be sure the children had sleep-disordered breathing or behavior problems. Before we start making any broad recommendations, especially if they involve surgery, we need more information. This should be based on sleep studies and actual examinations of children.

This study adds to what we know. I hope that more studies will make the picture clearer and give us the knowledge we need to give children the best sleep and the healthiest future.