A child making a sound like snoring or a low-pitched rumble while awake is understandably a source of concern for any parent. This unusual noise signals that air is moving through a partially narrowed or obstructed passage within the respiratory system. The sound is a symptom indicating an underlying issue in the airway, not a diagnosis itself. Understanding the origin and characteristics of this noisy breathing is the first step toward determining if the symptom is harmless or requires medical intervention. This article clarifies the different types of noisy breathing, explores the most common causes, and provides guidance on when to visit a healthcare professional.
Understanding the Types of Noisy Breathing
The medical world classifies noisy breathing based on the sound’s pitch and the location of the airflow restriction. While parents may describe the sound as “snoring,” healthcare providers categorize it into three distinct types.
One common sound is stertor, a low-pitched, coarse, snorting, or gurgling noise that resembles snoring. This sound originates in the upper airway, specifically the nose or the back of the throat, indicating a vibration of soft tissues. Stertor is frequently associated with congestion or enlarged structures near the nasal passages.
Another type is stridor, a high-pitched, turbulent sound typically heard as the child breathes in. Stridor is generated higher up in the airway, often at the voice box or windpipe, suggesting an obstruction or narrowing in this area.
The third type is wheezing, a musical, whistling sound that usually occurs when the child breathes out. Wheezing points to a restriction in the lower airways, such as the smaller tubes within the lungs. Recognizing whether the sound is high-pitched (stridor) or low-pitched and rumbling (stertor) helps pinpoint the general location of the problem.
Common Causes of Snoring Sounds While Awake
One frequent structural cause of persistent noisy breathing in infants is Laryngomalacia, which translates to “soft larynx.” This occurs when the tissues just above the vocal cords are softer than normal and collapse inward when the child inhales. This collapse creates a partial obstruction resulting in the characteristic high-pitched stridor.
The noisy breathing associated with Laryngomalacia often becomes more pronounced when the infant is feeding, crying, or lying flat. Although the sound can be alarming, the condition is benign in the majority of cases and typically resolves spontaneously as the cartilage matures. The stridor often worsens during the first several months of life before improving, with most children outgrowing the condition by 18 to 20 months of age.
In older children, a common cause of stertor (the low, snorting sound) is the enlargement of the adenoids and tonsils. These lymphoid tissues can become chronically swollen due to recurrent infections or allergies, reducing the space in the back of the throat. This physical narrowing causes turbulent airflow, which parents hear as snoring even when the child is awake, especially when resting or congested.
Temporary congestion from an upper respiratory infection, such as a common cold, is also a frequent cause of stertor. Excess mucus blocks the nasal passages and vibrates in the throat, mimicking a snoring sound. This is usually a transient issue that resolves completely once the illness passes and the congestion clears.
Warning Signs Requiring Urgent Medical Evaluation
While many causes of noisy breathing are not severe, certain symptoms indicate a child is struggling to breathe and requires immediate medical attention. One serious sign is an increase in the work of breathing, meaning the child is visibly straining to move air. This is seen as retractions, where the skin visibly sinks in around the collarbone, between the ribs, or under the breastbone with each breath.
Another alarming sign is the flaring of the nostrils, as the body attempts to open the airway wider to take in more oxygen. Look for any changes in skin color, such as a bluish tint around the lips or fingernails, known as cyanosis. Cyanosis signals dangerously low oxygen levels and is a direct indication of a medical emergency.
A grunting sound on exhalation is another indicator of respiratory distress, as the child’s body tries to keep the air sacs in the lungs open. If the child shows extreme lethargy, drowsiness, or is suddenly unable to feed or drink, these are signs of respiratory fatigue. Any rapid worsening of the noisy breathing or a complete pause in breathing lasting more than ten seconds necessitates an emergency room visit.
Medical Diagnosis and Management
When noisy breathing persists, a healthcare provider begins the evaluation by taking a thorough medical history and performing a physical examination. The doctor listens to the child’s breathing to determine the sound’s specific characteristics and timing—whether it occurs on inhalation, exhalation, or both. This initial assessment helps localize the obstruction to the upper or lower airway.
To gain a definitive diagnosis, a specialist, often a pediatric otolaryngologist, may perform a flexible laryngoscopy. This office procedure involves passing a thin, flexible tube equipped with a camera through the nose to visualize the voice box and upper airway while the child is awake. This allows the doctor to see if tissues are collapsing, as in Laryngomalacia, or if another structural problem is present.
Management depends entirely on the underlying cause and the severity of the symptoms. For mild Laryngomalacia, treatment is typically observation, along with positional changes, such as elevating the head of the bed or keeping the infant upright after feeding. If the condition causes poor weight gain, feeding difficulties, or severe breathing problems, a surgical procedure called supraglottoplasty may be necessary to trim the floppy tissue.
If enlarged tonsils and adenoids cause stertor, the first line of management may involve treating underlying allergies or reflux, which contribute to the swelling. If the enlargement causes significant sleep disruption or repeated infections, surgical removal of the tonsils and adenoids may be recommended. The goal of all management strategies is to ensure the child can breathe easily, feed adequately, and grow normally.