Sleep disorders in kids
Parents, you are usually the first-line persons to recognize that there a potential problem with your child in almost every area of your child’s life! Sleep disordered breathing (SDB) includes snoring, upper airway resistance syndrome (UARS), obstructive sleep apnea (OSA), and obesity hypoventilation syndrome. OSA is a condition in which the tongue, tonsils, or adenoids completely obstruct the airway for 10 seconds or longer more than once per hour during sleep for children. And OSA may be overlooked by medical professionals — dentists and medical doctors — because the symptoms may not be recognized, and the seriousness of the health consequences of undiagnosed OSA may not be well known to the examining doctor.
Children experience UARS more often than OSA, and this condition is usually caused by airway interferences. It is experienced by children with an airway that is more prone to collapse due to abnormal airflow when they inhale or when they exhale. With UARS, there is not a complete airway obstruction as in OSA, but the condition causes fragmentation in the child’s sleep as well as activation of the “fight or flight” response.
Some of the symptoms to look for in children are:
• Forward head position which helps open the airway
• Long, narrow face
• Dark circles under the eyes
• Wiggly, hyperactive, poorly behaved child
• Difficulty following directions
• Constant nighttime snoring and tooth grinding
• Mouth breathing at night and/or during the day
These children are very high risks for:
• Misdiagnosis of ADHD
• Social problems
• Poor performance academically
• Low attention to any task
• Behavioral problems at home and at school
• Anxiety and/or depression
• Altered brain function — delayed processing
• Trouble completing schoolwork
• Poor grades in school
The big tip-off is mouth breathing. Another is waking up gasping. If your child is a mouth breather or snores, he or she should have a formal sleep study, since the consequences of an untreated sleep disorder are so drastic.
When the child breathes with the mouth closed, the tongue is on the roof of the mouth 10-15 times a minute all night long helping to cause the upper dental arch to be expanded properly from birth onward. If the child breathes with the mouth open, the tongue is on the floor of the mouth and the pressure from the cheek muscles will cause the arch to be too small, resulting in crowded teeth, need for orthodontics, and a lifetime of OSA and the health consequences. The child may use “binkie,” thumb, or finger sucking to reposition the tongue out of the airway to get more air.
Wear on the primary teeth is the easiest to detect. The child may grind the teeth at night to help open the airway; this grinding helps to pull the tongue forward off the airway. Grinding when the child breathes through the mouth is destructive to the teeth, since the mouth is dry and there is more friction on the teeth. These teeth need to be built up until the permanent molars are fully erupted or the child will have “short” teeth and a reduced vertical dimension, resulting in reduced room for the tongue. Also, chronic dry, chapped lips are another tip-off that the child is a mouth breather. These conditions can lead to OSA.
Tonsils and/or adenoids may be the cause of mouth breathing, with adenoids causing more trouble. This is because they cannot be seen as easily as the tonsils and may be overlooked by health professionals. Therefore, an endoscopic exam should be done on any child with these problems. Frequent enlarged tonsils, frequent sore throats, and frequent ear infections are also indications that tonsils and adenoids should be ruled out as the cause of mouth breathing.
If the tonsils and adenoids are the main problem, removal may be the best choice you should make with the medical doctor. This will facilitate the proper use of the tongue muscle during breathing. The goal here is to get the child to breath with the mouth closed, which will position the tongue on the roof of the mouth to help with ideal growth of the child’s midface. If the problem is the tonsils or adenoids and one waits until about the age of 7 to remove them, the effect of the removal may not be ideal. At that time, after removal, a palatal expander placed by a dentist or orthodontist can help give the tongue its proper room and help in development of the dental arches. This can help the child avoid UARS and OSA in the future.
And after removal of the tonsils and adenoids, you may find yourself saying, “We have a brand new child!”
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Dr. Donald Johnson founded Northwest Treatment Center for Snoring & Sleep Apnea in Coeur d’Alene to help patients stop their snoring and live free with no limits! His office is at 114 W. Neider Ave. in Coeur d’Alene, near Costco. The website for more information is www.NWSleepDoc.com and the office phone is (208) 667-4551. Schedule an appointment today!