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Snoring and sleep-disordered breathing
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SnoringChoose any
SymptomsChoose any
ExamChoose any
PlanChoose one
Additional treatmentChoose any
Follow-upChoose one
Follow-up (no referral)Choose oneNot in the note with these choices
Counseling
Snoring with pauses or labored breathing can disturb sleep and affect daytime behavior, attention, and growth. Removing the tonsils and adenoids helps most children with sleep apnea and enlarged tonsils. Recommended supportive care with an emphasis on a regular sleep schedule and treating nasal congestion. Return precautions given including breathing pauses with color change, severe breathing trouble during sleep, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
CounselingNot in the note with these choices
Snoring without pauses, gasping, or daytime problems is common and usually does not need testing. Recommended supportive care with an emphasis on a regular sleep schedule and treating nasal congestion. Return precautions given including pauses in breathing, gasping, labored breathing during sleep, new daytime sleepiness, behavior, or school problems, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
What the sources cover
- Screen for snoring
- Table 2 history (plus irritability)
- Table 2 exam
- PSG or refer to sleep specialist or ENT
- Primary snoring; watchful waiting for mild OSA
- Adenotonsillectomy first line
- Weight loss if overweight
- Intranasal steroid for mild OSAS when surgery isn't planned