Sleep Apnea in Children – The Role of the Tongue

The tongue is intimately involved in the development of the palate, which in turn is directly involved with nasal breathing. Sounds a little confusing? Well not really. If you think about the anatomy of your mouth, your palate is directly below your nose. Still confused? Let’s go deeper into the development of the mouth and nose.

As a fetus develops, it is surrounded by amnionic fluids, and in fact swallows this fluid later in development. As it swallows, the tongue gently touches the palate each time. Why does it touch the palate? Well try to swallow with your mouth completely open. It’s almost impossible. That’s because we need to create a vacuum within our mouths to swallow efficiently. As the tongue touches the palate, it pushes the developing bones upward and outward to help form the palatal bone. This movement in width is what in turn forms the floor of the nasal bone. The width of the nasal bone is directly related to the width of our upper airway!

Why do such a high percentage of premature birth infants (prior to 36 weeks) have sleep apnea? They are born before the tongue has the opportunity to properly shape the palate and many develop a very high, narrow palate. Remember above we said the top of the palate is the floor of the nose. Well a high, narrow palate is similar to the top of a triangle. It is narrow, so the floor of the nose develops very narrow, creating an underdeveloped upper airway.

What about full term birth babies? What are some of the reasons that they can have underdeveloped palates? Some are born tongue tied. That is when a very thin muscle develops attached to the base of the tongue, almost to the tip. This keeps the tongue from touching the palate and therefore hinders the palate from developing, as discussed above. Some have this tongue tied situation into adulthood. Most, though, have this muscle snipped by the pediatrician or a pediatric ENT at a very early age. This is called a frenectomy. If done within the first month of life, it is almost 100% successful. After the first month, not only does it need to be snipped, but it also needs to be cut a little more aggressively or else it has a high degree of recurrence or reconnection.

If we go back to our blog from a few weeks ago, we said that we need to be able to breathe through our noses 96% of the time and from our mouths 4%. If the nose is underdeveloped, we cannot breathe effectively from our noses and therefore are forced to mouth breathe. The more we mouth breathe, the more there are further developmental effects. With the mouth open most of the day and night to breathe, the tongue continues to fail in helping to shape the palate and the face develops longer than usual and there is the typical “long face syndrome” often noted. The nose is long and narrow, the lower jaw also becomes shorter and narrower, following the shape of the upper jaw.

This cascade of failures in facial development will have more severe consequences as we go further in depth in the coming weeks. In the next entry, we will discuss the ultimate reasons that this development most often results in obstructive sleep apnea in children and continues into adulthood.

Call Dr. Scott Danoff, a board certified sleep apnea dentist if you have any questions on this important health issue.

Call 844-44-SNORE or go to http://www.44snore.com .

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Sleep Apnea in Children – What Does It Look Like?

Understanding and recognizing the hallmark signs and symptoms of sleep breathing disorders are of utmost importance if we are going to try to begin to understand the problems that might arise if these go unnoticed.

Mouth breathing or an open mouth can change the shape and appearance of a child's face, and can also lead to a number of health concerns.

-problems with breathing muscles

-underdeveloped upper and lower jaws

-narrow upper jaw (narrow maxilla)

-dark circles under the eyes

-lip or tongue tied

-long narrow facial features

-narrow nose

-convex profile

-mouth breathing and tongue out and forward during breathing

-enlarged tonsils and adenoids

-snoring or heavy breathing at night

-over-eruption of back teeth so front teeth do not touch

-difficulty falling asleep and maintaining sleep

-relatively short stature (height)

There are also behavioral signs of sleep deprived children. These include:

-difficulty sitting still

-difficulty with concentration, focus and attention

-aggression

-impulsivity

-interrupting

-talking out of turn

-hyperactivity

-anxiety

-trouble with literacy

If this sounds a lot like ADHD, it’s because about 25% of those who are diagnosed with ADHD actually have sleep breathing disorders and therefore it is critical to make the proper diagnosis before simply giving your child drugs to treat the behavioral problems or symptoms.

Every child diagnosed with ADHD should be screened for sleep disorders!

