How children apnea is determined and treated
Sleep apnea is a dangerous syndrome that often occurs in children. At particular risk are infants whose respiratory system is still imperfect.
The causes of the ailment are many, and the consequences can be the most serious, even fatal.
Parents should know how to provide first aid to the child and prevent new attacks.
What is apnea in a child, what are the causes of an attack in newborns and how dangerous is this syndrome? - Read about this in this article.
What is night apnea in children?
Nocturnal apnea or short-term respiratory arrest in sleep is more common in adults, even older people. But sometimes this problem is also found in children. The risk group includes both infants up to one year old and older children.
What is apnea in children and how does it happen? Diagnose 3 types of disease.
- Central. Respiratory failure occurs due to the lack of appropriate brain signals, the airways are free and do not interfere with the passage of air.
- Obstructive. It is also associated with a narrowing of the respiratory throat due to internal edema, overgrowth of soft tissues, information of the soft palate or tongue.
- Mixed. Connects both types of apnea, obstructive and central.
The central type of apnea in premature babies is more common than in babies born on time. For children aged 3 years and more, a mixed or obstructive form is more characteristic.
What is an apnea attack?
An apnea attack is called holding the breath in a child in a dream. The attack can last from 5 seconds to 2-3 minutes. More than 10 stops per night indicates a pathological condition. At the time of an apnea attack, children develop hypoxia - oxygen starvation of the brain. In this case, the cells of the organ are damaged.
Temporary respiratory arrest - apnea - often occurs in children and adolescents.
But unlike infants, in children after a year of apnea is not physiological, but indicates a number of health problems.
A typical picture of this disease is periodic, fairly frequent (more than 5 times in one hour) respiratory arrest, always occurring only in a dream.
Their duration is more than 10 sec., Can reach 30-40 sec.. During the period when the lungs stop working, the child’s body does not receive the required amount of oxygen.
This leads to a variety of impaired functioning of the nervous, vascular and other systems.
Apnea in newborns and in older patients is caused by various etiological factors.
The most common causes of apnea in newborns are:
- Prematurity. A baby born before the 37th week of pregnancy differs from full-term immaturity of the nervous and respiratory systems. The respiratory centers in the crumbs are not yet formed, therefore, in premature babies, respiratory arrest of the central type occurs.
- Anomalies of the development of the lower jaw. Too small jaw (micrognathia), as well as anatomical disturbances in its structure can cause episodes of nocturnal apnea in children.
- Congenital malformations of the cardiovascular, nervous system. With abnormalities in the functioning of internal organs, tissue hypoxia occurs, which can provoke respiratory arrest in a dream.
- Injuries during childbirth. Intracranial, spinal injuries received during the passage of the birth canal divide the nerve connections between the respiratory center of the medulla oblongata and the respiratory tract receptors.
- Mother taking drugs, certain medications, alcohol, smoking during pregnancy. Scientific studies have shown that in mothers who smoke during pregnancy, babies are 3 times more likely to suffer from respiratory arrest. The negative role of narcotic and psychotropic drugs, sleeping pills, and alcohol is obvious. Penetrating through the placental barrier, substances interfere with the maturation of the fetal nervous system and destroy it.
At an older age, respiratory arrest in a dream is caused by:
- Obese. Being overweight can cause respiratory arrest in a dream. Fat deposits forming in the soft palate, palatine arches, tongue, contribute to the narrowing of the lumen of the pharynx and a more pronounced decline in the upper respiratory tract during sleep.
- ENT pathology.Overgrown adenoids, enlarged tonsils, disturbances in nasal breathing create a mechanical obstacle to the passage of air in a dream and cause episodes of respiratory failure.
- Endocrine disruption. Diabetes mellitus, hypothyroidism and other diseases of the endocrine system can provoke such episodes.
- Infections. Sometimes respiratory arrest in children can occur with a high activity of the infectious process in the body: against the background of sepsis, meningitis, necrotizing enterocolitis.
- Metabolic disorders. Electrolyte imbalance: hypomagnesemia, hypocalcemia, increased sodium ions in the blood, ammonium - is another reason for the development of this syndrome.
- Exposure to certain drugs. Hypnotics, some antihistamines that have a pronounced sedative effect, can cause apnea in children up to a year.
Apnea from Fenistil, a popular antihistamine in drops, can occur in premature babies, as well as under 1 month old. Therefore, the drug is not recommended for infants.
Infant Apnea: State Features
Infant apnea syndrome is often confused with normal respiratory delays. With periodic breathing, pauses between inhalation and exhalation are 2–10 seconds, while any symptoms of pathology are absent: bluish nasolabial triangle and nails, wheezing.
If, after holding his breath in a dream, the baby continues to breathe measuredly and calmly, there is no reason for concern.
If delays are repeated frequently, with a duration of up to 20-25 seconds, accompanied by other symptoms of apnea syndrome, you should consult a doctor.
It is necessary to differentiate the syndrome of central and obstructive apnea:
- in the first case, short-term breath holdings are not accompanied by any efforts on the part of the child: he simply periodically stops breathing. The syndrome can be associated with pathologies of the lungs, heart, respiratory center of the central nervous system,
- in the second case, breathing is difficult as a result of obstruction of the airways.
The essence of the violation
This term is understood to mean respiratory arrest in a child lasting at least 20 seconds. Also, the duration of the attack may be shorter, but additional manifestations arise - a significant slowdown in the heart rate, a decrease in the amount of oxygen in the blood.
