4 years old with airway issue.

I wanted to ask you a few questions regarding my daughter. I appreciate your experience and expertise. She just turned 4, I’ve been seeing signs of sleep apnea since she’s little. She doesn’t stop breathing, but she turns her head back when she sleeps, she snores, mouth breath mostly at night, high narrow palate and crowded teeth (crossbite). All of these observations are classic presentations of children who are having a sleep related breathing disorder at some level of the oral, nasal or pharyngeal level. These obstructions can be as a result of inflammation caused by allergies, anatomical blockage; ie; tonsils, enlarged turbinates, adenoids,  retrognathic mandible, midface deficiency, or other skeletal delay in growth.. or it could be a small airway diameter that is closed off while they sleep.

You mention that she turns her head when she sleeps– that is the body’s response to open up the airway. My first thought is to take pictures or even better video tape her while she is sleeping– and see if you can get a video of her attempting to open her airway. As an illustration– when we do CPR, we manually tilt the head backwards and thrust the jaw forward–which many individuals of all ages do, as a response from the body to open the airway.

She started receiving Myo therapy in November last year and we did see a progress, but once she got sick (usually she gets very congested even if it’s a minor cold) it’s like she relapsed, she started snoring again and mouth breath because obviously it’s hard for her to breathe through her nose. I believe that Myo really can help to re-establish nasal breathing- which is so important! If there is lip incompetency– that can also be addressed along with swallowing issues. It doesn’t surprise me that she regressed– and that will be a repeated pattern of seeing improvement and then regression, unless the underlying obstruction is corrected.

Well, I took her to the ENT and everything was fine, doctor said she only has minor allergies (did she receive any saline rinse instructions or did they treat with Nasal steroid spray?)  so I went ahead and took her to an airway dentist and she said there is a tongue/lip tie and recommended myobraces, which she’s already using (she’s not able to keep it in through the whole night, but she’s working on it). There have been some good results with Myobrace for many children in helping to encourage lip seal, and promote nasal breathing; and by moving their jaws to more forward position, helps to breathe better while wearing it—-  however, if she is nasally congested, I would be concerned that her mouth breathing is what’s helping her to get Oxygen — so if she is congested and is taking it out at night, it’s so that she can breathe through her mouth. Wearing the appliance if she is nasally congested can actually make the breathing issue worse.

I guess my question is, do you think I should do the frenectomy? I’m scared because she’s not a baby. It’s difficult for me to make a comment on the need for a frenectomy. Lingual frenums are frequently seen in children with your daughter’s symptoms. But– there is no Direct correlation between a “tongue tie” and an airway disorder– as I teach in my lecture— it’s usually a multi-ethological situation and all the pieces need to be “picked out”– which is what you are doing.

Personally, even if she does in fact have a tongue tie, it would be at the bottom of my list to address at this time.

The priority is that she needs to breathe and sleep well. — and I would suggest that you get a recommendation from a pediatric dentist who has specialized training in airway or see an airway orthodontist and get the name of an ENT who understands the “whole picture”.

I’m not a “wait and see” person, but I don’t want to make a  hasty decision. I agree– with your description of her symptoms and things you have been doing— I don’t suggest that you wait– You just need to get to the “right” ENT to be fully evaluated and treated to open her airway.

I hope this helps. If you have any additional questions, feel free to reach out.

 Dr. Karen