The Hidden Airway Epidemic by Jennifer Blunston, PhD, Cert. BBM, PTS

The first 1000 days of life is crucial in terms of setting the stage for optimal health and growth of our children. Identification and prevention of sleep disordered breathing is therefore key to help give babies the best chance to flourish— to transform into adults with healthy jaws, healthy airways, and restorative sleep patterns. For these conditions to be met, we need to look at how children are breathing

Nasal breathing with the tongue resting against the roof of the mouth is a crucial component to the proper growth and development of a child’s jaw and airway. In the beginning of life, breast feeding not only promotes the proper position of the tongue against the palate, and initiates correct swallowing patterns, but also helps the baby maintain nasal breathing. The tongue’s pressure against the palate, with lips lightly closed, drives the growth of the face, jaws and airway in a forward direction. This essentially shapes the palate into a broad u-shape and creates a strong jaw, a wide straight smile, and a healthy airway. With poor tongue function, we can expect to see a flatter and narrow face, crooked teeth and a smaller airway.

So what causes low tongue posture and mouth breathing in infants & children?

The growth and development of a child’s face, jaws and teeth are determined not only by genetic factors, but by maladaptive habits and environmental factors. Extended bottle or pacifier use, thumb, blanket or finger sucking, allergens, pollutants, and nasal congestion can all cause mouth breathing in a child.

If a child mouth breathes or has a tongue which is tethered to the floor due to a tongue-tie, a high arched and narrow palate can develop. The one thing we should remember is that the roof our mouth is the base of our sinuses. So the problem gets further compounded because the child now feels like its difficult to breathe through the nose and thus keeps breathing through the mouth! On average, we swallow over 1000 times per day. Proper swallowing with the tongue against the palate promotes a pumping action that releases sinus congestion as well as fluid in the inner ear. Therefore a low tongue resting posture may cause a baby to experience feeding issues, breathing issues, disturbed sleep, speech and articulation issues, and ear, sinus or eye infections. In addition, most of us think that digestion begins in the gut, but it actually begins in the mouth. The peristaltic wave actually starts with proper tongue mobility and an effective swallow. Tongue-tied kids who are swallowing incorrectly are often sympathetic dominant, our stuck in “fight or flight” mode, and can often hold tension or stress in the body. This results in a decrease in gastrointestinal motility and the development of possible gut issues, such as gas and constipation. If we release the tongue tie, and tension, these children can tap into their parasympathetic system or “rest and digest state” and begin to relax the body.

Once your child gets older, you may notice them having chewing and swallowing difficulties. Chewing wholesome, natural, hard foods is essential to the development of wider jaws and faces. Unfortunately, modern society has advocated the use of soft, mushy baby food and processed foods that lack texture which has eliminated the need for proficient chewing and swallowing. Even when children do not have teeth yet, the gums can be used to masticate small bits of solid foods like apples, peaches, cooked squashes or carrots, and meats. Not only will this baby-led weaning promote fine motor skills but also encourage healthy eating of foods with a variety of textures. By simply chewing harder foods, the muscles in the face are able to work and get stronger. This will promote the development of a healthy bite and airway. So the next time you are shopping, maybe reconsider the yogurt and apple sauce pouches! (1)

A low tongue posture can result in the back of the tongue falling into the airway as the baby or child sleeps, potentially causing sleep disturbances or sleep apnea. In 2016, the American Academy of Physiological Medicine and Dentistry called overlooked sleep disorders in children a “hidden airway epidemic.” In addition, between 25-50% of pre-schoolers exhibiting sleep problems, also have behavioral issues. A six year study of over 11,000 children by Dr. Karen Bonuck at Albert Einstein College of Medicine revealed that children with sleep disordered breathing (SDB), such as snoring or sleep apnea, are twice as likely to develop behavioral difficulties like hyperactivity, emotional symptoms, and aggressiveness. (2) Sleep not only promotes physical restoration of the body, but promotes the proper neurological development of the prefrontal cortex—the part of the brain responsible for attention, focus, memory, behavioral control, and learning.

Many parents are unaware of how their child truly sleeps. Become “Sleep Detectives” and simply watch and listen while your child is sleeping at night. Common red flags that may suggest improper tongue position and sleep disordered breathing include the following:

• Audible breathing
• Daytime fatigue
• Open mouth posture/ dry lips/ drooling
• Snoring, gagging or choking in sleep
• Cessation of breath or gasping for air
• Restless Sleep or frequent night time awakenings
• Night terrors or sleep walking
• Grinding teeth (Nocturnal Bruxism)
• Frequent bed-wetting past the age of 5 years old
• Hyperextension of the neck while asleep
• Poor school performance or behavioral issues
• Persistent dark circles under the eyes
• Hyponasal speech as if the child has a cold
• Asthma/Allergies/Eczema
• Constipation

What can I do if my child has one or several of these symptoms?

Speak to your pediatrician and get a referral to an otolaryngologist (ENT) who can assess the health of the child’s airway. In addition, orthodontic intervention may be needed to expand the palate and give the tongue enough room to rest on the roof of the mouth. Further, consult an orofacial myofunctional therapist (OMT) who is knowledgeable about myofunctional disorders who can assess your child’s tongue posture, swallowing and breathing to determine if therapy is required to help restore nasal breathing and function to the tongue and airway muscles. Research is demonstrating that the re-education of these muscles is a crucial component to treating pediatric sleep disordered breathing. (3) Prevention, recognition, and treatment of sleep breathing disorders can truly impact not only the quality of a child’s sleep, but their behavioral, cognitive and social development as well. Be an advocate for your child’s oral health and their airway health—this is truly the foundation of their wellness.

About Jennifer Blunston

For the past 6 years Jennifer Blunston, BSc. PhD. has helped clients achieve better overall health as an orofacial myofunctional therapist—an emerging field in health care. Based out of Calgary, Alberta, Jennifer enjoys educating her clients on how proper nasal breathing, and palatal tongue rest posture can help balance the nervous system, optimize our physiology, and promote physical recovery and wellness. She works with a wide range of clients including children who have adopted improper breathing or swallowing habits, to adults who are undergoing treatment for sleep apnea.

"In addition, many of my clients seek treatment to improve their fitness and manage stress levels. My passion is working with clients who suffer from sleep breathing disorders, jaw pain, or anxiety. We all deserve to breathe better, sleep better and feel better!" states Jennifer.

Jennifer holds a Bachelor of Science at St. Francis Xavier University, a Doctorate degree in organic chemistry at the University of Alberta, she is certified in a personal training, and as a certified instructor in the Buteyko breathing method. To learn more about Jennifer you can visit her website at www.myofunctionalfitness.ca or follow her on Instagram @myofunctional_fitness.

References

(1) Rapley, G, Murkett, T. Baby-Led Weaning: The Essential Guide-How to Introduce Solid Foods and Help Your Baby to Grow Up a Happy and Confident Eater. New York, NY; 2019.

(2) Bonuck, K. et al. Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years. Pediatrics 2012; 129(4): 857-865.

(3) Guillmenault, C. et al. Critical role of myofascial reeducation in pediatric sleep-disordered breathing.Sleep Med. 2013; 14(6): 518-525.