Preschool-aged kids who snore loudly on a regular basis may be at a greater risk for behavioral problems, a study shows.

The behavioral issues include hyperactivity, attention problems, and depression.

The study is published in Pediatrics.

In the study, 9% of 249 children snored loudly two or more times a week when they were ages 2 and 3. These kids were more likely to have behavior issues at age 3 than kids who didn't snore or who snored at age 2 or age 3, but not both.

Breastfeeding, however, may help protect kids from snoring and possibly its negative impact on behavior.

"The effects we see in older kids who snore a lot also hold in 2- to 3-year-old kids," says researcher Dean Beebe, PhD. He is the director of the neuropsychology program at Cincinnati Children's Hospital Medical Center in Ohio. "This is not on many parents' or pediatricians' radar."

Researchers don't know exactly how snoring at ages 2 and 3 increases the risk for behavioral problems. But poor-quality sleep is likely at least partly responsible.

"Some snoring is normal, such as when a child has a cold. But if you are concerned, speak with your child's pediatrician," Beebe says. "New moms should strongly consider breastfeeding for as long as possible because it can have a strong protective effect against snoring."

Children from poorer families and those who were breastfed for short periods of time, if at all, were most likely to be persistent snorers.
Advice for Parents

Richard M. Kravitz, MD, believes parents shouldn't ignore snoring in kids. He puts it like this: "If your kids snore, you have to ask more." He is the medical director of the pediatric sleep lab at Duke University Medical Center in Durham, N.C. "Don't sleep on it, act on it," he says.

"If your child snores, you can't say that everyone in your family does. You need to follow it up with your pediatrician."

Kravitz puts the link between snoring and behavior problems in perspective.  "Kids with persistent snoring have a higher risk for behavioral problems," he says. "But this doesn't mean that every kid who snores will have behavioral problems or that all kids with behavioral problems are snorers."

But "snoring is not normal for children." Some children may need surgery to remove their tonsils or adenoids.

Andrew Adesman, MD, agrees. He is the chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children's Medical Center of New York.  "An evaluation can help determine whether the snoring is innocent or whether treating the underlying problem will make the snoring and behavioral problems better," he says.

It can be a vicious cycle, says Yosef Krespi, MD. He is the director of the Center for Sleep Disorders at the New York Head and Neck Institute of Lenox Hill Hospital in New York City. "Kids who don't sleep well are tired and cranky, and don't eat well," he says. "The snoring sound by definition means there is partial airway obstruction during sleep, which can cause poor oxygenation and restless sleep." 

"If it is a seasonal issue or because of a cold, it's no big deal, but if snoring is severe and causing sleep issues, seek a formal evaluation," Krespi says.