Children and Sleep Disordered Breathing

Posted on October 30, 2017 by Dr. Erin Elliott

I assess breathing. Everyday. Every hygiene patient—adult and child. I call it an “airway exam.” So, when I ask parents of young children how they breathe—through their nose or mouth–most of the time they give me a funny look. I’m sure they are thinking, “What does breathing have to do with my kids teeth?”
Breathing is important, as you know, without it we wouldn’t be alive. But most people are unaware that there is a proper way to breath. Breathing through the nose is optimal—you get more oxygen delivered to the brain and tissues, it balances out the gases in your lungs, the air is filtered from germs and it’s warmed and humidified before hitting your lungs.
Chronic oral breathing in early childhood can contribute to poor orofacial growth, crooked teeth, bad bites, tongue thrusting, speech problems and a risk for sleep disordered breathing or sleep apnea. That’s why I am evaluating this in the dental office! Think of your tongue, lips and cheeks as a retainer for your upper and lower jaws. The correct resting position for your tongue is on the roof of the mouth. The upper and lower jaws grow around the tongue position. The lips and cheeks hold the dental arches and teeth in alignment. It’s a balancing act. If the orofacial muscles and tongue are out of balance, such as what we see in mouth breathing when the tongue rests low, the dental arches collapse, the airways become narrow and teeth become misaligned. All the functions of breathing, sucking, chewing, speaking have a critical role in development the first two years of life. Additionally, we know that adults who suffer from sleep apnea are predisposed to the disease because of poor orofacial and cranial development stemming from early childhood. So, how can we help our children early on to optimize orofacial development?
Breastfeeding: Most understand the vast nutritional and immunological benefits of breastfeeding, but many do not know that it also stimulates a baby’s oral muscle and bone development. Breastfeeding requires more tongue and oral muscle activity. The tongue works hard to work like a vacuum extracting milk from the breast. It facilitates the tongue to sit on the palate and stimulates proper growth of the jaws and airway. Furthermore, when your child is old enough (6 months and over), you can lightly steam, finely diced raw vegetables such as carrots and celery. Introducing crunchy hard foods continuously allows more muscle activity and stimulates bone growth of the jaws. Children who enjoy healthier foods early on are not as “picky” eaters.
Non-Nutritive Sucking Habits: Sucking is a normal, instinctive reflex in infants and known to be very calming. However, we don’t want those habits to persist past infacny. Prolonged pacifier use and/or thumb sucking holds the tongue down low. This causes oral muscle dysfunction, mouth breathing, tongue thrusting and bad bites. The growth of upper and lower jaws and airways become affected negatively. Lastly, thumb suckers are more at risk for speech delays and ear infections. If your child is a pacifier user, wean them before they are 18 months. Don’t let them use it during the day and only at night to sleep. Distraction works well when they want it and find other ways to soothe them. A thumb habit can be more difficult. A reward chart works well with frequent prizes such as at the first night, 3 days, 7 days and so on. You can also try a sock over their hand or bad tasting finger nail polish. The older the child, the harder it is to break the habit so the earlier the better.
Breathing: Nasal obstruction is the most common cause of mouth breathing. It’s essential to address and treat any nasal congestion early on, which can be caused by enlarged tonsils/adenoids, chronic sinusitis, allergies and/or deviated septum. Mouth breathing creates a low positioned tongue (instead of on the roof of the mouth), small jaw and airway development, change in tone of the airway muscles, crooked teeth and children can develop long faces. Mouth breathing increases the risk for sleep disordered breathing. Consequently, children with sleep disordered breathing have more symptoms of ADHD, bullying behaviors and suffer academically and socially. If mouth breathing is only habitual, that is they can breathe through their nose well but prefer their mouth, there are some simple exercises you can do at home. Working on the lips to seal, you can blow bubbles, balloons and drink thick liquids through a straw. Set aside time everyday with your child and watch them breathe only through their nose, making sure the tongue rests on the roof of the mouth. This is easy to do while watching a movie or tv. Reminders of nasal breathing is important when you see oral breathing and creating that awareness for your child. Round garage sale stickers can be placed in various locations for reminders for your child to close lips, tongue on the roof of the mouth and nasal breathing.
All dental offices should do an “airway” exam on your child. It’s an easy assessment of breathing such as: checking for airway obstruction such as enlarged tonsils, asking about snoring and sleeping routines, pacifier and thumb sucking habits, behavior at home and school and breathing patterns such as chronic mouth breathing. Your child then can be referred and treated by a specialist such as an ENT, Myofunctional therapist or speech language pathologist. Myofunctional therapists are specialized therapists that treat orofacial muscle dysfunction. It’s all our jobs to care for the total health of our patients–when we know what we are looking for and why. I cannot tell you what an impact it makes on the health of your child and their quality of life for years to come.