The Approach to a Child With Sleep Disordered Breathing

Sleep disordered breathing in children is common, yet its recognition and management remain surprisingly inconsistent. The traditional approach often centres on the presence of snoring and the size of the tonsils and adenoids, with adenotonsillectomy frequently regarded as the default treatment. However, sleep disordered breathing is a far more complex disorder than simply a disorder of tonsil or adenoid size.

This presentation outlines a practical, systematic approach to the child with suspected sleep disordered breathing, from the initial history and examination through to appropriate investigation, diagnosis and treatment.

The assessment of the upper airway will be considered in the context of the individual child, including the nose, nasopharynx, tonsils, palate, tongue, craniofacial anatomy and dentition. The role, limitations and appropriate interpretation of polysomnography and other investigations will also be discussed.

Management should be directed at the underlying cause and the child’s functional consequences rather than an anatomical finding in isolation. Surgical and non surgical treatment options will therefore be examined, including when adenotonsillectomy is appropriate, when additional airway or orthodontic factors should be considered, and when persistent symptoms after treatment warrant further assessment and explain the teamwork necessary to deliver outcomes that we can all be proud of.