It should be borne in mind that short respiratory arrests lasting 5-10 seconds are often observed in newborn babies. Also, patients 3-6 years old are affected. The severity of the violation depends on the maturity of the child's body. Apnea is considered the most common occurrence in premature babies.
The main causes and symptoms
The causes of apnea in children may be a partial blockage of the upper respiratory tract. Most often it occurs when:
- Cerebral palsy,
- Down syndrome
- frequent respiratory infections
- congenital pathologies of the throat, palate, nose,
- childbirth injuries
- pathologies of intrauterine development.
Even a person who does not have experience in dealing with such patients can notice the manifestation of apnea.
The disturbing symptoms of nocturnal apnea in infants can be detected. With natural falling asleep, the baby begins to worry, snore, cough. Any unusual behavior of the baby should be cause for concern and a reason for an early visit to the doctor. Read on, what is apnea in newborns?
Short pauses in breathing are called sleep apnea syndrome. This is a dysfunction of the respiratory system, which is manifested by systematic short stops in breathing in a sleeping baby. In addition to episodes of respiratory arrest, childhood apnea is characterized by such phenomena as night snoring and lethargy and drowsiness in the daytime.
Sleepy Apnea Syndrome is considered to be potentially life-threatening. If pauses in night breathing exceed 10 seconds, then the child is quite pronounced hypoxia (lack of oxygen). Along with oxygen deficiency, the need for which is high at any time of the day, the level of carbon dioxide in the blood of a child rises. Both of these factors exert a hyper-stimulating effect on the state of the brain, which leads to the fact that the baby often wakes up at night, does not get enough sleep, feels overwhelmed and tired.
Up to 5 respiratory arrests per hour can be observed in boys and girls with mild night apnea per night; in severe forms of the disorder, up to a hundred episodes can be observed in 60 minutes. If you add up all the pauses and calculate the total time of respiratory failure, sometimes it turns out up to 3 hours. Apnea is considered the most common cause of sudden infant death in a dream.
Physiological apnea does not threaten the child’s health, they do not exceed the frequency of 5 episodes per hour, and each respiratory pause lasts no more than 10 seconds.
Causes of the syndrome in a child
There are two main reasons for the occurrence of night apnea in children:
- violation of the respiratory center in the brain stem,
- airway obstruction.
It can occur with epileptic changes in the central nervous system, after suffering traumatic brain injuries, as a result of taking medications, under the influence of bacteria or viruses, under the influence of changes in the composition of the blood (reducing the amount of sugar or hemoglobin), and overweight.
In the second, breathing stops due to narrowing of the airways, i.e. mechanical obstruction to air flow.
This effect occurs with excessive relaxation of the muscles that support the pharyngeal wall, overgrowth of the palatine tonsils, the appearance of polyps, the presence of congenital anomalies in the structure of the tongue and jaw apparatus, and spasms of the larynx.
A combination of causes leads to a complex syndrome, which is characterized by more severe respiratory disorders.
The most common is the second type, which is called obstructive.
By origin of sleep apnea there are:
- Central. Central mechanisms are more characteristic for newborns, especially premature babies, for infancy. They can occur at any age with damage to the central nervous system, craniocerebral, spinal injuries. They are caused by inhibition or immaturity of the respiratory center, blockade of the passage of impulses from peripheral receptors to the brain.
- Obstructive. Occur when squeezing, blocking the upper respiratory tract. Obstructive type of apnea occurs in the pathology of ENT organs in childhood, obesity, lymphoproliferative diseases, tumors and cysts in the pharynx.
- Mixed. This species is characterized by signs of manifestations of two other groups.
Primary and secondary apnea
In neonatology (a branch of medicine that studies the growth and development of infants and children in the first months of life) and obstetric practice, the concept of primary apnea refers to the initial difficulty in pulmonary ventilation due to perinatal hypoxia.
The condition is accompanied by respiratory arrest, hypertension and bradycardia. During primary apnea, the newborn frantically holds his breath: inspiratory muscles contract as much as possible, passive exhalation, this condition is called “gas-breathing”.
After assisted pulmonary ventilation, the baby’s breathing is quickly restored, without provoking any further complications.
Secondary apnea is the stopping of respiratory movements after gas-breathing and primary resuscitation. This condition is characterized by a weakening of muscle tone and a drop in blood pressure. In this case, the normal life of the baby will recover slowly, with possible complications in the future.
Primary apnea can also mean impaired respiratory function found in a newborn in the first weeks of life: it is common in children who are born prematurely or have suffered birth defects. In this case, short-term respiratory arrest at night in infants, appearing at 3-6 months and associated with various developmental pathologies and diseases, will be called secondary apnea.
First Aid Infant
What is night apnea in children under one year old? If a baby's breath is detected, she needs to be awakened immediately. You can shake it, pick it up, turn it over in the crib, massage the chest, rub the arms and legs. It is important not to scare the baby. If the child does not breathe, urgent need to do artificial respiration and call an ambulance. The health and even the life of the baby depends on the speed and clarity of the actions of parents.
Even if you managed to cope with an attack of apnea in a child up to a year on their own, in the near future you need to show it to a pediatrician. He may prescribe more detailed studies or recommend contacting a narrow specialist (for example, a neurologist).
