Dr. Kim Discussion: The Impact of Obstructed Airways in Children

Hi, this is Dr Kim, I wanted to talk a little bit about children’s airways and why it’s so important for awareness to be made the American general association is taking a huge initiative on children’s airways. A lot of this falls on the pediatric dentists because we see children so young and we can make a difference before there’s a problem.

We know that obstructive sleep apnea in adults actually started with mouth breathing early in life.

Because of this knowledge, we can intervene at the first sign of an airway issue which is really an issue with growth and development. It can make a huge difference in the quality of life of a child. The literature is now very clear that sleep-related disordered breathing can have a damaging consequence on a child’s craniofacial growth and development. Interrupted sleep can affect children’s behavior, learning, brain development, heart function, and can even lead to the incorrect diagnosis of ADHD.

Early signs of an obstructed airways in children are some of the following:

Obstructed airways in children actually is an issue of underdeveloped growth

mouth breathing

narrow maxillary arch

dental crowding

a gummy smile

a deep bite bites that come together and cross either in front or in the back

restricted tongue

low tongue position

poor lip seal

So what does the tongue have to do with anything? Well, when the tongue is resting in the roof of the mouth that is what actually causes your upper jaw to go wider and forward which is what we want. When the tongue is down low in the palate or down low in the floor of the mouth, the big buccinator muscles your cheeks, they push in every time you swallow which can be 2000 times a day. If that tongue isn’t resting up on that palate then those cheeks win every time and that arch narrows and it causes dental crowding.

Also, when that tongue is low, it directs the growth of the lower jaw and causes that lower jaw to grow backwards. When the tongue is up in the correct resting position on the floor and the roof of the mouth where it should be, the lower jaw goes forward so now you have an upper and lower jaw that are growing wider and forward so your airways are growing wider and forward.

We know now that the floor of the nose and the roof of the mouth are the same bone. So when that arch is wide and forward, we have great nasal passages with little airway obstruction in the nose. If we have a narrow arch and a high palate, we have a much constricted nasal cavity with restricted nasal airflow. This makes it harder to breathe through your nose and a child will revert to mouth breathing.

There are other things that can cause mouth breathing as well, not just tongue position.

This includes big tonsils and adenoids, allergies or many other things. Make sure the nose is open when dealing with allergies. If there’s a huge obstruction with tonsils and adenoids then you need to see an ENT ( Ear, nose, & throat Dr.)

A lot of things can be treated by getting in there working on nasal hygiene and working on great tongue position. That can be done through an exercise called myofunctional therapy.

It’s kind of a new word that most people haven’t heard of but a myofunctional therapy is either it’s therapy given by a hygienist or maybe by a speech-language pathologist with special training and oral motor muscle. We have a wonderful Myofunctional therapist on staff at our office that can help with this.

There are three things that need to happen in nasal breathing:

1. Open nasal passage

2. Correct tongue position. which is up in the roof of the mouth

3. Proper lip seal

When kiddos sit with their lips open at rest, that means their tongue is down. If they’re sleeping with their mouth open at night or doing any mouth breathing, then we know that tongue is down. The tongue should be glued up and out of the airway at night so that you can breathe properly

Kids that nasal breathe, sleep better. Kids that mouth breathe don’t sleep as well as and they get their sleep cycles interrupted.

When kids get their sleep cycles interrupted, you see things like behavior change, wetting the bed, moving all around, bad neck positions, and poor memory. Whole-body growth is also affected. Your growth hormone is released during the deep sleep state so, when you get those sleep states interrupted in children there is a ripple effect of these symptoms.

Adults will have more full obstructive apnea when their tongue falls back. They aren’t as excitable to breath as children are so, adults will stay sleeping and they’ll obstruct completely and their oxygen saturation will go down. They’ll completely stop breathing and then they wake up, right? Children don’t do that. They most often don’t completely obstruct. The tongue falls back as soon as their bodies realize it, they get into this little panic state called a sympathetic state. They have micro-arousals and don’t really open their eyes and wake up but, their brains wake up and it interrupts that sleep cycle. After sleep is interrupted, you don’t just enter right back where you were, you have to start all the way back to the beginning of your sleep cycles each time. As a result, you aren’t getting that growth hormone release.

As pediatric dentists, we can see a lot of early signs of airway obstructions. I like to say that we can see kids when there’s just a little bit of smoke, then when they are adults they’re completely on fire they have to be on a CPAP. They have full sleep apnea.

In kids, we can see these little signs of an airway issue..and boom if we intervene then we can prevent all the crazy things from happening later down the road.

• How are they sleeping?
• How is their tongue position?
• Is their speech impeded?
• Are there feeding issues?

That’s why we’re asking all these crazy questions and that’s why it’s important to know how your kid breathes.

If you have any questions, please let us know by filling out our contact form or calling 832 521-9024

Read our next blog about understanding lip tie or understanding tongue tie.