Children and Sleep-Related Breathing Disorders
Sleep apnea and sleep-disordered breathing (SDB) are life-threatening medical conditions that we typically associate with adults. What many people do not realize is that children suffer from SDB and that it can have serious effects on their health and development.
SDB results in a lack of airflow and oxygen while we sleep. This puts stress on our body and disrupts our brain from getting the benefits of uninterrupted sleep. SDB in children can result in delayed growth, chronic allergies, poor performance in school, and other medical issues. With nearly 40 million children affected, SDB in children is truly an epidemic.
The key to understanding how to help children with sleep-disordered breathing is to recognize some of the major signs and symptoms. The more of these that your child exhibits, the greater the chance they are suffering every night from a lack of oxygen.
Snoring, Mouth Breathing, & Apnea
Humans are designed to breathe through our noses. It cleans the air for our lungs, releases nitric oxide in our body, and better regulates our breathing.
An obstructed airway prevents the normal flow of oxygen to our lungs. As we work harder to get air in, the tissues in our airway start to vibrate, resulting in a snore. It is estimated that up to 27% of children are habitual snorers. When a child cannot breathe through their nose, they resort to mouth breathing. The downside is that mouth breathing gives us poorer quality air, and can actually make it harder to breathe.
Think of it this way. A child’s airway is normally the size of a McDonald’s straw. When they open their mouth just half an inch, the airway shrinks to the size of a coffee stirrer. Imagine trying to get enough oxygen at night through an airway that small.
And in some cases, children actually stop breathing completely (apnea) at night. This prevents the child from getting any oxygen at all. In adults, we consider it “normal” for this to happen up to 5 times an hour. If this happens even once an hour in children, it is considered abnormal.
Snoring, mouth breathing and apnea is NEVER normal in children. And it is not something that they will “just grow out of”.
Grinding Their Teeth
Another red flag of SDB in children (and adults) is bruxism or clenching/grinding of the teeth. Grinding is thought to be your body’s natural defense to an obstructed airway. When the brain detects lower oxygen levels, it sends signals to the muscles of the airway and jaw to activate. Clenching our teeth is an attempt to stiffen (and therefore open) the airway. Grinding our teeth tries to pull the tongue off the back of our throat, and widen the airway to help get more oxygen to our lungs.
Grinding your teeth can result in headaches, pain in the jaw joint, and damage to the teeth. So if you hear your child grinding their teeth at night, or notice that their teeth are getting smaller, starting looking for other signs of SDB.
Swollen Tonsils & Adenoids
A narrowing of the airway in children is usually due to a lack of space. The tonsils and adenoids, especially when inflamed, can be the main culprit in blocking the airway and nose. And to make matters worse, if a child breathes through their mouth, they take in poor quality air. The tonsils then have to filter the air, making them even more inflamed. The good news…many of the problems with SDB can be improved when the tonsils and adenoids are removed!
Typically, children are fully potty trained by 5 years old. Sleep-disordered breathing is linked to chronic bedwetting in kids. With SDB, the hormones that control urine production and the urge to go to the bathroom are out of balance. Over 1/3 of all children who snore, and almost half of children with apnea, wet the bed. And when the SDB is finally treated, the majority of children are able to sleep the whole night without having to go to the bathroom.
If a child seems to be exhibiting “typical” ADD/ADHD behaviors (hyperactivity, inattention, etc.), the first thing parents and doctors should be looking for is sleep-disordered breathing. It is well established that SDB is associated with neurobehavioral problems like ADHD. Researchers think that disrupted sleep and the lack of oxygen chemically changes part of the pre-frontal cortex. This part of our brain is responsible for behavior, decision-making, and the ability to focus (among other things).
A study of 11,000 children over 7 years found that those with signs of SDB (snoring, apnea, mouth breathing) were up to 60% more likely to have behavioral difficulties by 4 years old. By age 7, children were up to 100% more likely to have these behavioral issues. The more severe the symptoms, the worse the behaviors were.
Research suggests that SDB can lead to academic difficulty and poor learning ability. Another study showed that children in the bottom 25% of their class were more likely to have snored during early childhood.
In fact, the link between SDB and ADHD is so strong, that a 2014 study recommended that “Treatment of comorbid sleep-disordered breathing should be considered before medicating the ADHD symptoms if present”. Or said another way, get your child to breathe better at night before giving them medication!
These are just a few of the signs and symptoms of sleep-disordered breathing in children. Recognizing these will help you get your child the treatment they need to live a healthier life. Talk to your dentist and pediatrician about what can be done to help.