Pediatric Airway Problems

The root of these issues often starts young — from allergies and enlarged tonsils or adenoids to muscular issues like mouth breathing or poor tongue posture. Left unchecked, they can impact your child’s sleep, focus at school, facial growth, and even self-confidence.

The current studies on the lack of oxygen caused by airway issues can have a dramatic effect on a child’s developing brain. Research using MRI technology has shown that children with apnea have visibly altered brains and neuron connections compared to children who sleep well. Many studies are now beginning to correlate sleep disordered breathing in children with behavior disorders, lower school performance and poor cognitive development, among other problems. Furthermore, new research is showing that children who are treated for sleep disordered breathing show significant improvement in these areas.

That’s why we take airway health seriously at Braces520. As the only orthodontic team in Tucson, Oro Valley, and Sierra Vista trained in airway-focused orthodontics, we know what to look for — and how to help.

Signs and Symptoms of Pediatric Airway Issues

Like many health issues, pediatric airway problems exist on a gradient scale of severity. A milder case may just involve some sleep disturbances and occasional mouth breathing, where a more severe case of full-blown Pediatric Obstructive Sleep Apnea may involve dozens of apnea episodes per night (apnea episodes=cessation of breathing). With increasing severity, comes increased symptoms and more long-term negative health effects. Due to the wide range in severities and underlying causes of airway issues, there is a wide variety of symptoms you may observe, as they can affect every child differently. Some children may become obese, others may have trouble gaining weight. Some may have excessive daytime tiredness, others may have hyperactivity and signs of ADHD. You may notice some seemingly unrelated symptoms on this list, such as teeth grinding and bedwetting, but there is actually very clear research linking these symptoms to a lack of oxygen to a child’s developing brain at night.

Here’s some signs and symptoms to look out for:

• Mouth breathing- during the day or at night
• Snoring or loud breathing– NO amount of snoring for a child is normal!
• Restless sleep– Lots of tossing and turning, sleeping in unusual positions, moves around excessively at night, gets very sweaty when sleeping, drools excessively, restless legs, rarely goes into a deep sleep
• Teeth grinding
• Daytime fatigue
• Dark circles under the eyes
• Behavioral issues: Irritability, aggression, difficulty listening, frustration, and anxiety
• Frequent bedwetting
• Sleepwalking or Sleep talking
• ADHD/Hyperactivity during the day
• Frequent allergies, frequent colds, or frequent ear and sinus infections
• Crowded or misaligned teeth
• Narrow jaws
• Frequent night terrors
• Slow growth
• Other cognitive delays or learning delays
• Hard to wake up in the morning
• Needs more frequent naps
• Morning headache
• Poor appetite

If your child shows many of these symptoms, schedule a consultation with us today so Dr. Rosen and Dr. Decker can examine you further and help determine if treatment is indicated.

Treatment of Pediatric Airway Issues

If your child is determined to have airway problems, the treatment depends on the underlying cause. Sometimes, enlarged tonsils and/or adenoids are to blame and may need to be removed. Other times, small narrow jaw dimensions are the sole cause and can be treated easily with orthodontics alone.

Typically, our early intervention treatment (ages 6-11) takes 12-18 months and involves the following steps:

1. Evaluation of tonsil and adenoid size and function
2. Myofunctional evaluation of tongue posture and function and swallowing patterns
3. Expansion of narrow dental arches- typically involving upper and lower expanders
4. Limited braces on some teeth to utilize space created from expansion to get teeth aligned and make room for erupting adult teeth
5. Leaving expanders in place for 9-12 months to allow new bone to fill grow into the new expanded jaw position
6. Removal of all appliances and braces and making retainers to continue to help hold the expansion until they are ready for full braces

If the child is older (11-12 or older) and having airway issues, we typically incorporate an upper expander into their braces treatment, in addition to myofunctional and ENT evaluations and referrals as needed. We do not use lower expanders on older children if they need full braces, as at that age using lower braces with special widening wires placed can serve the same purpose of widening the lower teeth to fit with the newly expanded upper jaw.

Please note: While we can still use an upper expander on children age 11-15 for some airway benefit, expansion is far more effective for airway problems when done at a younger age (ideally 6-9, but up to age 11 or so). Every year the child gets older, the airway improvement from expansion diminishes and the problem is more difficult to correct- Early intervention is key.

Past age 15 or so (depending on gender and skeletal maturity), if the child needs expansion then they may need the much more involved Maxillary Skeletal Expander (MSE) which we also use in our office.