← The Pediatrician Next Door - Simple Advice on Parenting and Family Health
The Pediatrician Next Door - Simple Advice on Parenting and Family Health
Ep. 144: When is Snoring a problem?
00:28:23
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So.
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So here's my big question. Have you ever wanted to put a pillow over your partner's head because they were snoring? I know someone in my house feels like that, and it's not me. Have you given someone a not so gentle shove in the middle of the night? Or pinched their nose and lips together to get them to stop snoring? And come on. One of you is using a sound machine to drown out snoring. Even if it's not your personality to get annoyed in general, there is something about interrupted sleep that brings out the worst in us. Right? We love our sleep. We protect it. We get defensive about it. And when someone or some tiny someone snores loudly, it's annoying. But here's the thing. What if that snore, especially when it's coming from your child, isn't just irritating? What if it's a sign of something wrong? Because snoring in kids can be a clue that their body is working too hard to breathe. So today we are tackling a mystery that every tired parent should care about. When should you care if your child is snoring? And when can you ignore it? I'm Dr. Wendy Hunter and I'm the pediatrician next door. I'm that doctor friend you call for practical advice about your kid's health. I mix the science of medicine with the reality of parenting. Here's the truth. Most kids and adults snore sometimes. But for some, that sound is more than just a snore. It might be a sign of a bigger issue that can affect sleep. Learning and even how a child's face develops. I'm going to get to that part. It's fascinating. Let's start with the basics. What is actually happening when we snore? Okay, here's what I know. Snoring means something is vibrating in the airway, usually because it's blocked. I know this seems obvious, right? I certainly didn't need to go to medical school to figure that part out. Here's the fancy ish part. A blockage to smooth airflow can happen if a child has big tonsils, if they have allergies, because allergies can cause swelling in the nasal passages and that changes the way air flows. That's why sometimes the. The first treatment is to treat nasal allergies. It's just easy to treat and if it works, great. Or airflow can be changed if the jaw and tongue don't rest in the right position. I also know from all the videos that parents have shown me and the parents acting out, what they see their children do while they're sleeping is that when the airway flutters or narrows, it can jolt the body out of sleep. So some of these videos are really impressive. And sometimes awakenings are quite subtle. You may not always notice it. We know that from sleep studies in kids. In these studies, some kids have multiple awakenings, but you can't actually see them with your own eyes. They do get recorded by the sleep lab monitors, though. For sure, snoring keeps a child from getting the deep breath restorative sleep that they need to learn and grow. But this is just my superficial understanding. I know there's a lot more to this because I know there are books written about this and there are like a million medical specialists who address breathing problems and snoring. And that's why I called in Dr. Shirin Lim. She is a dentist in Western Australia who finds and treats the root cause of breathing and sleep issues by looking at how the mouth functions and the jaw develops. She's also a sleep medicine expert and the author of the book Breathe Sleep Thrive. She has studied dentofacial orthopedics. Yeah, that's thinking about the face and teeth from a mechanical perspective, like an orthopedics doctor would. She combines traditional orthodontics with myofunctional therapy. That's a mouthful. What that means is basically using what she already does and combining it with physical therapy for the mouth to get the best outcome. Okay, you don't have to understand what I'm saying. My point really is that she knows what she's Doing. And this is a unique perspective on snoring, mouth breathing, and the way our mouth works. She can help us too, even if you can't visit her in Australia. Anyway, here is what she had to say about why we should be more concerned about mouth issues and why this is often an overlooked problem.
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Bedwetting is another key red flag that a child is not breathing well. It can be linked to increased efforts to breathe and the stress that this places on our body and a whole cascade of hormone release that actually leads to the bedwetting. We know that children that have interventions such as ENT surgery, like removal of enlarged adenoids and tonsils, as well as palate expansion, there's evidence to suggest that actually reduces bedwetting. So I've had that in many cases when I do pellet expansion, children will stop bedwetting within a few weeks. Because once we can get children breathing better, everything else tends to fall into place. A common problem is children that have speech pathology. They have speech therapy for years and years and they're not really making any progress. But whenever we have all these common issues, we really need to stop back and look. How is the tongue working? How are the jaws developing? If we can get to the root of the issue, we can actually help a lot of children thrive. And in doing so, their sleep and breathing will be better as well. Children that come to look for their parents in the middle of the night, so they have these unexplained awakenings. That is also a sign that we need to question, is there a breathing disruption that has woken up a child? So nightmares, terrors, sleepwalking, talking, they're all symptoms that we want to look at through the nighttime.