Pediatricians note that apnea in infants who are breastfed is much less common. Avoid viral infections and colds.
If the night stop of breathing was recorded at least 1 time, you need to monitor the quality of sleep of the baby. Apnea in infants can occur during daytime rest.
In this case, you can not bring yourself to paranoia, the nervous state of the parents can be transmitted to the baby. Pediatricians note that with age, the risk of respiratory arrest in a dream is significantly reduced.
In the causes of apnea in infants and older children, there is still a lot of incomprehensible, not obvious. But experts in the field of somnology and otolaryngology deal with this issue.
In newborns, apnea can be due to congenital insufficiency of the respiratory center, while the baby's skin is cyanotic, and respiratory pauses in sleep in babies occur due to the absence of pathologies from the lungs or heart. Such apnea, as well as arising after a head injury, are called central.
There is also a large group of obstructive apnea that develops in overweight children, hormonal disorders, and impressionable and nervous babies. Hereditary apnea is also distinguished.
The main causes of occurrence, known today, are as follows.
- Premature birth - It is in babies who were born before the 37th week of pregnancy that primary immaturity of the respiratory center is most often found. Premature babies usually develop central apnea.
- Maxillofacial pathology with a congenital small jaw, with other congenital forms of violations of its anatomical structure.
- Pathologies of the heart, blood vessels, nervous system. With some heart defects or circulatory diseases, hypoxia can be caused at the cellular level, which also affects the work of the respiratory system in a dream.
- Birth injuries. The true cause of apnea can lie in any trauma that the child suffered during childbirth.As a rule, if these are disorders of the central nervous system, then apnea is central.
- Mom's bad habits - refers to smoking, alcoholism, taking drugs while carrying the baby. The probability of apnea after birth in children of such mothers exceeds 30%.
If we talk about children over the age of one year, then the most common causes of apnea are the following situations:
- overweight and obesity - stopping night breathing caused by the deposition of adipose tissue in the soft palate, tongue,
- respiratory diseases - most often, sleep apnea syndrome develops in children with adenoids, chronic forms of rhinitis, when unhindered nasal breathing becomes inaccessible,
- hormonal disorders - most often, an increased function or insufficient thyroid function, as well as diabetes mellitus, are a risk factor,
- infectious diseases - in this case, anoe can develop not only in acute respiratory illness, but also in systemic diseases, for example, in sepsis,
- metabolic disease - insufficiency in the body of a baby or preschooler, schoolchild magnesium, calcium quite often lead to nocturnal apnea,
- medicines - drugs that are potentially capable of causing apnea in a child include hypnotics, potent sedative drugs, as well as some antihistamines, for example, Fenistil, if given to a child up to one year old.
What happens for any of these reasons is not hard to imagine: in the deep phase of sleep, pharyngeal collapse occurs. At the level of the pharynx, the airways fall. The lack of oxygen in the brain is felt instantly, it gives the command to "wake up", and the child wakes up. Breathing is restored, he falls asleep again and so on until the next episode of apnea.
Symptoms in Toddlers and Adolescents
The development of this pathology is accompanied by a steady complex of symptoms, the appearance of at least several of them should already alert parents.
One of the characteristic signs of obstructive respiratory arrest is snoring, which suddenly occurs during sleep.
It can be easily distinguished from the usual labored breathing that occurs in children with respiratory illnesses in a specific sound. Often after an episode of apnea, awakening occurs, or sleep becomes superficial.
Watching the respiratory movements of the chest, parents can mark the moment of their termination and renewal.
With an obstructive form, the muscles continue to work, but there is no inhalation and exhalation.
How to recognize apnea in a child in 3-4 years? In the daytime, the child's concentration is disturbed, memory worsens, lethargy and weakness appear. He often tends to sleep, irritability appears, moods become more frequent.
What are the signs of teenage apnea? Teenagers complain of constant fatigue, headaches, heaviness throughout the body. In a sitting position - while studying, at a computer or in transport - the patient often falls asleep.
During sleep, overall muscle tone decreases, including the tone of the muscles of the pharynx. The clearance of the airways is somewhat narrowed in healthy children, but not critical - these physiological phenomena do not interfere with the passage of air, and the quality of sleep does not suffer.
Excessive decrease in muscle tone of the structures of the upper respiratory tract or the presence of obstruction in them leads to a complete decline in the pharynx, the development of an episode of acute suffocation. It lasts from 10-30 seconds or more. The oxygen concentration in the blood decreases sharply, the sympathetic nervous system is activated, and pressure rises. The stress reaction “wakes up” the brain, which regains control of the pharyngeal muscles - an inspiration takes place. This is how obstructive apnea develops.
If the pathogenesis of the disorder is central, then there are no obstacles to the passage of air in children, the pathological process is localized in the central nervous system itself, which is not able to adequately control the act of breathing in a dream.
This pathology is characterized by a violation of the functioning of the respiratory center. During the episode of apnea, the muscle tissues that are responsible for breathing do not receive the necessary impulse necessary for their movement.
The main causes of sleep apnea in children include the following:
- Premature birth
- Birth damage to the spinal cord or brain,
- Low blood glucose
- Violation of gas exchange,
- Infectious diseases of a viral or bacterial nature,
- Epileptic seizures
- Taking certain medications
- Blood poisoning,
- Imbalance in electrolytes,
- Bronchopulmonary dysplasia,
- In some situations, idiopathic apnea is diagnosed. In this case, doctors cannot determine the exact cause of the problems.
