I have a six month old grandson who seems perfectly healthy in every respect except when asleep. He stops breathing for what seems forever. I’ve mentioned this to my daughter, but she says all small children do this. The reason I’m concerned is because she lost her first child to an incurable illness, and I fear she may not want to see anything that might be wrong in this child. Is this behavior normal in children this age? Am I overreacting?
 

Short pauses in breathing that are of less than 20 seconds can be normal in babies. I would be concerned, however, if the infant has associated poor weight gain, feeding difficulty, mouth breathing, noisy breathing or restless sleep, as these symptoms might point to an underlying, more worrisome sleep-related breathing disorder like sleep apnea. In light of the fact that the mother has already lost a previous child, the matter should be treated seriously. I would recommend that the pediatrician or family physician and a pediatric sleep specialist evaluate the infant. Don’t wait for the infant to “outgrow” the problem, as this can sometimes have disastrous consequences. By the way, the American Academy of Pediatrics also recommends that infants should be made to sleep on their back in order to lessen the chance of accidental suffocation.  

Suresh Kotagal, M.D.
Pediatric Sleep Specialist
Mayo Clinic
Rochester, MN

You are not over-reacting but acknowledging a possible sleep disorder that your grandson has or may be developing. This is not considered normal behavior in a child that stops breathing when asleep but rather a sleep breathing disorder called sleep apnea. Sleep apnea is when a child or adult stops breathing during sleep and can reoccur many times through the night causing fragmentation of sleep contributing to a number day-time symptoms. Obstructive sleep apnea (OSA) is the most common breathing disorder found in an estimated 1% to 3% of children. OSA is a partial or complete airway obstruction during sleep. The upper airway collapses as a result of muscle tissue relaxing in the throat region inhibiting complete air passage. Enlarged or swollen tonsils and adenoids can be a significant contribution to the blocking of the airway. Snoring, gasping, and snorting are usually accompanied and a prime indicator that OSA may be present. In synchrony with OSA, a decrease of oxygen occurs due to the blockage of the upper airway causing a deficit of total oxygenation in the body. Sleep apnea can cause daytime symptoms such as difficulty waking, morning headaches, attention, learning and behavioral problems. I strongly recommend consulting with the child’s pediatric physician or consulting a sleep clinician specializing in children for the evaluation and possible testing of sleep apnea in your grandson. 

Jeffrey Wathen, RPSGT
St. Anthony’s Sleep Disorder Center
St. Louis, MO

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