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How breathing issues cause chronic health problems in kids

Kathryn Matthews is a New York City-based lifestyles writer, editor and Certified Holistic Health Coach. She has written extensively about food, dining, nutrition, health and travel for numerous publications, including The New York Times...

Sleep-disordered breathing in kids

If you’ve been told that your child has a learning disability, demonstrates aggressive or bullying behavior, or exhibits symptoms of ADHD, social withdrawal, anxiety or depression, sleep-disordered breathing could be the real culprit.
Girl sleeping with mouth open

According to a recent Finnish study, approximately 10 percent of 6- to 8-year-olds have sleep-disordered breathing (SDB), a group of disorders characterized by breathing difficulties that occur during sleep. Unlike adults, where being overweight is associated with SDB, excess body fat was not associated with an increased risk of SDB in this age group.

Finnish researchers found that the risk of SDB increases among children who have the following craniofacial features:

  • Enlarged tonsils
  • A crossbite (a dental condition where the bottom and top teeth are not properly aligned)
  • A convex facial profile (prominent forehead and receding chin)

This is not surprising news to New York-based holistic dentist Dr. Howard Hindin. "Today, our craniofacial features are similar to those of a modern bulldog: We have smaller mouths, larger tongues, misaligned teeth and bigger necks."

The bulldog look may be evident in adult faces, but it starts at birth, says integrative health specialist and dentist Dr. Michael Gelb, co-founder of the Academy of Physiologic Medicine and Dentistry (APMD) and the Gelb Center in New York City.

He offers a historic perspective of facial development. Primitive man had a wider, U-shaped jaw because he ate fibrous (often hard) whole foods that required vigorous chewing. For the last 200 years, but, particularly, over the last 40 years, the changes in our facial structure — narrower faces, narrower palate and overcrowded, crooked teeth in smaller mouths — have not only become more pronounced, but detrimental to our well-being.

Social, environmental and dietary factors have played a role. For example, as women entered the workforce, they were less inclined to breastfeed their children. "Breastfeeding helps shape the structure of a child’s face because the act of sucking helps makes the palate (roof of the mouth) wider, opens the nose and shrinks the size of the tonsils and adenoids," explains Gelb.

Many children today tend to breathe through their mouths because of greater exposure to environmental pollutants and allergens, which pose a constant challenge to their immune system.

Rates of obesity among adults and children have doubled or tripled within four decades, thanks to the standard American diet, characterized by regular consumption of refined flour, sugar and processed food. Women who consume a standard American diet before and during their pregnancy tend to have children with narrow jaws and crooked teeth.

In the same period, pediatric ENT specialists (who focus on the ears, nose and throat) stopped removing tonsils and adenoids, once the standard protocol for children. This is a significant contributing factor to SDB because the tonsils in young children are quite large compared to the size of their throat. Swollen tonsils can block the airway, causing sleep apnea or SDB. "Tonsils and adenoids are at their biggest size between the ages of 2 and 8 — around the same time that SDB peaks in children," says Gelb.

Another U.S.-based study that examined the prevalence of sleep-disordered breathing in more than 12,000 children between the ages of 6 months and 6.75 years found that:

  • 1 to 2 percent of children in this age group suffer from chronic sleep apnea.
  • Children between the ages of 18 and 30 months are especially vulnerable to snoring.
  • By age 6, 25 percent of children mouth-breathe during sleep.

Symptoms of SDB

During the night, does your child:

  • Snore or mouth-breathe?
  • Gasp, snort or actually stop breathing while sleeping?
  • Sweat excessively or sleep in unusual positions?
  • Abruptly awaken during the night coughing or gagging?
  • Bed-wet?
  • Thrash in bed?

According to the National Sleep Foundation, children with SDB may manifest the following symptoms during the day:

  • Difficulty awakening in the morning
  • Excessive daytime sleepiness, or, conversely, hyperactivity
  • Exhibit conduct problems: behavioral, school or social
  • Have headaches, especially in the morning
  • Be irritable, agitated, aggressive and cranky
  • Speak with a nasal voice and mouth-breathe, which is associated with the development of a high, arched palate (upper jaw), an elevated upper lip, and an overbite.
  • Have allergic shiners — dark circles under their eyes.

Sad boyConsequences of undiagnosed SDB

Undiagnosed SDB and obstructive sleep apnea alters the brain, with serious long-term consequences for children, including:

  • Impaired learning and memory, resulting in poorer school performance and lower IQ levels.
  • ADHD, depression, anxiety, social withdrawal, aggression and bullying
  • Increased risk for hypertension, and heart and lung problems

What to do

"Kids who can breathe easily will sleep through the night. Fix their sleep, and you’ll reduce — or eliminate — behavioral and learning problems," says Gelb, who adds, "The earlier you can intervene, the better."

To diagnose and correct SDB, Gelb recommends a holistic team approach that includes a pediatric ENT, a pediatric dentist, an orthodontist and a pediatric sleep specialist.

He also advocates:

  • Breastfeeding children for at least two months.
  • Paying attention to your child’s breathing during sleep; if you suspect SDB, get an early diagnosis.
  • Removing tonsils and adenoids.
  • Expanding the palate (upper jaw) an inch (versus removing permanent teeth).

More on children's health

Are "fat letters" from school harmful or helpful?
Understanding well-child checkups: The whens, whats and whys
Does your child need ear tubes?

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