Features of the manifestation of the syndrome in an older child
What is an episode of nocturnal apnea in infants? Obstructive sleep apnea is more common, typical for adults. It is characterized by the decline of the soft palate, narrowing the respiratory throat. When inhaling, the air passes with difficulty, the tissues vibrate, creating a characteristic growling-whistling sound. The syndrome occurs in both boys and girls, under the age of 8 years, the frequency of the disease is from 8 to 12%.
In the morning the child is lethargic, slightly inhibited, complains of dryness and irritation in the mouth, fatigue, headache. Possible flashes of hyperactivity and a sharp change in mood. If the situation repeats frequently, developmental delay may be observed. The reason is regular problems with the supply of oxygen to the brain.
Lethal outcome in older children is rarely recorded, but obstructive sleep apnea can provoke many health problems, including heart failure.
The causes of apnea in a child can be as follows:
- frequent colds
- enlarged adenoids,
- congenital or acquired curvature of the nasal septum,
- excess weight.
Often there is nocturnal apnea in children with autoimmune diseases.
Among them is Down syndrome, which is characterized by the retraction of the tongue, overlapping the nasopharynx, as well as myasthenia gravis associated with weakness of the striated muscles.
In the following video about apnea, the cause of which is an increase in adenoids:
What is an apnea attack?
An apnea attack is noted when breathing stops for more than 20 seconds and for 10 seconds with concomitant bradycardia. After this period of time, infants develop hypoxia, which can damage brain cells.
The main cause of apnea in children born prematurely is the underdevelopment of the respiratory regulation center. This is a set of cells of the nervous system - neurons that ensure the coordinated work of the respiratory muscles, adapting them to internal and external changes. With the formation of the nervous system by 40-45 weeks, apnea attacks in most cases are eliminated.
In children born on time, as well as older than 1 year, apnea attacks mainly occur due to airway obstruction. This may be a consequence of congenital disorders and internal pathologies of the body. In these cases, careful monitoring and elimination of possible causes is required.
A special risk zone includes children with a gestational age of less than 34 weeks, weighing less than 2.5 kg, with birth injuries and congenital disorders of the central nervous system. The consequences of apnea attacks can be irreversible. Complete respiratory arrest disrupts the rhythm of the heart, which can lead to death.
Symptoms and signs
The main sign of pathology is intermittent, restless sleep. Parents of the baby can detect the problem faster, because most often the crib is placed up to 2-3 years in the parent's bedroom. If the child is 5 years old or more and he sleeps separately, then you need to pay attention to the fact that in the daytime the child is sluggish, lethargic, he does not get enough sleep, complains about it. Apnea is almost always accompanied by snoring.. Children with this pathology sleep restlessly - their bed is always “stacked” in a pile.
In the morning, the child has complaints of headaches, he wants to sleep in the daytime, his activity, curiosity, and learning ability are reduced. The child is irritable, tearful, it is difficult for him to concentrate and remember new information.
In children, quite often, apnea is combined with disorders such as enuresis, severe sweating in a dream. They can fall asleep in the most bizarre poses. Often you can pay attention that during the day the child breathes through his mouth.
According to the ICD-10 classification, apnea, like other sleep disorders, refers to diseases of the nervous system. However, its diagnosis should begin with a visit to the pediatrician.
After examining the patient and collecting the information provided by the parents about sleep disorder, the doctor will give a referral for a specialist consultation.
In an ideal situation, such a specialist should be a somnologist - a doctor who deals with sleep problems. But often it is not in our clinics. Then you can contact a neurologist.
To make a diagnosis, the doctor prescribes additional examinations. One of the diagnostic methods is oximetry, which allows you to determine the amount of oxygen in the blood.
It is performed using sensors mounted on the patient’s body and does not require blood sampling.
Polysomnigraphy can give more information about what is happening with the child in a dream.
This is a comprehensive study of the nervous and cardiovascular system during night sleep.
It includes recording the electrical activity of the brain, fixing the frequency of contractions of the heart muscle, tracking changes in the position of the eyeballs, determining changes in muscle tone of the chin and a number of other muscles involved in breathing.
It also measures the temperature of air passing through the airways and the level of oxygen in the blood.
If the doctor makes the assumption that the overgrown lymphoid tissue or polyps became the cause of the airway obstruction, then he sends a otolaryngologist for a consultation.
The same specialist will be necessary if respiratory arrest is caused by laryngospasm.
Types and causes of apnea in children
The main culprit in stopping breathing in infants born before the established deadline is the underdevelopment of the respiratory center. It is a structurally functional multilevel formation of the nervous system, the main duty of which is the management of the respiratory muscles. As soon as the nervous system is formed (and this happens approximately in 40-45 weeks), the attacks of respiratory arrest in a dream are nullified.
If nocturnal apnea appears in children who were born on time, then the cause most often is a violation of the patency of the bronchial tree. This is due to the fault of congenital pathologies or diseases of the respiratory system.
Types of Apnea of Premature Babies
Especially at risk are children born before 34 weeks of gestation, and whose weight is less than 2.5 kg. Such babies often are born with injuries received during childbirth, and with diseases of the nervous system. The consequences of long breath holdings are very dangerous (apnea becomes a source of poor heart function, heart rhythm disturbance, which often leads to death).
