It is easy to identify airway problems when a parent comes to your office already seeking help for that exact issue.
In those cases, the parent understands the problem and is actively searching for a solution.
Years ago, an eleven-year-old boy came to my office with a serious case of obstructive sleep apnea that was first noticed by a summer camp counselor.
Of course, the counselor did not make the diagnosis, but they observed apneic episodes and urged the family to seek care.
The child was later diagnosed with OSA by a physician and referred to me for treatment.
Even with the most aggressive non-surgical airway treatment available, this boy ultimately required surgery to advance both jaws in an effort to eliminate his sleep apnea.
Although it was never discussed by the family, I am almost certain the child had already suffered significant brain damage from oxygen desaturation long before he arrived at our office.
The obvious question is this: why didn’t the pediatrician, pediatric dentist, or even the parent recognize this serious problem earlier?
The absolute easiest airway sign to identify is whether a child has their lips apart at rest — even slightly.
Children should be one hundred percent nasal breathers.
The lips should never be apart, not even a millimeter, at rest.
Mouth breathing does not improve with time.
It gets worse.
As the child grows, the face falls back and the airway becomes compromised.
Any reduction in airway size is a significant negative.
Take a look around a kindergarten classroom. How many children have their lips apart, even a little?
A rolled-out, flaccid lower lip, an accentuated cupid’s bow of the upper lip, or chronically crusty lips are all easy signs to notice from a distance.
Children should be able to keep their lips together without strain.
When these signs are present, the child is almost always a chronic mouth breather.
In my own case, I woke up with a wet pillow every morning of my life until I began taping my mouth at night.
I have been taping my mouth during sleep for over fifteen years.
A pillow should never be wet.
Since changing my breathing habits, I have nearly eliminated colds from my life.
Parents can easily check their child’s pillow every morning.
Children with short attention spans, frequent interruptions, constant movement, or an inability to sit still often suffer from airway problems.
A child who wets the bed beyond the typical age is almost always dealing with airway issues.
Children with low energy, those who fall asleep in school, or those who cannot keep up with peers during recess are frequently struggling to breathe properly.
Normal breathing is silent.
Snoring or any noise during breathing — whether awake or asleep — is a clear sign of an airway problem.
A child with a gummy smile may actually be showing signs of an airway issue.
A gummy smile often indicates that the upper jaw is growing downward and backward.
This does not happen when the tongue rests properly against the palate.
A child whose bed looks like a tornado hit it overnight is often struggling to breathe.
Children who hyperextend their necks while sleeping or sleep with their rear elevated are simply trying to keep their airway open.
All of these signs are easy for parents to observe.
Dental professionals, who were mandated by the ADA in 2017 to screen for airway issues, must understand these signs and educate families.
As you begin to recognize these patterns in practice, you will quickly realize how few children today are truly healthy.
A mouth-breathing child is not a healthy child.
Dentists understood this in the early 1900s and treated children in the primary dentition.
Why the profession moved away from that approach is a story for another day.
