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Children, Airway, Snoring and ADHD

October 19, 2012

I was at meeting of a group of physicians, dentists, speech and physical therapists, other health care providers and the public that works to educate and provide integrated care for children and adults. The focus of the meeting was airway and how it impacts the health and development of children.

“What is airway?”

Airway refers to the passage by which air reaches the lungs.
The issue is that airway can be affected by anatomical issues like large adenoids and tonsils or a deviated septum, congestion, allergies, asthma and a narrow jaw. All these things contribute to a change from healthy nasal breathing through your nose, to mouth breathing. Mouth breathing is not as efficient because of the way the air flows.
“Why is airway important?”

Quite simply, your airway and the shape of it or anything that interferes with it, prevents good breathing and the flow of oxygen to the lungs, and therefore, the brain.
Many children (and adults) who have problems breathing due to allergies or large tonsils and adenoids may snore at night – a sign that their airway is interrupted. Some even have apnea, a situation where the breathing stops for up to a minute at a time, many times throughout the night. The stops in breathing lead to poor sleep.
Consider what happens to a developing child’s brain if there are regular interruptions in oxygen. Snoring in children has been associated with problems in memory, language and poor academic performance.
The AmericanAcademyof Pediatrics thinks airway is so important that they have issued new guidelines for screening children and adolescents for snoring at routine visits.
“What does any of this have to do with ADHD?”

ADHD (attention deficit hyperactivity disorder) in children is characterized by impulsivity, hyperactivity and difficulty focusing.
If a child is not sleeping well because of problems with their airway (or any other reason for that matter) they will be tired. A sleepy child acts different than a sleepy adult. Adults who are tired become withdrawn, and quiet and consider taking a nap. Children, on the other hand, try to keep themselves awake! To do this, they try to move around a lot, seem impulsive or talk to themselves to stay awake. Many doctors believe that children are mistakenly diagnosed with ADHD when really they are suffering from sleep apnea and are just tired.
“What are the signs that my child may have an issue with their airway?”

There are both medical and physical changes that may occur with airway issues.


Allergies or asthma
Large adenoids or tonsils
Physical – because breathing uses so many muscles, visible physical changes are common, many related to tooth and jaw position.

Narrow upper arch
Long, narrow face
Poor tongue posture
Small, poorly developed nostrils
Gummy smile
Open mouth posture (anterior open bite)
Short and turned up upper lip
“What do you do to treat airway issues?”

Removal of adenoid and tonsils helps resolve about 90% of the issues.
Speech and myofunctional therapy that retrain tongue position and encourage nasal breathing.
Orthodontic intervention that expands the jaw and the airway.
Medication to treat allergies or asthma
The most important step in this process is diagnosis. If you suspect airway issues in your child, see their pediatrician, an ear-nose-throat specialist or a dentist who understands airway problems. Remember to be an advocate for your child. You know them better than anyone else so it is your responsibility to find a professional who understands and can help you.

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