- Content version
- 1.0
- Last scientific review
- مايو 2026
What are the tonsils and adenoids?
The tonsils are two masses on either side of the throat, and the adenoid is similar tissue at the top of the throat behind the nose. They naturally enlarge in childhood, especially between ages 3 and 7, then gradually shrink.
Enlargement alone is not a problem unless it causes symptoms affecting the child's life.
What are the symptoms during sleep?
- Persistent snoring
- Breathing pauses or gasping during sleep
- Sleeping with the mouth open
- Frequent tossing and turning, or sweating
- Sleeping in unusual positions, such as with the head raised
- Bedwetting after the child had previously stopped
And during the day
- Continuous mouth breathing
- Nasal-sounding speech
- Drowsiness, hyperactivity, or irritability
- Poor concentration and school performance
- Slow eating or, sometimes, poor weight gain
- Recurrent ear infections or fluid due to adenoid enlargement
What is sleep apnea in children?
When the tonsils and adenoid are large, they may narrow the airway during sleep, causing the child's breathing to stop or reduce for repeated seconds. Deep sleep is interrupted without the child fully waking.
This affects the child's rest, growth, behavior, and concentration.
How is it diagnosed?
- Parents' description of the child's sleep and behavior. A short video of the child snoring is very helpful for the doctor.
- Examination of the throat and nose, sometimes using a scope or imaging to assess adenoid size.
- A sleep study for some children — such as those under 2 years old, those with obesity, Down syndrome, or other conditions, or when the diagnosis isn't clear.
What are the treatment options?
Watchful waiting
Suitable when symptoms are mild and not affecting the child's life, as the enlargement may shrink with age.
Medical treatment
A nasal steroid spray may help some children with adenoid enlargement or mild breathing pauses, or with allergic rhinitis.
Tonsillectomy and adenoidectomy
Usually recommended for:
- Sleep apnea affecting the child
- Significantly recurrent tonsillitis
- Adenoid enlargement with nasal obstruction or recurrent ear problems
The adenoid alone may be removed in some cases.
After surgery, snoring, sleep, and behavior improve in most children. See the booklet on post-tonsillectomy/adenoidectomy instructions.
What can I do at home?
- Observe your child's sleep, and record notes or a short video to show the doctor.
- Treat allergic rhinitis if present.
- Keep your child away from cigarette, shisha, and incense smoke.
- Maintain a healthy weight for your child.
- Keep a regular sleep schedule.
When should I see a doctor?
- If your child snores most nights.
- If you notice breathing pauses during sleep.
- If symptoms affect their behavior, schoolwork, or growth.
- If tonsillitis or ear infections recur.
Call 997 or go to the emergency room if:
- Severe breathing difficulty appears
- The child's color turns blue during sleep
- The child can't swallow or drink fluids, or drools continuously
Remember
- Persistent snoring in children isn't normal and needs evaluation.
- Sleep apnea can affect a child's behavior and growth.
- Not all enlargement needs surgery.
- Breathing difficulty or bluish color is a medical emergency.
This information is for health awareness and education, and does not replace a doctor's consultation or direct medical assessment.
Prepared by: Saudi Society of Otolaryngology–Head & Neck Surgery · Version 1.0 · Last reviewed: May 2026 · saudiorl.com
