American Sleep and Epilepsy Centers
CPAP for children
CPAP for Children
Obstructive Sleep Apnea (OSA) affects approximately 2 percent of children. In most children with
OSA, enlarged tonsils and adenoids are the primary factors that lead to upper airway obstruction.
Usually OSA can be treated effectively with tonsillectomy and adenoidectomy. In a small number of
children, however, additional anatomic factors (including obesity) or certain upper airway anomalies can
be the cause. In these children and those who are deemed inappropriate candidates for surgery, PAP
(Positive Airway Pressure) is the therapeutic option of choice.
The benefits of successful PAP therapy may include increased attention span, improvement in school
performance, less disruptive, hyperactive behavior, elimination of enuresis (bed-wetting) and vomiting,
normalization of growth hormone-release during sleep and a decrease in daytime sleepiness. Despite
the benefits of PAP therapy, bear in mind, that CPAP (continuous positive airway pressure) is not
cleared by the US Food and Drug Administration (FDA) for children under the age of 7 or who weigh
less than 40 lbs.
Currently, there are 2 FDA-cleared pediatric masks. One is the ResMed Mirage Kidsta nasal mask and
the other is the Respironics Profile Lite Youth nasal mask. Nasal masks are preferred over full face
mask use with children, as vomiting is a potential response to pediatric OSA. Heated humidification
should be prescribed as a standard practice to overcome nasal allergies, prevent bloody noses and
The degree of a child’s compliance with CPAP is often tied to the level of the parents’ understanding
of the treatment.
Therefore, it’s important that parents have a full understanding of sleep apnea and its long-term
effects. If the child sleeps in different homes during the week, all caregivers must be uniform in keeping
the child in compliance with their CPAP use.
A child will not benefit from occasional PAP use. It is extremely important that the child uses their
CPAP every time he/she goes to sleep whether it is at home, a sleep-over at a friend’s house summer
camp or vacation. Letting the child sleep without their PAP therapy “just this once” may make it difficult
to resume PAP compliance of subsequent nights. A sleep psychologist will often work with a child and
his/her parents to determine the best ways to adjust to the child’s new therapy and enforce age-
appropriate proper sleep habits. Remember, the more comfortable and knowledgeable the caregiver is,
the more relaxed and cooperative the child will be.
As children age, their mask size and optimal PAP setting will change. Pediatric patients should
consult their board-certified sleep physician every 6 months. Both homecare technicians and parents
must monitor children for periodic changes. Long-term use of a nasal mask can lead to incomplete
development of the face, if it is not used properly. This potential side effect of long-term PAP mask use
may be subtle, but significant. While children’s facial structures alter with age, a mask fit too tightly may
actually impact the craniofacial formation. Nightly use of a nasal mask for PAP therapy in children
should always be associated with regular evaluations of growth of the upper and lower jaw.
In conclusion, the PAP therapy experience can be both successful and pleasant with proper
education, creativity and compliance by the parent and child.
Tips to Help Kids Adjust to CPAP:
- •Try to make it a fun experience. Tell your child that they look like a
super hero or a fighter pilot.
- Try to make them feel special because they have something that
friends do not.
- Let your child hold the mask in their hands and try applying it
- Let your child hold a blanket, stuffed animal or anything they find
- The parent or sibling may try on the mask in an effort to eliminate
the child's fear.
- Apply the mask to a stuffed animal or doll.
- Remind your child that their equipment is not a toy and that they
shouldn't play with it.