Further topics will include tongue tied newborns, palatal development, palatal expansion, tonsillectomy, adenoidectomy, ADHD and each of these relationships with airway development.

Call Dr. Scott Danoff, a board certified sleep apnea dentist if you have any questions on this important health issue.

Call 844-44-SNORE or go to http://www.44snore.com .

Sleep Apnea in Children—A Potentially Critical Medical Condition

Attended an outstanding 3 day program on the latest research and current diagnosis and treatment of newborns, children and young adults with potential and existing sleep apnea in not so sunny (in fact cold and rainy) South Florida this weekend. All I can say is wow!! What a wealth of new knowledge we were presented with, by some of the world’s most prominent physicians and dentists.

Most important facts learned….

1. It’s never to early to be evaluated. In fact, newborns need to be seen by healthcare providers who really understand the critical interrelationship of the mouth, tongue and nasal breathing for the development of the face, head and upper airway.

2. Premature births, prior to 36 weeks, have a 77% chance of developing sleep apnea. Most important reason is that the swallowing reflex begins to develop in utero when the fetus swallows amnionic fluid. The tongue muscle will help develop the palate, which must be of a certain width to allow the nasal bone to create enough space for upper airway development. Upper airway breathing is critical for proper development.

3. Mouth breathing is always abnormal and will affect the development of the upper airway.

4. For optimal health, we are supposed to be able to breathe through our noses 96% of the time and through our mouths only 4% of the time.

5. Snoring in kids is NOT okay! Snoring at any age is annoying, but in children it is clear sign of airway development problems.

Proper screening of all children is critical, but who should do the screening? The vast majority of pediatricians do not yet know or understand the relationship of breathing and development of the face and nasal passages and the potential for sleep apnea. This very well could result from improper development due to blockages which could result in mouth breathing. Mouth breathing is only one of the signs of airway disorders.

Screening should be done by a well trained pediatrician, pediatric ENT, pediatric sleep physician, sleep apnea dentist or orthodontist. Preferable one who is board certified, so you can be assured you are seeing someone who stays up on the latest developments and treatments.

There are many more signs and symptoms to consider and we will continue this discussion in the coming days and weeks. Please follow along for further discussion on this important topic.

Further topics will include tongue tied newborns, palatal development, palatal expansion, tonsillectomy, adenoidectomy, ADHD and each of these relationships with airway development.

Call Dr. Scott Danoff, a board certified sleep apnea dentist if you have any questions on this important health issue.

Call 844-44-SNORE or go to http://www.44snore.com .

The Snoring & Sleep Apnea Center Of Queens & Nassau

We work together with physicians, sleep therapists, and psychologists and collaborate closely to ensure you receive comprehensive care and a treatment plan that works. Based on your own case, we may provide oral appliance therapy to treat your snoring and obstructive sleep apnea.

 

The Snoring & Sleep Apnea Center of Queens & Nassau is covered by most insurances plans. We offer FREE SCREENINGS to see if you are at RISK for Snoring or Sleep Apnea.

Patient Testimonial:

 

Meet Dr. Scott Danoff

Scott Danoff, DMD
Diplomate of the American Board of Dental Sleep Medicine and a Diplomate of the American Sleep and Breathing Academy

Dr. Danoff has double board certification in sleep apnea and is very proud to be a Diplomate of the American Board of Dental Sleep Medicine and a Diplomate of the American Sleep and Breathing Academy. Additionally, Dr. Danoff is the Dental Director of the Snoring & Sleep Apnea Center of Queens & Nassau, an AADSM Accredited Facility and one of only 4 accredited facilities in the State of New York. Dental Sleep Medicine facilities that have earned AADSM accreditation have demonstrated that they meet the AADSM’s high standards of proficiency, professionalism and quality patient care.

Snoring & Sleep Apnea Center of Queens and Nassau

Little Neck Location:
49-33 Little Neck Parkway
Little Neck, NY 11362
Phone: 718-229-0193

Manhattan Location:
1049 Fifth Avenue (at 86th Street) Suite 1A
New York, NY 10028
Phone: 917-750-5058

www.44snore.com