Habits that warrant correction prior to age 6

This is usually a result of the child stopping or at least slowing down a sucking habit while in school because of embarrassment.

However, recent research on sleep-related problems in young children has shown there are strong links between these habits and many behavioral and physiological problems, such as attention deficit, hyperactivity, mouth breathing, tooth grinding, daytime sleepiness and poor performance in school.

These associations are often the result of adverse problems in the early dentition, such as open-bites, narrowed palates, receding mandibles and protrusion of the upper arch and front teeth.

For example, a receding mandible, frequently accompanying an active thumb habit, often is responsible for a narrowing of the oropharynx because a retrusive mandible also is the cause of a retrusive tongue, which narrows the airway and reduces the air and oxygen intake of a young child. This is thought to cause many behavior and physiological problems.

Other problems, in addition to those already named, are morning headaches, irritability, bed wetting, talking in sleep, nightmares, a desire to sleep with parents, restless sleep, aggressiveness toward peers and difficulty in school, particularly with mathematics and spelling.

Many of these problems can be the result of other causes, but the association with habitual snoring is so strong that serious consideration should be given to a child’s sleep pattern.

What should the doctor be looking for in a 3- or 4-year-old patient? The most important procedure is to simply ask a parent if his or her child snores rather regularly. Further questions involve the symptoms listed above.

Snoring, however, is a very meaningful diagnostic element to ask about. Is there interrupted snoring involved where a child stops breathing for four seconds or more twice an hour or more? This is called sleep apnea and should be referred to the child’s pediatrician.

Also of importance is labored, difficult and loud breathing, as though the child is having difficulty getting enough air into his or her lungs. This is called hypopnea and should also be referred to a pediatrician.

Enlarged tonsils or adenoids are also strong indications for a referral.

When these symptoms are ruled out, the child probably can be significantly helped by one of three pre-formed, easy-to-wear removable appliances: the Nite-Guide, the Youth Habit Corrector and the Youth Snore Cure.

These appliances are generally used for various problems at this young age. The Nite-Guide is used to advance the mandible and tongue — or prevent them from slipping posteriorly while sleeping — and for cross-bites and occlusal problems as well as TMJ problems in the early deciduous dentition.

The Youth Habit Corrector is to correct mouth breathing, open bites and sucking habits. It also is capable of advancing the mandible and tongue.

The third appliance is the Youth Snore Cure, which also advances the mandible and tongue.

All three appliances can greatly lessen snoring and can also often correct many of the behavior and physiological problems mentioned above.

Anything that can influence a child’s normal sleep pattern, such as sucking habits, open bites, narrow palates and mouth breathing, should be corrected at a young age. All of these things, when left uncorrected, can have a strong influence on normal sleep by restricting the naso- and oropharyngeal airways, which can severely limit the amount of oxygen intake for a child.

(Note: This article was published in Ortho Tribune U.S. Edition, Daily at the AAO, Vol. 5, No. 3.)