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What she is saying is that there are a variety of symptoms that could be the downstream effects from an obstructed airway. We may only see snoring, and we might not realize that there are significant health issues caused by the snoring. And this issue is complicated by the fact that we might also have no idea what we're looking for. For example, when you think of a kid who is not sleeping well, you imagine one that's tired. You picture they might fall asleep easily, be cranky, have dark circles under their eyes and so on. Right, because that's what you would look like if you were sleep deprived. But here's the twist. Most pediatric patients that I have taken care of that turn out to have breathing problems when they're sleeping. They never seemed tired. Actually, they are more likely wired. They are the kids that bounce off the walls in fact, I've heard teachers have told the parents of some of these snoring kids, they say he just can't sit still. And what have I heard from parents? They say things like, oh, she's so emotional lately, everything sets her off. And sometimes these kids end up with ADHD evaluations or getting overdosed on melatonin. And that doesn't help at all when what they actually need is just to breathe easier so they can sleep better. If a child is snoring night after night, their sleep is interrupted. And like I said about that, we see this on sleep studies, sometimes their sleep is interrupted hundreds of times an hour. Even if you don't notice it, these kids brains never go into that deep restorative stage of sleep that helps them focus, regulate emotions and grow. And what's fascinating is that the body tries to compensate. Their heart rate goes up, adrenaline kicks in. So instead of being sleepy during the day, these kids can look hyperactive. Their nervous system is in overdrive just trying to stay awake. That's why when a parent tells me he snores but it seems fine, I always want to look a little closer. Because sometimes fine is just a kid who's gotten really good at running on fumes. This is where I turned back to Dr. Lim. I asked her how sleep and breathing affect behavior, learning and emotions, and what clues she looks for in her young patients.
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Overall, there's really an under recognition of it that comes from our lack of training. Most healthcare professionals are aware that really key pillars of health include nutrition, exercise and sleep. But when it comes to sleep, we're not really trained to consider the quality of the sleep. A lot of childcare professionals really understand these are the sleep routines and how many hours per night a child should get depending on their age. But we're really not taught to check. How are they breathing? What is the quality of their sleep? What are the questions or the red flags when children are not breathing? Well, we miss that in our education. For instance, the American Academy of Pediatrics, they have a policy statement which suggests that any child that's coming in should be inquired about their snoring. But a lot of the time it's a simple yes or no answer if they even get a chance to ask, or they don't know how to investigate deeper questions with the mouth breathing, the restlessness and tossing and turning, and all the different sleep positions that we mentioned already. So that's one issue that we are overlooking this airway health as a fundamental pillar of healthy children. But the other thing is that Healthcare is really set up to deal with symptoms. So for instance, one child, they might go to an enuresis clinic to deal with their bedwetting. They may go to a dentist to deal with their teeth grinding, or they may go to an ENT to deal with their obstructive breathing, or they may go to a psychologist to get an assessment for ADHD or learning difficulties. But really we need to pull together to really ask what is the root issue? And can we identify airway health as a key pillar that can help children better?
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Let me guess your next question. Are you wondering, okay, but can I tell if my kid's snoring is actually a problem? Occasional snoring during a cold or allergy flare up. That is fine, normal, common. Most kids will sound like a little bear when they're congested, right? That's just mucus physics. But when snoring happens every night or every time they fall asleep in the car or an airplane, that's when you need to pay attention. I asked Dr. Lim what she considers the tipping point. When should parents go from let's wait and see to let's get this checked out?
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There is research to support that when children are snoring or even with mouth breathing, they're going to have greater symptoms of adhd. There's even research to support when that is addressed, for instance, with removal of adenoids and tonsils, that children will have the reduction of ADHD symptoms. I think before we medicate children or label them, we need to investigate their sleep quality. Are they breathing okay through their nose? Are they having any symptoms of snoring and other sleep disturbed breathing as well in terms of teeth grinding? Teeth grinding is the strongest red flag inside the mouth that a child is not breathing well. Teeth grinding tends to be a compensation. It's a stress response to any airway obstruction in a child where their fight or flight or sympathetic nervous system is quite sensitive and active. Anytime there's a collapse of the airway before there's a full obstructive sleep apnea, they will grind their teeth and that will help recruit the muscles to open up the airway so that they never get that full obstruction. It helps them keep their airway open, but it actually is very disturbing for sleep. It's a chronic stressor. And this can be linked to symptoms like insomnia where children have difficulties falling asleep and a lot of kids get put on melatonin or it could be linked to sort of anxiety or high stress. So oftentimes when we address the underlying sleep, disturbed breathing Children can function and they're more settled. And we see things like less separation anxiety, yet more better attention, concentration, their learning potential. We can see parents report that their child is able to cope and manage with their emotions better.
