Pediatric Development of Airway

Pediatric Development of Airway

Did you know that the American Academy of Pediatrics recommends any child who snores have a diagnostic sleep study? It is not normal for your child to snore and snoring alone can cause delays in cognitive development.

The human body requires an uninterrupted flow of oxygen to fully develop and rejuvenate from the previous day’s activities. Growth hormones are released during deep sleep thus making it essential to have proper breathing to prevent impaired or delayed development.

In 2012 the American Academy of Pediatric Medicine established a  “CLINICAL PRACTICE GUIDELINE” regarding sleep. This directive suggests that all pediatricians who find a particular sleep issue with any of their patients should follow the academy’s guidelines as outlined. The following statements are the first two directives for children who present with sleep-disordered breathing problems.   

Recommendations for the diagnosis of OSAS:

• All children should be screened for snoring.
• Complex high-risk patients should be referred to a specialist.
• Patients with cardiorespiratory failure cannot await elective evaluation.
• Diagnostic evaluation is useful in discriminating between primary snoring and OSAS, the gold standard being polysomnography.

This is very informative because it suggests that any child who makes noises, such as snoring or even grinding of their teeth, should be considered for sleep-disordered breathing. Unfortunately, this directive is poorly followed by pediatricians.  Many parents have detected that their children have sleep issues oftentimes before the pediatrician does.  It is important to understand that an early diagnosis of these issues can be valuable in treatment.  This early intervention can thwart the normal trajectory that these airway problems can cause.  As we engage in “orthopedically redeveloping the airway” of these children, we can assist in preventing these problems from being present in adulthood.  By redeveloping the architecture of the airway it will allow proper air movement through the nose into one’s lungs.  This allows for proper nasal breathing and avoidance of mouth breathing.  To be clear, it is not normal for a child to mouth breath while asleep or awake and this symptom alone can suggest many concerns for the growth and development of a child.

Many symptoms that might occur in children that have airway issues might include:

• Delayed development
• Impaired intelligence
• Memory loss and depression
• Weight gain and obesity

A common problem that is present with these sleep issues is something called Sleep Apnea or Obstructive Sleep Apnea (OSA).  It is interesting to note that there is a 70% overlap between snoring and apnea in children.  It is my belief that apnea for adults starts when they are in their youth.  Certainly, there are other factors that can influence OSA such as weight gain but my thoughts are focused on the structural changes that are occurring as children are developing.  One activity that influences the architecture of our mouth is mouth breathing.  It has become an epidemic in our day and age.  The evidence is clear that the oral volume of our mouths is becoming smaller.  These changes are not evolutional because they have only developed over the last several hundred years.  The underdeveloped maxilla can cause our tongue to live in the back of the mouth instead of the palate where it should normally reside.  As the tongue finds its way back to the oral pharyngeal area, it can impede our ability to receive air which can cause apnea or cessation of breathing.  The backward movement of our tongue is a result of the oral environment getting smaller as a result of structural changes.  One interesting point about OSA is that it is a nocturnal activity and does not occur when we are awake.

Sleep can also result in behavioral issues related to:

• Decreased performance/learning problems in school
• Hyperactivity
• Aggressiveness
• Social isolation, withdrawal

At the TMJ & Sleep Centre, our focus is to structurally redevelop the airway using orthodontic appliances.  One difference that sets us apart from others is we try to develop the oral environment in 3 dimensions.  As this redevelopment occurs we have seen apnea in children reduce.  The late Dr. Christian Guilleminault, MD, who many consider the pinnacle of sleep medicine,  suggested that the primary goal of airway treatment for children is to have them become nasal breathers.

Monitoring your Child

• Does your child wake in the morning in the same position they went to sleep in?
• In the morning, are your child’s bed sheets nicely placed or strewn all about the bed?
• Does your child have dark circles under their eyes?
• Does your child seem inattentive?
• Does your child grind their teeth at night?

In addition to snoring, other symptoms might include:

• Tooth grinding
• Mouth breathing
• Restlessness during sleep
• Sleeping in odd positions
• Periods of not breathing
• Night terrors
• Recurrent ear infections
• Night sweats
• Mood changes
• Poor concentration
• Bed wetting
• Headaches
• Frequent infections