Breathing and Airway Problems in Children
The little 5 year old boy in the reception room looked tired and had dark circles under his eyes. He was sitting next to his mom looking at a book, but he seemed lethargic and sleepy. When I escorted his mom and him into my treatment room, I noticed he was not looking around or exhibiting any interest. He got into my chair without any coaxing, but would not look at me. When his mom tried to engage him he didn’t really look at her either. I tried my usual tricks of “show, tell, do” to familiarize him with my mouth mirror, suction tip, water triplex syringe, patient light, and how the patient chair moved up and down. He showed little reaction. I wondered what might be happening with this little guy. Might he have some type of emotional issue?
Mandy is also 5 years old and is known by all the staff as a “real handful”. When we see her name on the schedule we brace ourselves. She is so active! When she is in the chair she’s constantly reaching for things off the bracket table, grabbing the water triplex syringe and squirting it around the room, moving in her seat, and talking, talking, talking. At the end of her appointments we are exhausted and so is her mom. We wonder if she might have ADHD.
Joey, age 6, has something in his mouth all the time. If he isn’t sucking on his thumb, he is chewing on the ear of a stuffed animal or sucking on the tail of his t-shirt. His mom has tried “everything” to get him to stop all of this. She is very worried because he’s starting kindergarten in a few weeks. She doesn’t want the other children to make fun of him because of his “baby” actions. She asks us if she should purchase one of the devices she has seen online that looks like giant gloves and covers both thumbs. Would that break him of this “habit”?
Amazingly enough, each of these children may be exhibiting signs of a breathing and/or airway problem, and not what might immediately come to mind. Dentists and hygienists are in a unique position to identify some of these issues, and give some direction in how to help these kids.
According to the literature, obstructed airways can cause the dark circles we sometimes notice on children. The darkness under the eyes is not simply from what we might think of as the child being tired, but from circulating blood not receiving enough oxygen. It is being shown that obstructed airways can also impact learning, eye-contact, engagement, posture, activity/hyperactivity and “sucking habits”. Children who show some of the signs listed above may be given drugs for “hyperactivity” or labeled with some type of condition, when in fact, they just can’t breathe normally!
Diagnosis of an obstructed airway can begin by simply looking into the child’s mouth and asking him to say “ah”. Are the tonsils large, is the uvula big, is the palate red? Going on; do the tissues bleed easily, is the gingiva red, are the teeth “splayed” in an outward direction? What does the lingual frenum attachment look like? Is it tight and high? Can the child touch his tongue to the roof of his mouth?
If, in addition, the parent tells us the child sleeps poorly, grinds his teeth during the night, snores and breathes though his mouth most of the time, we may be getting a picture of a child who is not getting enough oxygen. He may have an obstruction that is preventing him from breathing correctly through his nose, causing him to present with many types of symptoms and behavioral issues that might seem to have little to do with breathing. If he is not breathing through the nose with his mouth closed, not only will he have less oxygen, but the lips, tongue, roof of the mouth, teeth, facial features and posture may be adversely affected.
If a child appears to have an airway issue, the next step may be to refer him to a pediatric ENT for an evaluation of his tonsils and adenoids. If removal is indicated, this service alone may allow for improved breathing, and therefore proper oral and facial development. With improved breathing, behavioral corrections may also be seen. If tonsil and adenoid removal is not enough, orthodontic intervention can also be helpful. Current thinking is the sooner the better.
While involvement with breathing and airway issues has not been a typical activity for the dental profession, more and more interest in these topics is making it possible for patients, particularly children, to receive the early treatment they may need to prevent life-long problems. Simply keeping an eye out for the symptoms and conditions that may be telling us an airway is obstructed can make a big difference in our patients’ lives.
Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email firstname.lastname@example.org.
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