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So here are the things you look for. If you can hear your child snoring most nights, if their mouth is always open when they sleep, if they wake up sweaty or toss and turn like they're in a wrestling match, if you ever hear them gasp, choke or pause in breathing. We didn't even mention that one yet. Those are your red flags. Another clue. Watch them during the day. Kids who don't get restful sleep might breathe through their mouths all the time. And then don't forget the grinding of the teeth at night. Remember, Dr. Lim says that's another big hint. It's the body's way of trying to open up a tight airway. I'm sure I'm missing some other issues. What other problems might be linked to having an obstructed airway during sleep? Here's what Dr. Lim says.
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As I mentioned, I think it's really important to be really aware of. What are those red flags? The nighttime symptoms that we discuss. We really want children to close their mouth, breathe through their nose. We want them to look peaceful and relaxed. It should be concerning if we notice a child is thrashing with the arms around everywhere, or they're really difficult to sleep with and kicking, or they're making any sounds or sweating. It's a sign of effort. A lot of these things that people don't recognize because quite often I'll ask parents, how well is your child sleeping? They'll be like, fantastic. They never wake me up. But it's really important to recognise those characteristics that could suggest that a child is not sleeping as soundly as we think.
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So here's my really, really, really quick pediatrician rule of thumb. If your child snores more than three nights a week when they're not sick, it's worth looking into. It really can be hard to know. I mean, I can't ever tell, honestly. Fortunately, there are people who can help you sort this out. After the break, we'll talk to Dr. Lim about what to do next and which expert to see first. You're listening to the pediatrician next door where we get to the bottom of these crazy kid mysteries. I'll be right back. So don't fall asleep. Have you ever wondered whether those colorful sports drinks actually hydrate you and are good for you? Here's the Most of them are loaded with sugar and artificial ingredients your body doesn't need. CURE is totally different. It's a plant based hydrating electrolyte drink mix with no added sugar. Just a natural, delicious, convenient way to stay hydrated without the junk. CURE uses the same science backed ratio of electrolytes that's been proven to hydrate as effectively as an IV drip. That's why I trust it and why I drink it. I use CURE when I'm traveling and on long days when I realize I haven't had enough water. I recommend it for parents, student athletes, and honestly, anyone who wants to feel better through the day. Staying hydrated isn't just about water. You also need electrolytes. That's why I love cure. It's clean, tastes great and actually works. And here's a bonus Cure is FSAHSA approved so you can use your FSA or HSA funds to stay hydrated the smart way for pediatrician next door listeners. You can get 20% off your first order@curehydration.com that's D R W E N D Y with code Dr. Wendy and if you get a post purchase survey make sure to let them know you heard about CURE right here. It really helps support the show. Don't just drink more water, upgrade it with cure.
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We can also look at it from the perspective of what are the jaw structures like as well. So if their jaws aren't growing fully, we can have orthodontic problems like crooked teeth. We can have cross bites, under bites, overbites and deep bites, and lack of spacing between the baby teeth. They're all symptoms that the jaws aren't growing well. And this means that our airway structures aren't going well because the jaws form the bony framework for the throat or collapsible throat, as well as the floor of the nose, the housing for the tongue. So any under development of the jaw as well as orthodontic problem which is a symptom of that, can be a red flag. If we really understand that the jaws are really influenced by the muscle function, how the tongue is working, the muscles of our face, how well they're working, we can actually understand that really early warning Signs where jaw growth will be affected and therefore the airway will be affected, is looking for old dysfunction. Myofunctional disorders like difficulties with breastfeeding or difficulties with swallowing or chewing, mouth breathing, the use of pacifiers, thumb sucking, all these things that alter the way that the muscles work and the way that the tongue works. Because the tongue is really the main upper airway, the bulk of the tongue forms the genioglossus, which is the main upper airway dilator muscle. It keeps the throat nice and open during sleep. So any oral dysfunctions, they're also red flags or markers that there's going to be problems, and we need to pay closer attention to children's sleep and breathing.
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When Dr. Lim talked about airway development, she went deeper than I expected, straight into muscle science. She explained that how a child uses the muscles of their face, jaw, and tongue literally shapes how they grow. Here's how it works. When kids breathe through their nose, their tongue rests naturally on the roof of the mouth. That gentle, constant pressure helps the upper jaw widen and flattens the palate, leaving plenty of space for air to flow and teeth to line up. But when a child breathes through their mouth, everything changes. The tongue sits low, the mouth stays open, and the muscles of the face start pulling in different directions. And over time, that can narrow the palate, crowd the teeth, and make the airway smaller. It's not just about looks. This is also about oxygen. Every breath is like a mini workout for those muscles, and if they're trained the wrong way, they can grow the wrong way. That's why Dr. Lim focuses on function. First, she retrains the muscles that control breathing, chewing, and swallowing so growth can get back on track. And that is called myofunctional therapy. I asked her what treatment is like when parents decide to act, what steps actually make a difference. She explained that treatment can range from simple things like addressing nasal allergies or tongue posture to more advanced care like myofunctional therapy. Treatment can also involve orthodontic expansion or taking out your tonsils and adenoids. The key, she said, is finding the root cause early and helping the airway grow and function properly, rather than just quieting the snore down.