Consider the types of apnea and the causes of their occurrence.
The leading symptom of an apnea episode is a lack of breathing, chest excursions for 10-15 seconds. In some cases, if the child’s breathing is accompanied by snoring, parents note episodes of its cessation, and after some time an intensified resumption of snoring sound. Such "dumb" episodes of sleep are apnea.
The longer the periods of respiratory arrest (up to 40-50 seconds), the worse the consequences for the body: episodes cause sudden death syndrome or cause brain damage due to prolonged hypoxia.
Such respiratory arrests during the night can occur more than 100-150 times, their number and duration affect the night's sleep, its phase, the general condition of patients.
Other symptoms by which this pathology can be suspected are:
- Snoring in a dream.
- A feeling of lethargy, weakness in the morning, despite the fact that the child slept a sufficient amount of time at night. Children are especially moody, tearful in the morning after waking up.
- The tendency to fall asleep in the middle of the day, at school.
- Headaches in the morning.
- Increased irritability, restlessness, hyperactivity.
- Memory impairment, attention deficit.
- Bedwetting (enuresis).
- Increased motor activity in a dream.
- Teeth grinding (bruxism).
- Conversations in a dream.
- Delay in psychomotor development.
Obstructive sleep apnea
Respiratory arrest due to obstruction of the respiratory system. If air flow is disturbed, a change in the movements of the chest is observed. The main reasons for this deviation are the following:
- Pathological increase in the size of the tongue,
- The lag of the development of cartilage and bone tissue,
- Enlarged tonsils,
- Cleft lip
- Laryngospasm - accompanied by an involuntary contraction of the muscles of the larynx,
- Excess weight,
- Congenital airway contraction
- Problems in the work of the back muscle of the larynx - may be due to paralysis or traumatic injuries,
- Robin syndrome - in this case, there is insufficient development of the lower jaw and tongue.
See a doctor
If the first signs of apnea are detected, an urgent consultation with a doctor is necessary. The pediatrician will conduct a detailed examination and issue a referral to a specialist. With an increase in adenoids, they are recommended to be cut, this gives an almost 100% guarantee of getting rid of apnea and snoring.
If the problem is caused by excess weight or neuromuscular pathologies, CPAP therapy will help the child. It is carried out using special devices that regulate respiration, pressure, humidity and air supply intensity.
Such a treatment for apnea is prescribed by a somnologist, he also offers the best course. To achieve a lasting effect, it may take several months of therapy, but in especially difficult cases the device is used for life.
Some measures to improve the situation can be taken by the parents of the child. To reduce the risk of night apnea will help:
- gradual weight loss in overweight children.
A balanced diet with a minimum of sweets, fast food and fried foods, the addition of fresh fruits, vegetables, dairy products, an increase in physical activity,
Now you know what an attack of apnea is in children after a year and in infants. And you understand that this is an infrequent, but very dangerous syndrome. It is impossible to cope with the situation on your own, to determine the exact diagnosis and selection of a treatment program, you need to contact a pediatrician who will give out referrals to narrow specialists.
Apnea negatively affects everyday life and its quality. A child who has not slept at night in the daytime is inattentive, scattered, which increases the likelihood of injuries, falls, accidents.
Apnea increases the likelihood of developing hypertension, heart rhythm disturbances. Also, this problem noticeably worsens the course of all respiratory ailments, and children often suffer from them.
Actions in an attack in a dream
All therapeutic measures can be divided into immediate, produced at the time of the attack, and basic, aimed at eliminating the cause of the disease.
Immediately at the moment the breath stops, efforts are made to restore it.
To do this, it is necessary to bring the child out of sleep, which activates the work of all systems and organs and will lead to the resumption of inspiration-expiration cycles.
If this does not happen, resuscitation is necessary.
With loud snoring, you should change the position of the body, the optimal position is on the side, with slightly bent knees.
The head should not be thrown back. It’s better to remove the pillow. The room must be ventilated to ensure oxygen flow.
Initially, central apnea occurs, but airway obstruction gradually develops. The main causes of pathology include the following:
- Heart diseases,
- Glucose and calcium deficiency,
- Subcooling and overheating,
- Exposure to alcohol and drugs that a woman takes during pregnancy.
This form of apnea occurs quite rarely, but it is very difficult to diagnose and treat.
What to do?
Waiting for apnea to pass by itself is dangerous.
If facts of respiratory arrest in a child’s sleep are discovered, parents should show the child to the pediatrician.
The doctor will weigh the child, establish the weight of his body, determine whether the child has obesity, measure the pressure and give direction to the ENT doctor. Examination by an otolaryngologist plays an important role - it is necessary to identify the mechanical factors by which the upper respiratory tract in a dream fall excessively.
Polysomnography is performed for children - simultaneous recording of electrical potentials for 8 hours or more, or a polygraphic study is prescribed, in which the heart rate and nasal breathing are recorded overnight, and episodes of snoring are determined.
There are certain factors that greatly increase the risk of apnea. The risk group includes children with an abnormal structure of the skull or internal organs.
Also provoking factors include the following:
- Prematurity. In such children, the nervous and respiratory systems are not fully formed. After birth, babies are often placed in special incubators. This allows you to monitor the parameters of temperature, respiration, heart rate. Thanks to this, it is possible to protect the child from negative consequences and identify the causes of apnea.
