While sleep apnea is commonly associated with adults, it can be a significant challenge for children as well. In fact, up to 20 percent of snoring children can suffer from pediatric obstructive sleep apnea. A child with this disorder will stop breathing for short periods multiple times each night.

One of the causes of pediatric sleep apnea is structural abnormalities in the face and mouth. Early orthodontic intervention can help to correct these issues to improve airway health and prevent long-term complications from obstructive pediatric sleep apnea.

Understanding Pediatric Sleep Apnea

Pediatric sleep apnea is a series of disruptions to a child’s breathing while they are asleep. This happens repeatedly throughout the night, sometimes as often as 30 times per hour. All of these interruptions in their breathing wake the child’s brain and lead to poor sleep quality overall.

Symptoms and Causes of Pediatric Obstructive Sleep Apnea

While parents may not notice the breathing difficulties during the night, these symptoms can be a clue about their poor sleep:

• Snoring marked by snorts between breaths
• Night wetting
• Sleepiness during the day
• Moodiness and irritability

Causes and Risk Factors

Sleep apnea in children is caused by the muscles at the back of the throat relaxing too much and partially obstructing the airway. Most often in pediatric obstructive sleep apnea, oversized adenoids and tonsils are to blame. Some children with low muscle tone and abnormalities in the mouth and throat have more difficulty with their breathing while asleep.

Preventing Long-Term Health Issues

Due to the repetitive wakefulness caused by these sleep disturbances, there are many concerns for their long-term health. Some of the potential medical issues these children can face are:

• Attention Deficit Hyperactivity Disorder (ADHD)
• High blood pressure
• Type 2 Diabetes
• Heart Issues

The longer that a child suffers from frequent waking and disruptions to their sleep cycle, the more risk they have of developing these life-long health concerns.

The Connection Between Jaw Development and Sleep Apnea

If a child has poor jaw alignment or parts of their face and mouth develop atypically, this can impact their airway. Mouth breathing can worsen issues with jaw alignment, further increasing the likelihood of developing sleep apnea.

How Jaw Development Impacts Airway Health

When the parts of the jaw do not develop correctly, it impacts the child’s airway and breathing. There are a few ways that improper jaw alignment creates breathing issues including pediatric obstructive sleep apnea.

• Mouth position: The best resting position for proper jaw development and alignment is a closed mouth with the lips sealed. This keeps the front teeth in place and the lips in a closed position, opening the airway. When the resting position is an open mouth, the front teeth can push out and lead to an overbite and a narrow airway. Pacifiers and thumb-sucking can worsen this.
• Poor tongue posture: Correct jaw alignment keeps the tongue forward and up, providing a good and healthy airway. When the mouth is frequently in the open position, the tongue hangs low and back, restricting the airway.

Orthodontic Expansion

One way to correct incorrect jaw development is through orthodontic expansion. These treatments correct jaw development issues that restrict the airway and contribute to pediatric sleep apnea.

Orthodontic Expansion Techniques

There are two main orthodontic expansion techniques that can be used to address child jaw development issues.

Rapid Palatal Expanders

• What it is: This device is used to treat children with a narrow upper jaw. It moves the jaw into the correct position to create a wider airway. It also enlarges the nasal airway to improve breathing.
• How it works: The rapid palatal expander connects to teeth on both sides of the mouth. It has a screw in the center to gradually widen the expander. As this happens, new bone will grow to fill in the extra space to provide permanent stability.
• What the process looks like: At the installment appointment, the expander is connected to the upper molars on both sides of the jaw. The orthodontists will tighten the screw incrementally over time. As the jaw expands, it might be slightly uncomfortable and there may be haps in the teeth. These are expected and can be addressed with the orthodontist.

Mandibular Advancement Devices

• What it is: This device improves the airway by moving the lower jaw into a different position. It allows the tongue to move forward and create more space for air to flow.
• How it works: The mandibular advancement device has two pieces that affix to the top and bottom teeth, with a connecter to push the bottom jaw forward. This opens the airway enough to encourage nasal breathing and appropriate jaw alignment.
• What the process looks like: The orthodontist will order a device to the specifications of the child’s mouth. The device will be inserted at night and removed in the morning. Some children might experience excessive saliva production and teeth discomfort at first.

Benefits of Orthodontic Expansion for Sleep Apnea

Using expansion devices as orthodontic treatment for sleep apnea is relatively non-invasive and manageable for young children. There are also many immediate and long-term benefits for children with sleep apnea.

Immediate Benefits

With children’s orthodontic care to address jaw development, users can immediately experience:

• Easier breathing
• Better sleep
• Improved mood
• More rested and alert

Long-Term Benefits

In addition to the immediate improvements, orthodontic expansion treatments can also help long-term with:

• Better sleep quality
• Improved jaw alignment
• Larger airway to allow breathing through the nose
• Improvement in quality of life
• Reduced risk factors and improved overall health

Orthodontic Success Stories

According to a meta-analysis of studies on children who underwent orthodontic expansion, about 75 percent saw an immediate and long-term increase in their oxygen intake. Most also saw a resolution of their sleep apnea.

Another study showed positive outcomes in increasing the airway space in children using rapid palatal expanders. These children also developed a widened nasal passage, encouraging breathing through their nose which prompted appropriate jaw development.

The Importance of Early Intervention

Early orthodontic intervention is essential for securing positive outcomes for the child’s breathing. An early diagnosis of sleep apnea means that the child can receive treatment sooner for improving airway function, lowering risk factors for health issues down the road.

Additionally, when sleep apnea is caught early and parents pursue pediatric orthodontics, it helps to prevent future problems that can develop from poor jaw structure such as overbite, crossbite, and crooked teeth. By resolving the issue with minimally invasive devices, surgery and further orthodontic treatment can be avoided down the road. Regular orthodontic check-ups during and after treatment are essential for maintaining these results and preventing other problems.

What to Expect During Treatment

The pediatric orthodontist will guide parents and children through every part of the treatment process. From diagnosis to follow up care, we offer support at every step.

Diagnosis

Typically, a specialist diagnoses sleep apnea through an overnight study. The child is hooked to a machine to measure breathing patterns and wakefulness. However, the x-rays and evaluations that we perform in the orthopedic office can identify enlarged tissues or airway concerns to lead to a diagnosis.

Treatment

Based on the tests and evaluations, we will recommend orthodontic appliances to address the specific structural concerns we identify. We will explain the process for insertion and how to care for the device. Additionally, we will advise about any side effects or concerns to be aware of during treatment.

Follow-Up Care

After treatment, it is important to keep up with orthodontic check-ups for kids. Seeing the child regularly and monitoring the treatment outcomes will let us help with any problems and maintain the success of the treatment.

Common Concerns and Tips

Often, parents are concerned about managing discomfort in their children during treatment and with making their children comfortable. Parents should talk to their orthodontist so that we can:

• Make a proactive plan for pain
• Discuss what will happen with the child so they know what to expect
• Make the environment more comfortable for the child

Contact Us

Pediatric sleep apnea can lead to difficulties with sleeping and issues with mood and drowsiness during the day. An early diagnosis and appropriate children’s sleep apnea treatment are essential. Orthodontic expansion is a non-surgical solution to improving airway function and health outcomes for your child. Contact our office for a consultation on how to resolve your child’s sleep apnea and restore their health and quality of life.