The Relationship Between Your Child’s Facial Development and Obstructive Sleep Apnea

Nature vs. Nurture. 

You have no doubt heard of this expression when discussing psychological and cognitive development of children. Is it in the genes, in the environment, or both? 

When it comes to a child’s facial development it is both. Children clearly have a genetic template that they start with, but of great significance are the environmental factors that we, as parents and healthcare providers can have influence over to maximize the best developmental potential for every child.

In particular, I am referring to the constellation of tongue position when swallowing, proper nutrition, and breathing pattern; through the mouth or nose.

The development of the middle part of the face, particularly the nasal and upper jaw/teeth area is highly influenced by where a child places their tongue when swallowing.   Proper placement of the tongue when swallowing (up against the palate, not down between the front teeth) will determine if the upper jaw develops wide enough to accommodate the size of all the upper teeth, and if the nasal cavity (the upstairs neighbor above the palate) will develop broadly enough to facilitate nasal breathing.  In addition, if the tongue has a low placement (tongue thrusting swallow), the upper and lower jaws will tend to drop lower relative to the lip position, leading to gummy looking smiles, and long narrow faces as seen in photo 1. Crowding of the teeth is a common finding in such children, as well as an anterior open bite, where the front teeth do not meet. See photo 2.

Improper tongue placement when swallowing can start off as early as infancy! Some experts observe that breastfed children have better tongue postures than non-breastfed infants.  Children who continue to tongue thrust develop longer, narrow faces, are mouth breathers, and frequently lisp. This should be detected early so that corrective measures can be made.   Speech therapists and oral myofunctional therapists are helpful in correcting improper tongue posture.

Next, food choices. Chewing certain foods will exercise the muscles of the upper and lower jaws- determining their development.  A diet rich in fibrous fruits and vegetables will increase muscle strength, reducing the tendency to develop a “long-face” that is seen in children and later on as adults. (See photo 1) Lastly, and most serious, is the relationship of the tongue placement to development of Obstructive Sleep Apnea (OSA), a life threatening problem.  OSA is a condition where breathing stops for a period during sleep. These episodes can last from 30 50 seconds or more.   This deprives the brain of oxygen.  This condition is linked with heart disease, stroke, diabetes, daytime sleepiness, morning headaches and increased risk of motor vehicle accidents.  Patients with

OSA typically snore at night when the lower jaw relaxes and drops back. This is caused when the respiratory path is temporarily blocked, usually by a large tongue that drops back into the throat during sleep, as well as a long, low positioned soft palate.  Patients experiencing OSA have larger tongues, neck size, and may be overweight.

What does this have to do with the facial development of a child?  As mentioned, a low tongue placement inhibits the development of a broad palate, which provides the tongue enough room to “park”.  If the palate isn’t large enough to accommodate the tongue, the tongue has no choice but to drop down and away from the palate, into the throat, thereby blocking the airway path. While a well developed palate and proper tongue posture are important, they alone aren’t the only factors in OSA, but are important ones.  They are perhaps some of the few influences that we can have in a child’s facial/respiratory development that will optimize the genetic package that he/she is born with.

If your child keeps his/her mouth open most of the time, breathes through their mouth or has a perpetually stuffy nose I highly recommend that they first be seen by their pediatrician or pediatric ENT specialist.  This should be detected as early as possible.  This is an under diagnosed problem that should not be ignored, even if your pediatrician doesn’t identify it.

These problems are also readily identified during your child’s first orthodontic examination, which should be no later than age 7, according to the American Association of Orthodontists.  (See My Blog Post 2.15.13 "Why Should My Child See an Orthodontist, He's Only 7 Years Old!")

For more information visit our website www.braceace.com.  For additional questions, please feel free to contact me or respond to my Blog. Your comments and feedback are always welcome!