Children, Airway, Snoring and ADHD
I was at meeting of a group of physicians, dentists, speech and physical therapists, other health care providers and the public that works to educate and provide integrated care for children and adults. The focus of the meeting was airway and how it impacts the health and development of children.
“What is airway?”
- Airway refers to the passage by which air reaches the lungs.
- The issue is that airway can be affected by anatomical issues like large adenoids and tonsils or a deviated septum, congestion, allergies, asthma and a narrow jaw. All these things contribute to a change from healthy nasal breathing through your nose, to mouth breathing. Mouth breathing is not as efficient because of the way the air flows.
“Why is airway important?”
- Quite simply, your airway and the shape of it or anything that interferes with it, prevents good breathing and the flow of oxygen to the lungs, and therefore, the brain.
- Many children (and adults) who have problems breathing due to allergies or large tonsils and adenoids may snore at night – a sign that their airway is interrupted. Some even have apnea, a situation where the breathing stops for up to a minute at a time, many times throughout the night. The stops in breathing lead to poor sleep.
- Consider what happens to a developing child’s brain if there are regular interruptions in oxygen. Snoring in children has been associated with problems in memory, language and poor academic performance.
- The American Academy of Pediatrics thinks airway is so important that they have issued new guidelines for screening children and adolescents for snoring at routine visits.
“What does any of this have to do with ADHD?”
- ADHD (attention deficit hyperactivity disorder) in children is characterized by impulsivity, hyperactivity and difficulty focusing.
- If a child is not sleeping well because of problems with their airway (or any other reason for that matter) they will be tired. A sleepy child acts different than a sleepy adult. Adults who are tired become withdrawn, and quiet and consider taking a nap. Children, on the other hand, try to keep themselves awake! To do this, they try to move around a lot, seem impulsive or talk to themselves to stay awake. Many doctors believe that children are mistakenly diagnosed with ADHD when really they are suffering from sleep apnea and are just tired.
“What are the signs that my child may have an issue with their airway?”
There are both medical and physical changes that may occur with airway issues.
Medical
- Allergies or asthma
- Snoring
- Large adenoids or tonsils
- Bedwetting
- Hyperactivity
Physical - because breathing uses so many muscles, visible physical changes are common, many related to tooth and jaw position.
- Narrow upper arch
- Long, narrow face
- Poor tongue posture
- Crossbite
- Small, poorly developed nostrils
- Gummy smile
- Open mouth posture (anterior open bite)
- Short and turned up upper lip
"What do you do to treat airway issues?”
- Removal of adenoid and tonsils helps resolve about 90% of the issues.
- Speech and myofunctional therapy that retrain tongue position and encourage nasal breathing.
- Orthodontic intervention that expands the jaw and the airway.
- Medication to treat allergies or asthma
The most important step in this process is diagnosis. If you suspect airway issues in your child, see their pediatrician, an ear-nose-throat specialist or a dentist who understands airway problems. Remember to be an advocate for your child. You know them better than anyone else so it is your responsibility to find a professional who understands and can help you.
Steve
2:22 pm on Tuesday, October 16, 2012
Thanks for posting this. We just took my 2 year old son to his allergist because he is having problems breathing at night.
Dr. Allison M. Adams
5:13 pm on Thursday, October 18, 2012
Hope things go well with your son. Please let me know if there s anything I can do in terms of answering questions or giving you referrals, if needed.
Steve
9:40 am on Friday, October 19, 2012
To help relieve my son's stuffiness we were instructed to flush his nostrils with saline and we have an Rx for a nasal mist. Then we are to report back in 2 weeks on any changes.
I am just hopping my son did not inherit my airway and small mouth. In order to prevent over crowding in my mouth I had 4 bicuspids and 4 wisdom teeth removed. I was diagnosed with very bad sleep apnea about 5 years ago. After having my uvula, tonsils removed and my deviated septum repaired I went down to mild apnea. I sleep on my side now and I don't require a CPAP. I did not realize how how much sleep I was missing and how much better I felt during the day after the surgery.
My ENT is in the Newark area but I may need an ENT referral for my son in the Hillsborough area.
Dr. Allison M. Adams
10:09 am on Friday, October 19, 2012
Steve, Sounds like your allergist is doing what's right - offering a conservative approach to the situation to see if it just nasal congestion that is causing the breathing problem.