- Deviations in the structure of the respiratory system, nose, jaw. This can lead to air obstruction, which increases the likelihood of developing apnea.
- An increase in the size of the tonsils, the appearance of polyps and adenoids. All these formations lead to difficulties with the flow of air. If such anomalies are detected, you should immediately consult a doctor.
- Overweight. The cause of apnea quite often becomes overweight. Adipose tissue leads to compression of the pharynx, which entails respiratory failure.
- Deviations in the work of the cardiovascular and digestive systems. Especially often, apnea develops in newborns with reflux.
- Imbalance of minerals. Another common cause of respiratory arrest.
- Birth injuries and diseases, intracranial injuries, Down syndrome. Kids with such pathologies are much more likely to experience symptoms of apnea.
Symptoms of Infant Apnea
The main symptom of apnea is respiratory failure: a stop can be detected by the cessation of diaphragm movements. So you can differentiate between central and obstructive apnea: in the second case, the infant continues to make respiratory movements.
In addition to respiratory arrest, apnea can be identified by the following symptoms:
- Pale or bluish tint of the skin, blue in the mouth and nasal folds (associated with oxygen deficiency).
- Snoring is the main symptom that indicates the obstructive genesis of apnea.
- Restless sleep.
- Enuresis is one of the signs of a malfunction of the central nervous system; it is difficult to detect in infants for obvious reasons.
- Convulsive gasping by mouth, breathing through the mouth during sleep and wakefulness.
- Shortness of breath after restoration of normal breathing.
Due to the constant lack of sleep, the child's daytime behavior changes, he becomes more tearful and irritable.
Attacks can be observed in newborns in the first weeks of life, and in children older than 6 months.
How is it treated?
For the treatment of apnea in childhood, a large list of medications is used. There are also non-drug methods. It is acceptable to use the achievements of surgery, but only to eliminate the root cause of respiratory dysfunction in a dream. If the child has a mild form of pathology, he is strongly advised to go to bed with his head raised. It is also recommended that parents teach the baby to sleep on their sideavoiding the back position.
Be sure to treat ENT diseases that were identified as a result of the examination. Overweight children are recommended to reduce this parameter.. There are many different devices that will help your baby sleep more comfortably - tongue holders, jaw extensions. These orthopedic appliances can also be recommended.
Prevention of childhood apnea includes monitoring the weight of the child, timely treatment of the common cold and other respiratory diseases.
First aid and seizure prevention
Apnea attacks can pass unnoticed even with constant visual monitoring of the sleeping baby. In case of severe asphyxia - blue skin around the mouth and nasal folds, prolonged lack of respiratory movements, slow heart rate (in a child up to a year old, the pulse is easier to feel on the brachial artery or fontanel), first aid should be provided to the baby:
- You need to take the newborn in your arms and try to bring it to life: any tactile irritation will help, whether it is patting and stroking the back from the bottom up, rubbing the hands, feet, earlobes, tickling and popping in the feet.
- You can sprinkle crumbs with cool water.
- To facilitate breathing, the baby needs to be turned on his stomach, turning his head to the side (often this is how premature babies are laid in incubators).
If a few seconds after the start of the manipulations the child does not begin to breathe, artificial respiration is required. The baby is laid with its back on a flat hard surface, a rolled towel is placed under the shoulder blades, the head tilts slightly. Holding the head with your hands, you need to inhale the air in small portions (the newborn has a small volume of lungs) simultaneously in the mouth and nose. If breathing is not restored after 5–8 breaths, an indirect heart massage is performed.
When a child is hospitalized with suspected apnea, a complex of diagnostic procedures is performed, after which measures are taken to alleviate the condition of the baby. Drug treatment of the disease is aimed at eliminating the causes of the syndrome.
Premature babies suffering from this disease are placed in a special incubator.
When repeating the attacks, the following measures are taken: the temperature inside the incubator decreases, the air flow in the incubator increases, the baby is connected to an artificial pulmonary ventilation system.
Holding your breath in a dream can be prevented by observing the following rules:
- The bedroom should be regularly ventilated and moistened. Before going to bed, the child should not be overheated.
- For the baby, you need to choose the right bedding: elastic, hard mattress, hypoallergenic pillow and blanket filler (feather products are not suitable).
- In the presence of a newborn, it is impossible to spray aerosol household chemicals and cosmetics, use perfume, and distribute cigarette smoke.
At the first suspicion of apnea, it is worth moving the child's bed to the parents bedroom: this will allow him to continuously monitor his condition.
When the danger is real
Even a slight delay in breathing in a dream can lead to dangerous consequences. Such attacks per night can be from 5 to 100.
If respiratory arrest occurs frequently, then tissues and organs experience hypoxia - a lack of oxygen, hypoxemia - an increased content of carbon dioxide in the blood.
Danger when apnea attacks occur frequently
Sometimes the total duration of apnea for the whole night can reach 3-4 hours. This happens, as a rule, from 22-00 to 6-00. In this case, there is a violation not only of the general condition of the baby and the quality of his sleep, but also of the functioning of all organs and systems. First of all, the brain and heart suffer. This condition really carries a great danger to the health and life of the baby.
For infants, especially premature babies, this can lead to sudden infant death syndrome. The essence of this phenomenon is as follows. A healthy baby dies while sleeping. After opening, no signs of the disease are noted. It is known that sometimes this happens due to nighttime apnea attacks. Other causes of medicine are still unknown.
