“My child has grown perfectly and doesn’t have an airway problem!” Words like that from a parent were not uncommon, particularly in the early years of my airway-centered practice. As the years went by and word-of-mouth caused my practice to grow, I heard that sentiment less frequently because parents were referred by friends and dentists who had made them aware of real health issues.
After James Nestor’s book Breath was published in 2020, I rarely heard this as many parents had read his work and realized how prevalent airway problems are.
The last thing a doctor should do is push back hard and tell the parent they are wrong, that the child’s face is not balanced, the airway is compromised, and there are already significant problems. Bad idea.
Frequently, problems are not obvious to parents but can be glaringly obvious to someone trained to see signs, symptoms, and to interpret a thorough medical history. Pushing back only causes someone to dig in their heels further.
Here is an approach I have used:
“I completely understand and felt the same with my own kids when they were this age. Since that time I’ve learned that many things are not overtly visible. I wish I had been aware of things then that their pediatrician also didn’t recognize. Kids don’t even have to snore to have serious issues which can result in brain damage, permanently impaired motor coordination, and reduction of IQ of up to 10 points with oxygen desaturation that most of us would never see.
My practice is now totally dedicated to helping everyone sleep and breathe better, including me. That is why I brought this up to you. I’ll sleep better if you would agree to have a sleep test for Johnny. I won’t sleep and would never forgive myself if I didn’t at least rule out problems with sleep. I wouldn’t want to feel like I overlooked something that might make a difference the rest of his or her life.”
This may seem a bit strong, but it gives you ideas for how to handle such conversations.
First of all, acknowledge the validity of their opinion. It is easy for me to personalize this conversation because I did not recognize issues when my boys were very small that have affected them. I didn’t know.
I have also been on my own airway journey, working to change from having my mouth open too often as a child and sleeping every night with my mouth open. It has taken me 14 years of effort to turn this around in my own life, and I often relate this to parents. Most parents get it.
There are times when I would like to say:
“Untreated OSA in a child can result in a 10 to 15 point drop in IQ. If your child is the next Einstein, don’t worry. If he isn’t, how many IQ points are you willing to sacrifice when you’re helping him fill out college applications?”
The good news is that I’ve never said this to anyone.
It can be frustrating when parents dismiss things I know could be a real problem. The key is creativity in how you approach the conversation.
Acknowledge their perspective. Make your response genuine. Keep it consistent with your personality. Most importantly, keep it non-confrontational.
Good luck.