However, genetics trumps a lot and it is possible that he inherited your airway anatomy. The great news is that we are doing less extractions of bicuspids and more expansion of the jaw to create room for all the teeth so your son is not necessarily destined for apnea. Palatal expansion through routine orthodontics also creates expansion of the nasal airway to help improve breathing in children.
Glad to hear that you've made progress with your apnea. It is amazing how many people I see with exactly the same problem. A history of having teeth extracted which inevitably leads to a smaller mouth with less room for tongue space and many times a lower jaw that is too far back. All these things contribute to apnea.
I don't have anyone in Hillsborough, but have some fantastic ones in the Morristown/Summit area. Email me if you need help: drallison@adamsdentalnj.com
Jeff
6:06 pm on Thursday, October 18, 2012
What meeting was it? It sounds like a very progressive group.
Dr. Allison M. Adams
10:11 am on Friday, October 19, 2012
AAPMD - American Association of Physiological Medicine and
Dentistry. It was started by a group a dentists who were treating TMJ and sleep apnea issues in adults who realized that diagnosis and action in children at risk was the best way to avoid issues as an adult. http://www.aapmd.org/
Thomas Harrigan
8:32 pm on Thursday, October 18, 2012
Parents, if you read this, please know that ADHD is a ploy for doctors and drug companies to make money. In a lot of European countries, ADHD diagnosis is very rare, because instead of drugging the child, thus sedating them and turning them into a different and less individual person, the solution is to take away stimuli that make the child hyperactive, such as too much video games and TV, too much food coloring and high fructose corn syrup in their genetically modified food(which is illegal in most of Europe because we don't yet know the full effects), and especially not enough and/or low quality attention from their parents.
Dr. Allison M. Adams
10:22 am on Friday, October 19, 2012
Thomas,
You'll notice that I stated "Many doctors believe that children are mistakenly diagnosed with ADHD when really they are suffering from sleep apnea and are just tired."
There are so many factors that contribute to a child's behavior and I think it is worthwhile to evaluate as many of them as possible before making a diagnosis. Certainly, with all the research being done about the importance of sleep, ensuring that your child sleeps properly should be one of the first things looked at when faced with an impulsive, distracted child. Imagine if sleep were the issue and medication could be avoided - how wonderful would that be! Also, because children are different than adults in both their behavior and their anatomy, finding a pediatric sleep physician is ideal.
Any diagnosis of ADHD, sleep apnea or any other medical disorder, must be made by a physician so that should be the starting point with any issue.
clyde donovan
10:31 pm on Friday, October 19, 2012
I've always wondered if wild, out-of-control children are, in most cases, the result of incompetent parenting and not ADHD.
Dr. Allison M. Adams
8:55 am on Saturday, October 20, 2012
Clyde,
I can assure you that behavioral differences exist in children because they are unique. As a parent of three, it is evident to me that innate qualities, behavioral characteristics and personalities are present that have nothing to do with my parenting skills. We could talk about nature vs. nurture forever.
What I do know is that most parents who are struggling with a child's behavior, whether it is formally diagnosed or not, are doing everything they can to help that child. They need encouragement and a support system from family, schools, and health professionals.
SZ
9:44 pm on Tuesday, October 23, 2012
Thank you Dr. Adams for providing "informed responses" to both Chris Bacon and Thomas Harrigan regarding their "misinformed comments" regarding ADHD/behavorial issues. As a parent of children with ADHD, I can tell you that none of my children were wild or out of control. Their combined struggles included attention issues, fidgeting, impulsivity, organizational difficulties, social issues, etc. While medication does help them focus to do school work, it is only one component of a treatment strategy. Healthy food, exercise, therapy, and, as you mentioned, a positive support system from family, schools and health professionials are all components of a treatment strategy. There can be serious implications that result from children with ADHD not receiving the proper treatment and more efforts are needed in our communities to educate and create awareness.
Dr. Allison M. Adams
5:35 pm on Wednesday, October 24, 2012
Chris - apologies to you - I don't know why I thought your name was Clyde.
Dr. Allison M. Adams
5:40 pm on Wednesday, October 24, 2012
SZ,
Sounds like you are doing your best with your children. I talk to parents every day who are struggling to find the "perfect solution" to their children's behavior, only to find out that it doesn't exist. The uniqueness of children forces us to develop lots of different solutions. The more we work as a community to help and encourage children, regardless of what their diagnosis is, the better their futures will be.