It is worth noting that up to 6 months the baby's breathing can be quickened, slowed down, superficial and uneven. This is not worth fearing. Such signs are associated with the underdevelopment of the nervous and respiratory systems.
Really dangerous for the health and life of the child are:
- conditions when uneven, intermittent, shallow, rapid and slow breathing is observed in children older than 6 months,
- heart rate less than 90 beats per minute,
- frequent stop breathing in a child’s sleep, frequent night awakenings,
- a change in respiratory rate is accompanied by a slowdown in heart rate and cyanosis of the skin, mucous membranes.
Most often, apnea affects infants born before the established deadline, of low weight (up to 2.5 kg), as well as in babies with a diagnosis of cerebral palsy, Down syndrome.
If the baby was born at 28-37 weeks, then it is placed in a special incubator located in the maternity hospital. There, for such children, suitable conditions are created that are as similar as possible to intrauterine ones. They are monitored by medical personnel around the clock, and special equipment records all changes occurring in the body of crumbs. With their help, interruption of breathing in a child’s sleep is also determined.
One method is oxygen inhalation.
The following methods are used to treat apnea in children.
- Tactile irritation technique. During the attack, the baby is massaged with heels, ears, fingers, fingers held along the back along the spine. Some hospitals are equipped with special incubators in which there is a vibration system.
- Mechanical ventilation (mechanical ventilation). It is characterized by artificial inhalation of air into the lungs. Appointed when episodes of apnea last a very long time.
- Inhalation with oxygen, or oxygen therapy. The technique is used for oxygen starvation, developing during an apnea attack.
- CPAP therapy. It is considered a secondary treatment. With its help, breathing during sleep is normalized.
If breathing during sleep is held by preschoolers and school-age children, then doctors prefer to delay treatment, that is, turn to expectant tactics (since as the bones grow, the opening in the airways increases).
If the diagnosis is confirmed, then treatment begins with the elimination of obstruction and the causes of this condition.
In rare cases, doctors resort to surgical intervention. The type of operation will depend on what triggered apnea.
- Tonsilloectomy. Removal of hypertrophied tonsils.
- Correction of a curved nasal septum.
- Adenoidectomy Removal of adenoids.
After the operation, approximately a month later, a second breath assessment is performed.
What can you do
Frequently recurring incidents of nocturnal childhood apnea cannot be overcome at home. However, they can be prevented if:
- Follow all doctor’s instructions
- Do not self-treat
- Do not resort to traditional methods of therapy,
- not to start and timely treat ARVI, ARI, as well as diseases developing in the respiratory tract,
- teach your child to wash his nose with saline every day,
- if possible, turn the baby to the side during sleep, do not allow rest on the stomach,
- do not smoke in the presence of a child,
- set the baby’s crib so that the front back is lower (about 15 cm),
- do not give the child medications with hypnotic and sedative effects,
- maintain a favorable family environment,
- do not give to eat at night.
If you follow all these rules, then the duration and frequency of occurrence of attacks of night apnea can be significantly reduced or completely nullified.
What does the doctor do
The doctor should conduct a thorough examination of the baby.
Therapy is based on:
- taking medications (very rare),
- non-drug methods (oxygen therapy, establishing sleep and rest, rinsing the nose, using special devices to improve nasal breathing),
- surgical intervention.
Treatment is prescribed only after the results of analyzes and studies.
Signs of Nocturnal Apnea in Children
Episodes of apnea are more likely to occur on the background of general muscle relaxation, so respiratory arrest mainly occurs during sleep.
During breath holding, short-term hypoxia develops, from which the child suddenly wakes up. This is accompanied by a strong fear, provoking a strong release of adrenaline into the bloodstream, which irritates the nervous system and disrupts sleep functions.
Characteristic symptoms of apnea:
- lack of breath for 10 seconds or more,
- mouth breathing
- restless sleep
- headaches during the day
- decrease in development dynamics.
A constantly sleeping child develops chronic fatigue, it becomes moody and irritable. Appetite is impaired, weight and overall activity are reduced.
From the video you can find out by what signs apnea can be recognized, and why snoring in a dream is so dangerous.
To begin with, you should pay attention to the pregnant woman’s lifestyle. She should not drink alcohol, smoke, take illegal drugs, or use allergenic products.
Nutrition during childbearing should be rational and proper. Expectant mother just needs to avoid stress and ensure comfortable living conditions (humidity 50-70%, indoor temperature - up to 20 ͦС).
In order to avoid respiratory arrest in a child, you need to:
- put the baby on a barrel,
- no soft mattresses and high pillows should be
- control weight
- do not overfeed the child at night,
- do not feed 3 hours before bedtime (this does not apply to infants),
- timely treat ENT diseases, respiratory diseases,
- moisten the room, carefully ventilate, prevent dryness and heat.
For older children, constant physical activity is recommended: jogging, bicycle, pool, frequent walks in the fresh air in the park and forest areas.
The health and development of the child directly depends on the correct actions of mom and dad, as well as timely access to a doctor. If you find that your baby is holding your breath during sleep, you should immediately seek medical help.
Regardless of the type of apnea, pathological changes occur in the child's body. With a periodic lack of breathing, oxygen deficiency forms.Depending on the reason, such episodes can be repeated 5-100 times per night, which develops in an impressive period of time up to 4 hours.
