Airway/Sleep Disordered Breathing
Breathing and Airway Development in Children
Your child’s ability to breathe correctly and efficiently is dependent on many factors. If the airway is constricted during key years of growth and development, poor breathing habits and anatomical abnormalities will almost certainly develop.
One of the most common breathing issues many children face is an inability to breathe through their noses. Allergies and chronic sinus infections are some of the most common reasons that your child might find it difficult to breathe through their nose. Anatomical blockages such as enlarged turbinates, enlarged tonsils, adenoids, or a deviated septum may also be part of the problem.
For these children, mouth breathing is not a choice, but it is a necessity in order to receive oxygen. An example of these children are those that chew food with their mouth open. They are not being rude, rather, they are needing to breathe through their mouth as they are eating since they cannot breathe through their nose. This is important because nasal breathing provides up to 20% more oxygen uptake to the body and brain than mouth breathing does.
If your child has a cold, they will adapt to their situation and will probably only mouth breathe for a relatively short period of time. If it is a chronic problem, however, there will be a significant impact on the development of the face. This includes restriction of growth in the midface causing a flatter facial appearance and a narrow upper jaw. This is usually associated with a small and retruded lower jaw. The combination of these anatomical changes combined with the initial chronic problem contribute to even more breathing problems like Obstructive Sleep Apnea (OSA) or Upper Airway Resistance Syndrome (UARS).
OSA in Children
Obstructive Sleep Apnea is a serious condition that can develop in both children and adults. In short, OSA is caused by a collapse of the soft tissue in the throat that may either constrict or close the airway completely during sleep. A constriction of the airway often manifests as snoring, and a full closure will appear as a period of not breathing often followed by a choke or gasp. Children and adults who suffer from mild to moderate OSA are commonly lacking enough time in the deeper stages of sleep each night. This sleep deficit has multiple impacts on the body.
Physicians and parents are now encouraged by the medical community to consider OSA and/or other sleep disorders as a factor in ADHD, and to pursue sleep and airway evaluation in these cases before starting a treatment regimen of medication (which usually includes stimulants).
Diagnosis and Treatment
Identifying all the possible contributing factors to your child’s breathing disorder is extremely important. Narrow arches and retruded upper and lower jaws can be fixed with orthodontics and/or Orthotropics. If those conditions were originally caused by mouth breathing related to uncontrolled allergies or other anatomical blockages, and the underlying cause has not been addressed, then the orthodontic treatment will eventually relapse and the breathing disorders may return. On the other hand, if allergies and anatomical blockages have been resolved, but narrow and retruded arches still remain, they still may not be able to breathe correctly.
- Consider the following questions:
- Does my child snore, gasp, choke, stop breathing, or move a lot during sleep?
- Does my child grind their teeth?
- Does my child suffer from chronic allergies?
- Has my child had frequent sinus and/or throat infections or ear tubes?
- Does my child toss and turn while sleeping and end up laying in different positions throughout the night?
- Does my child usually breathe through their mouth while awake and/or sleeping? Is their breath excessively smelly on waking? ( a sign of mouth breathing)
- Is my child hyperactive?
- Does my child have behavior problems at school, day care, or at home?
- Is my child still wetting the bed and they are older than 5?
If you answer yes to any of the above questions, then it may be wise to seek an evaluation for sleep disordered breathing. Here’s where to start:
This is the first place to begin exploring if your child has allergies, sinus infections, or weight issues that may develop into a chronic condition that is affecting your child’s ability to breathe well. Your pediatrician can also screen for enlarged tonsils. Just because your child isn't having throat infections does not mean the tonsils are not causing breathing issues. Many pediatricians still do not seem to put all the pieces together when it comes to seeing manifestations of a breathing problem so they may not encourage you to get further treatment if your child has allergies or sinus infections. It is often up to you, as the parent, to recognize that these things are happening and deciding to seek further medical attention for your child.
An Ear Nose and Throat doctor that specializes in airway disorders is one of the most important pieces to our team. Not all ENT’s focus on the underlying causes to the problems and simply treat the symptoms (ear tubes). If the tonsils and adenoids are chronically inflamed and/or infected, your child will continue to have breathing problems. A good ENT will be able to help you evaluate whether or not your child should have those removed, or, if simply improving the nasal passages before sleep (with doctor-prescribed nasal sprays) may be an appropriate first step.
Environmental and food allergies can both create excess mucus and chronic inflammation that may be contributing to your child’s inability to breathe well. In Austin, the Allergy Capital of America, this is often part of the puzzle.
A Pediatric or Orthodontist Specifically Trained in Functional Orthodontic Concepts
Everything talked about thus far can contribute to pathological bite developments that can further exacerbate any breathing issues your child may already be having. Treating those bite discrepancies in conjunction with addressing the underlying contributing factors is the best way to help your child achieve optimal breathing function at night and during the day.
A Pediatric Sleep Specialist
A sleep study should be considered especially if your child does not demonstrate any chronic infections, allergies, weight issues, or bite discrepancies during evaluation, or if their sleep quality does not improve after treatment is completed in the other areas. Centralized Sleep Apnea (CSA) is generally not associated with the above conditions, but it could still be affecting your child’s ability to breathe and sleep well at night.
If you feel your child has trouble breathing or you were able to answer any of the questions above please give us a call today to schedule a consultation. (512) 346-1283