With all the other stresses that come with raising a child, sleep disordered breathing (SDB) is not typically at the top of the list for things you have to worry about… but maybe you should! Approximately 10% of all children suffer from SDB and the vast majority of pediatric SDB cases go untreated and undiagnosed. This can have dire effects on the overall health of your child not only now, but in the future as well. Children with undiagnosed SDB end up having to use health care much more than most of the general population. If sleep disordered breathing and sleep apnea sound scary, that’s because it really can be. Pediatric SDB/OSA is so detrimental to a child’s health that Dr. Greenberg at RxSmile Orthodontics is passionately working to change that.

Due to SDB affecting a multitude of different facets of a child’s health, health care professionals in a variety of fields are typically presented with symptoms in patients, and that’s what they treat. However, most are not trained to recognize SDB. Dr. Greenberg has extensive airway training and growth and development knowledge of the face and airway of patients at the age where a screening should take place (ages 7-8). Why should an orthodontist screen for SDB symptoms? Dr. Greenberg explains, “through the screening process, we are looking for the recognition of a potential issue. If a child is not getting enough oxygen, it can affect them long-term and can lead to years of potential developmental issues. We are not treating, but screening for those potential issues.”

Below is a summary of a case study of two twin girls with SDB, and their journey as they were treated by multiple health care professionals, in differing fields of practice:

Pediatric Sleep Disordered Case Study Background

A mother of two twin 9-year-old girls noticed that they both snored loudly, were overly drowsy during the day, and had been very irritable and moody when waking up each morning. Naturally, their mother was very concerned, so she took them to not one, but two doctors, to ensure that her children were alright. The girls’ mom took them first to their pediatrician then to an ear, nose, and throat specialist (ENT). Both of the doctors expressed no need for any follow-up tests or treatments. Later on, the twins were taken to the dentist where a standard pediatric sleep quiz was taken. Scoring an 8 or higher prompts the need for further evaluation. They scored a 12!

The dentist then called for a home sleep study to be conducted (HST) to determine if the girls had pediatric SDB. The dentist being able to detect an issue after administering a simple questionnaire demonstrates how little knowledge other medical professionals have about sleep disordered breathing (SDB) and sleep apnea.

Treatment
Pediatric SDB, in the early stages, can begin by affecting only one part of a child’s health. Symptoms, however, can be detected not only by a regular pediatrician but by a variety of different health care specialists. Albeit, many health care professionals do not have enough knowledge about SDB or Obstructive Sleep Apnea (OSA) to detect or diagnose it. Dr. Greenberg is trained in the treatment and diagnosis of SDB and OSA. Based on the American Organization of Orthodontics recommendation, Dr. Greenberg believes that all children should be evaluated by an orthodontist before the age of 7 in order to detect SDB and other development issues before they have a chance to seriously or permanently affected a child’s health. He encourages parents to sign up younger patients as part of his RxSmile Orthodontics Wired-Up Club.

As a child, breathing through your mouth instead of your nose can seriously affect and damage the development of your craniofacial bones. It can even cause facial deficiencies. It also may lead to OSA (a severe version of SDB) and other disorders that can greatly decrease one’s quality of life.

There are many different methods of treating SDB. Treatment depends on the cause of the disorder and the extremity. Typically removing a child’s tonsils is the first step of a treatment plan. This is because enlarged or swollen tonsils and adenoids can lead to trouble breathing. However, if the child’s tonsils and adenoids are not the issues, an adenotonsillectomy will not fix pediatric SDB or OSA.

Often times, an orthodontist will use rapid maxillary expansion (RME) if the underlying issue is craniofacial. RME is when an orthodontist balances the width of the jaw through enlarging the roof of the mouth and the arch. RME is almost exclusively done by orthodontists. Again, whether or not a child with OSA or SDB is a good candidate for RME depends on the cause of SDB or OSA.

In the case of the twin girls, they were diagnosed with severe OSA. Their treatment consisted of 7 weeks of RME, an adenotonsillectomy by an ENT, and myofunctional therapy with the goal of fixing their midface deficiencies.

Therapies and treatments typically used to fix adult OSA cannot be used in cases of pediatric OSA. Because children are still developing their craniofacial bones, simply using a CPAP machine can worsen pediatric OSA. This is because it can change their bones in a way that heightens the disorder.

Results
The home sleep test (HST) taken prior to treatment showed both of the girls snoring frequently throughout the night and moving fairly consistently, if not constantly. After treatment, the girls snored very little, if at all, and they had very little movement. This suggests that they slept deeper and better. Their mom reported that following treatment the girls’ energy levels went up; they focused better; their social skills greatly improved, and they, overall, were much happier. Treatment changed these little girls’ lives forever.

Possible Errors
Due to the control of the case study being based upon a home sleep test, it is very possible that there were errors in the before and after examinations of the girls’ sleep. For more accurate results, the girls’ would have had to do a lab sleep test. This was not chosen due to the possible trauma it may have caused the girls.

Make Sure Your Child Does Not Have SDB

Dr. Greenberg offers a complimentary i-CAT FLX Cone Beam 3D scan as part of his OSA Sleep Screening process. The i-CAT 3D scan can detect craniofacial deformities and can be the key in evaluating if your child has sleep disordered breathing or Obstructive Sleep Apnea. So we urge you to call if your child has SDB symptoms; it won’t cost you a penny!

To make an appointment with Dr. Greenberg, please call 972-335-1300 (Monday through Thursday) or submit an online appointment request and we will respond within one business day. See what Dr. Greenberg and the RxSmile team can do for you!

The original, detailed case study article was featured on the Journal of the American Osteopathic Association.