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So really, our ultimate goal is to ensure children have good nasal breathing. And when we want nasal breathing, we need to look at ent. So one option is an ear, nose, and throat specialist who can actually look inside the nose and the throat. So they're typically looking for things like enlarged adenoids, enlarged tonsils, deviated septums, any enlargement of the turbinates, that is looking inside the airway, that is one pathway that we can go to. But we also need to pay particular attention to the outer borders of the airway, which are really framed by the jaws, the jaw structures, in terms of who to look for with that, we want to look at dentist or dentist or orthodontist. So they're really responsible and they can help modify the jaw growth with early orthodontic intervention, including palate expansion, to help develop the jaws. And I really think it's really important for parents to recognize that the palate is the floor of the nose. And we really do need to pay attention to it because there's enormous amounts of literature to support that. When we widen the palate, it actually opens up the nasal airway. That can improve nasal airflow and even reduce symptoms of obstructive sleep apnea. If a child has a narrow palate or orthodontic problems, then palate expansion and orthodontic treatment is another potential option. Quite often it gets to the root of the taking out things from inside the nose and throat. It's like removing furniture from a small room. If we can actually do orthodontic treatment to remodel the airway or make the outer borders bigger, that's a very effective intervention. Lastly, when we do things like pellet expansion and surgery, what these do is we take things out or we make the airway bigger. We actually need things to work better as well. When children have had mouth breathing for some time, we need to retrain them how to close their lips, we need to get them how to lift their tongue better. We want ideally, the tongue to be lightly suctioned to, to the roof of the mouth. And it's impossible to breathe through the mouth. And so that's really the one of the end goals and one of the things that's really missing when we want nasal breathing, not just closing the mouth, we want the tongue lightly suctioned to the roof of the mouth. So how do we achieve this? We can work with myofunctional therapists. Myofunctional therapists are people that actually work with the muscles of the mouth and the face to actually restore normal patterns, including lip seal or chewing and swallowing, and good tongue tone, where the tongue sits lightly to the roof of the mouth. And so myofunctional therapist can do targeted exercises to help children achieve those aims. And sometimes we have this thing called a tongue tie, which is a shortened attachment between the under surface of the tongue and the floor of the mouth, and it prevents the tongue from lifting. So addressing the tongue ties can be a really important part to achieve those goals of myofunctional therapy, getting that tongue resting correctly in the roof of the mouth and promoting good nasal breathing. There's a variety of options. And even then, I still work with a lot of other providers, including osteopaths and chiropractors who can address the body because the tongue is connected to the rest of the body through a connective tissue called fascia. So there's a lot of different other professionals that we can work in collaboration, even breathing retrainers who can actually teach children how to breathe properly. It involves a team approach.
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That is a lot of options. And if you want to learn more, check out Dr. Lim's book, Breathe, Sleep, Thrive. The link is in the show notes. Here's what I love about this approach is that it's not one fix or one solution. There are lots of options to help kids breathe well, and it isn't just about sleep or disruptive sleep. And snoring is just one sign. This is about giving their brains, bodies and emotions the oxygen they need to be successful. So tonight, if you hear that little rumble down the hallway, don't just smile and close the door. Take a moment, listen, maybe record it. Because that sound might be the first clue in a mystery that only you can solve. Okay, you know what you need to do next for your own family. And you might want to help your friends, too. Send this episode to your friend who laughs or complains about the bears living in their house. Thank you to Dr. Sherene Lim for helping us work through this issue. I hope you all get some good sleep tonight. For more from the pediatrician next door, find me on the web@ pediatriciannextdoorpodcast.com if you've got a question about the weird things kids do, send an email to helloediatriciannextdoorpodcast.com for a chance to hear your best on the show. I'm Dr. Wendy Hunter and I'm the pediatrician next door. This show is produced by Red Rock Music. Make sure to subscribe and leave a review wherever it is you're listening. I'll be back next time with more. Limu Key and Doug. Here we have the Limu emu in its natural habitat, helping people customize their car insurance and save hundreds with Liberty Mutual. Fascinating. It's accompanied by his natural ally, Doug Limu. Is that guy with the binoculars watching us? Cut the camera. They see us only pay for what you need@libertymutual.com Liberty Liberty Liberty Liberty Savings vary Underwritten by Liberty Mutual Insurance Co. Affiliates excludes Massachusetts the world moves fast.
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