Is Your Child Mouth Breathing or Snoring?

The question of mouth breathing or snoring in children is a hot topic.Debated widely among dental, orthodontic and medical professionals, many parents feel confused about how to best help their child.Mouth breathing, snoring and obstructive sleep apnoea syndrome (OSAS), as it’s technically known, are worsening problems in developed countries.The science behind these disorders in children is quite compelling.  Often related to a sedentary lifestyle and unhealthy diet, in a developing child, there are both short and long term effects.In the short term, a child’s craniofacial structures, teeth, and whole body posture may be affected.Long term, there is evidence to suggest a lack of oxygen to the brain can lead to frequent night awakenings. In turn, this can also lead to attention deficit and hyperactivity. A child may fall behind at school. Their skeletal growth may be affected. Long term, the chance of cardiovascular problems increases. The risk of hypertension, stroke and heart attack in adulthood increases too.All of this sounds really gloomy, doesn’t it?Conflicting science, alarmist advertising by product manufacturers, and personal (often financially-driven) agendas are not helpful.My preferred approach to any condition facing a parent is to provide a balanced appraisal, together with a range of solutions.That’s the purpose of this blog, so let’s dig in a little deeper.

What is Obstructive Sleep Apnoea Syndrome (OSAS)?

Obstructive sleep apnoea syndrome (OSAS) is defined as a disorder of breathing during sleep.  It occurs when part of the upper airway is obstructed for a prolonged period or when the airway is completely obstructed (obstructive apnoea) intermittently during sleep. Disruptive to breathing, the condition also fragments a child’s sleep patterns causing negative consequences to their cognitive and skeletal development.While snoring is common, and for the most part quite harmless in kids, more severe snoring can be linked to attention deficit and hyperactivity. A child’s physical development can also be impacted negatively.Signs your child may be suffering from sleep apnoea are:

• Loud snoring
• Pauses in breathing
• Restless sleeping, including nightmares, sweating and sleep walking
• Mouth breathing
• Fatigue
• Bed wetting atypical for the age
• Mood swings
• Headache, nausea and vomiting
• Difficulty paying attention.  

Bear in mind, not every child who presents with these symptoms is suffering from sleep apnoea.Consider these figures:An estimated 3 to 25 percent of children are habitual snorers and between 1.2 and 5.7 percent of the general paediatric population present with OSAS. That is a relatively small percentage. Add to this general presentation, mouth breathing and sleep disorders occur most commonly between the ages of 2 and 8 years of age.If your child has some of these symptoms, don’t panic. Just make a time to investigate further and obtain more information. Early diagnosis is key to avoiding development of long term issues.

What Causes Mouth Breathing and Sleep Disorders?

Mouth breathing and breathing related sleep disorders are generally thought to be caused by allergies, anatomical or obesity related issues. They are are also associated with weak muscles or low muscle tone.These conditions are characterised by upper airway collapse during sleep. There are various reasons for this: large adenoids (tonsils), anomalies in the structure of the face or cranium (the part of the skull that encloses the brain), weak muscles or low muscle tone, and obesity.A study published in the European Journal of Paediatric Dentistry suggests mouth breathing and “sleep-disordered breathing” occur in children who are either, slim and suffer from allergies or are obese.

How Are Mouth Breathing and Sleep Disorders Treated in Children?

In my professional opinion, the best way to treat mouth breathing and sleep disorders is by engaging a multidisciplinary team of specialists. This team might include a dentist, orthodontist, ENT specialist, speech therapist, allergist, and paediatrician.There are many causative factors to mouth breathing and sleep disorders and this is why the solution needs to be tailored to the cause. For this reason a multidisciplinary team is required.Only then will a complete picture be clear of what is needed to address the physical and behavioural causes.In the past, typical treatment has been the removal of adenoids and tonsils.However, as science and practice has advanced, other options have been explored with each yielding variable results.Nasal continuous positive airway pressure (nCPAP) is a non-surgical option for children with OSAS, but the jury is out on how effective this is.Based on scientific results, some suggest the results from CPAP are negligible. It is even suggested PAP could have negative consequences in children. Other articles suggest it is well worth the effort.Regardless of where you sit in your level of support for surgery and CPAP, there is a need for alternative solutions. Depending on the cause of the breathing disturbance, certain orthodontic treatments can help. Therefore, it is important to seek an early orthodontic assessment to get the correct diagnosis and treatment plan. When consulting an orthodontist, he or she may recommend one of the following to assess your child:

• An overnight attended, in laboratory sleep polysomnography (PSG) study, which allows the child’s sleep and breathing patterns to be observed
• Oximetry studies performed during sleep, which measure the level of blood saturation in oxygen during sleep, although these are shown to be less effective when used with children
• Respiratory polygraphy (RP) studies, performed in a laboratory or at home (less expensive)
• Completion of a sleep questionnaire, completed by the parent
• A physical examination by the orthodontist, which records, subjective symptoms and clinical historial or behavioural and cognitive problems. The orthodontist will assess the child’s facial features, width of the airway and palate as well as position and size of the jaws and teeth. If the upper airway is deemed to be narrow or the lower jaw small and backwards positioned an orthodontic solution maybe all that is required.

Studies (and practice) have shown orthodontic expansion of the upper jaw widens the upper airway and can be a very successful treatment for kids with OSA. Other growth modification techniques where the lower jaw is advanced forward using oral appliances can also help.These treatments are best carried out in the growing child and thus it is imperative that an early orthodontic assessment is made. As I mentioned above, the ideal solution for a child’s specific needs will be determined when all causative factors have been considered. If you are concerned your child might have an issue with mouth breathing or is suffering with a sleep disorder, take steps to get informed.A visit to the orthodontist, who specialises in dental and facial development in children, will help place you on a pathway to an ideal solution.Dr Sarah Dan is an orthodontist and an advocate of early interceptive assessment to help improve treatment outcomes for children. Through her experience as a clinician and having orthodontic treatment herself, Sarah truly understands the orthodontics from the patient’s perspective. She ‘gets’ it and has developed her unique 5-Step Process to help patients navigate the treatment journey to a confident, beautiful smile.