Breathing and Airway Development in Children

A child's ability to breathe correctly and efficiently is dependent upon many more factors than respiratory health alone. The lungs may be functioning properly, but if the airway is constricted for a significant length of time during the key years of growth and development, poor breathing habits and even anatomical pathologies may develop.

One of the most common breathing issues many children face is an inability to breathe through the nose. Allergies and chronic sinus infections are the most common reasons that a child might regularly find it difficult to breathe through the nose, but other types of anatomical blockages may also contribute to the problem.

For these children, mouth-breathing is not a choice, but a necessity in order to receive the oxygen they need to survive. The body is remarkably creative in finding short-term alternatives to normal function when necessary, but when these short-term solutions become long-term habits because the underlying factors are not addressed, other pathologies tend to develop. Specifically, long-standing habits of mouth-breathing throughout childhood can have a significant impact on the development of a healthy bite. Narrow arches and a retruded lower jaw are often the result. And in an unfortunate cyclical pattern, those same narrow arches and retruded lower jaw can in turn constrict the airway further and contribute to even more breathing problems like Obstructive Sleep Apnea (OSA).

OSA in Children

OSA is a serious condition that can develop in both children and adults. In short, OSA is caused by a collapse of the soft tissue in the throat that may either constrict or close the airway completely during sleep. A constriction of the airway often manifests as snoring, and a full closure will appear as a period of not breathing often followed by a choke or gasp. Children and adults who suffer from mild to moderate OSA are commonly lacking enough time in the deeper stages of sleep each night. Sleepiness, an inability to concentrate, irritability, and sometimes even mild forms of hyperactivity have all been associated with OSA and other possible sleep disorders. In fact, physicians and parents are now highly encouraged by the medical community to consider OSA or other sleep disorders as a factor in mild to moderate cases of ADHD, and to pursue sleep and airway evaluation in these cases before starting a treatment regimen of medication.

Diagnosis and Treatment

Identifying all the possible contributing factors to your child's breathing disorder is extremely important. Narrow arches and a retruded lower jaw can be fixed with functional orthodontics, but if those conditions were originally caused by mouth-breathing related to allergies that have not been addressed, your child's orthodontic treatment will eventually relapse and OSA conditions may return. Conversely, if allergies or chronic infection have been resolved, but a bite disorder still remains, your child still may still not be able to breathe correctly during sleep. Chronically enlarged tonsils and adenoids are usually another a major contributing factor, especially in cases of OSA. And like adults, obesity in children is dangerous to multiple aspects of overall health, including the ability to breathe at night and during the day.

If you suspect your child might have a breathing disorder, consider the following questions:

•	Does your child snore, gasp, choke, stop breathing, or thrash during sleep?
•	Does your child suffer from chronic allergies or frequent sinus and throat infections?
•	Does you child always breathe through his or her mouth while sleeping or awake?

If you answered yes to any of the above questions, it may be wise to seek an evaluation of your child's airway development. Here's where to start:

Your Pediatrician

This is the best place for you to begin exploring whether or not allergies, sinus infection, or weight issues may be developing into a chronic condition that is affecting your child's ability to breathe. Your pediatrician can also look at your child's throat to assess whether or not the tonsils and adenoids may be a problem.

A Pediatric ENT

If the tonsils and adenoids are chronically inflamed and infected, your child will continue to have breathing problems. A pediatric ENT will be able to help you evaluate whether or not your child should have those removed, or if simply improving “nasal hygiene” by clearing out the nasal passages before sleep (sometimes with the help of a doctor-prescribed nasal spray) may be a more appropriate first step.

An Allergy Specialist or Naturopathic Physician

Environmental allergies and food allergies can both create excess mucus and chronic inflammation that may be contributing to your child's inability to breathe well. Explore this possibility especially if your child seems to be chronically congested without infection.

A Dentist or Orthodontist Specifically Trained in Functional Orthodontic Concepts

All of the above conditions can contribute to pathological bite developments that can further exacerbate any breathing issues your child may already be having. Treating those bite discrepancies in conjunction with addressing any other possible contributing factors is the best way to help your child achieve optimal breathing function at night and during the day.

A Sleep Specialist

Centralized Sleep Apnea (CSA) and other types of sleep disorders are not generally associated with any of the above conditions, but they could be affecting your child's ability to breathe and sleep well at night. A sleep study should be considered especially if your child does not demonstrate any chronic infection, allergies, weight issues, or bite discrepancies during evaluation, or if his or her sleep quality does not improve after treatment is completed in these areas.

References:
American Journal of Orthodontics: Mouth breathing in allergic children: Its relationship to dentofacial development
Pediatrics: Facial development of children who breathe through the mouth
Sleep Medicine: Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up
Sleep and Breathing: Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36-months of follow-up
Pediatrics: Sleep and neurobehavioral characteristics of 5- to 7-year children with parentally reported symptoms of attention-deficit/hyperactivity disorder
International Journal of Pediatric Otorhinolaryngology: Outcome of adenotonsillectomy for severe obstructive sleep apnea in children
Otolaryngology – Head and Neck Surgery: Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children
The Journal of Oral Rehabilitation: The importance of a multidisciplinary approach to the assessment of patients with obstructive sleep apnea

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