- Attention deficit hyperactivity disorder.
This syndrome manifests itself in difficulty concentrating, hyperactivity, impulsiveness and uncontrollability of the child.
During oxygen deficiency, the body activates compensatory mechanisms, increasing blood circulation. This leads to an increase in blood pressure, which is periodic. Constant changes in the rhythm lead to wear of the structures of the heart.
Lack of nutrition of the heart muscle violates automatism, which immediately affects the rhythm of heart contractions, and atrial fibrillation develops.
A child with apnea is at high risk of developing coronary heart disease, heart failure, and against the background of these pathologies, heart attack and stroke.
Constant lack of sleep leads to daytime sleepiness, which significantly increases the level of injuries.
Small snoring does no harm. In such a situation, it is recommended to follow expectant tactics. Quite often, with the development of cranial bones and an increase in the lumen of the respiratory system, problems disappear. However, doctors recommend polysomnography every year.
If the diagnosis is confirmed, active therapy is indicated. It aims to combat obstruction and inadequate ventilation. Be sure to eliminate the causes that triggered the development of apnea.
This treatment method used with the appearance of congenital or acquired pathologies of the respiratory system.
Common operations that are carried out in this situation include the following:
- Tonsillectomy - an indication for such an intervention is tonsil hypertrophy,
- Correction of the nasal septum - is used when it is curved,
- Adenoidectomy - performed with a significant increase in adenoids.
In difficult situations, the following types of interventions can be performed:
- Tracheostomy - indicated for obstructive pathologies and insufficient development of the respiratory tract,
- Uvulotomy - is a clipping of the tongue.
The effectiveness of surgical methods of treatment is at the level of 75-100%. One and a half months after the surgery, a reassessment of respiratory functions is performed.
This is an effective way to treat sleep apnea in children. The essence of this technique is to constantly maintain high air pressure in the organs of the respiratory system. Due to this, it is possible to avoid vibration and subsidence of their walls. The technique is used if there is no indication for the operation.
During therapy, a mask is put on the baby with a hose through which the air produced by the compress is supplied. The procedure should be ongoing. The device is used during day and night sleep.
The pressure and humidity parameters are selected by the doctor. It depends on the body weight and age of the patient. Parents must adhere to the recommendations of a specialist. The duration of therapy can be from several months to several years. In especially difficult situations, you have to use the device all your life.
Such methods are most often used to treat apnea in children after a year, since most procedures cannot be performed on infants. It is worth considering that folk remedies must be used in addition to the main methods of treatment. This can only be done after consulting a doctor.
The most effective means include the following:
- Cabbage juice with honey. To prepare a drink in a glass of fresh juice, you need to dissolve a small spoonful of honey. This remedy should be given to the child before bedtime. The course of treatment is 1 month.
- Moisturizing the sinuses. To do this, use a saline solution. Thanks to a simple procedure, it will be possible to clear the nose and airways of mucous secretions. For cooking, it is recommended to use sea salt: for 1 small spoon, you need to take 200 ml of warm water.
- Sea buckthorn oil. This tool has pronounced bactericidal and wound healing properties. To achieve good results, you need to introduce 3-5 drops of the drug into each nasal opening. This must be done before bedtime.
Surgical removal of the problem is the first choice in the presence of congenital or acquired airway abnormalities.
- tonsilloectomy (with tonsil hypertrophy),
- adenoidectomy (removal of adenoids),
- nasal septum correction.
Rarely, only in extremely difficult cases:
- tracheostomy (with congenital and acquired obstructive abnormalities, underdevelopment of the respiratory tract),
- uvulotomy (clipping of the tongue).
The effectiveness of surgery on average is 75-100%. After 1-1.5 months after surgery, a second breath assessment is performed.
First aid for episodes of apnea
Prolonged episodes of apnea can lead to asphyxiation, which threatens the life of the child. In these cases, a favorable prognosis completely depends on the quick and coordinated action of the parents.
Urgently need to call an ambulance if the child:
- the limbs turned blue, the wings of the nose, the rim of the lips,
- heart rate below 90 beats per minute,
- legs and arms hang involuntarily.
Blue skin (cyanosis) of the skin indicates a decrease in the level of oxygen in the blood (asphyxia). First you need to try to help the child with tactile irritation. This is holding a finger along the back along the spine, massage the ears, arms, legs and chest. If the measures do not help, proceed to artificial respiration.
To do this, you need:
- put the child on a horizontal surface,
- check the airways, raise your chin and take your head back while lowering your tongue,
- to grip the child’s nose and mouth with his lips, holding his head tightly,
- breathe in half the volume and produce 2 smooth blows with a duration of no more than 2 seconds,
- in the absence of chest movement, repeat the procedure, changing the position of the head,
- after the beginning of the movement of the chest, you need to try to feel for the pulse on the inside of the arm above the elbow,
- continue the procedure, if there is a pulse,
If there is no pulse, proceed to massage the heart. To do this, 2 fingers are applied to the middle of the chest just below the line of the nipples. After that, sharply press 5 times for 3 seconds. The chest should bend 1.5 −2 cm. Next, 1 injection and 5 presses alternate.
Procedures continue until the arrival of emergency doctors. After such manifestations of apnea, the hospitalization of the child is indicated.