Sleep-Disordered Breathing in Children
Treating pediatric patients involves unique challenges and complications. Because children are especially vulnerable during their formative years, the responsibility to maintain or restore health places an additional burden on clinicians.
Treating pediatric patients involves unique challenges and complications. Because children are especially vulnerable during their formative years, the responsibility to maintain or restore health places an additional burden on clinicians. Therefore, providers must understand the risk factors and therapies that will help ensure optimal oral and systemic health for this population. As evidence of its importance mounts for pediatric health, one area of screening has been drawn into the spotlight: airway patency and sleep-disordered breathing (SDB). This article will examine the ways in which clinicians can offer life-changing evaluation and intervention to pediatric patients affected by SDB or airway disorders.
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Airway function disorders, SDB, and obstructive sleep disorders (OSDs) are characterized by conditions that limit airway function at multiple levels. Clinical symptoms range from obstructive sleep apnea (OSA) and upper airway resistance syndrome to primary snoring (PS). The risks of SDB have become more disconcerting, as studies indicate that even mild cases can have severe behavioral cognitive effects on children. Awareness is key when it comes to avoiding the detrimental effects of sleep disruption, especially due to OSA, which has been linked to somatic growth delay, cardiovascular and central nervous system diseases, and diminished quality of life.
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Screening for Signs and Symptoms
Historically, pediatric exams have involved caries evaluation and control, as well educating the patient and parent/caregiver about proper nutrition and oral hygiene. In today’s practice, screening children for SDB or airway disorders is every bit as important. Recognizing the signs of an airway disorder is a significant step toward a diagnosis that can help a child avoid a lifetime of challenges associated with poor sleep quality (including OSA). Research shows that craniofacial, respiratory, and neurological development—including behavior and learning—can be significantly affected by how well a child breathes, both during the day and while sleeping. Physically, evidence of SDB presents in myriad forms, such as a long and narrow face, habitual open-mouth posture, or venous pooling. Behavioral symptoms might include chronic mouth breathing, hyperactivity, snoring, or bedwetting. In addition, daytime irritability can stem from SDB and OSDs. A short lingual frenulum has also been implicated as a phenotype in pediatric sleep apnea, and has been associated with challenges in speech and sucking, as well as increased risk for maxillary hypoplasia.
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When the signs of SDB are apparent, the child can be referred to specialists, including oral myofunctional therapists, orthodontists, pediatric dentists, child-focused general dentists, pediatricians, and pediatric ear, nose and throat (ENT) professionals. Oral appliances, orthodontia, and surgical treatment of the maxilla and mandible have also been used to reduce the effects of sleep apnea. Oral myofunctional therapists can help evaluate and remedy poor tongue postures or contributing habits, such mouth breathing and tongue thrusting. These therapists are trained to help children learn proper tongue positioning and optimal nasal breathing. Appropriately trained orthodontists, pediatric dentists, and general dental practitioners can help by expanding and protracting retrusive and constricted dental arches, which will result in redirection of impaired growth of both the maxilla and mandible. In addition, ENTs are helpful in evaluating the volume of the airway, and structures that may be impeding it, such as swollen nasal turbinates, tonsils, and/or adenoids. As noted, early intervention can improve a child’s airway during the critical formative years. Proper tongue positioning and eliminating harmful oral habits, ensuring adequate room for the tongue, and promoting nasal breathing can provide lifelong benefits for these patients.
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The seven common signs of SDB include:
- High/narrow palatal vault
- Mouth breathing
- Clenching and grinding or tooth wear
- Enlarged tonsils and adenoids
- Allergic rhinitis or prevalence of allergy symptoms
- Tongue tie and/or lip tie
- Maxillary and mandibular deficiency