--- title: Sleep-Disordered Breathing in Children - Diagnosis, Symptoms and Treatment at Smile Solutions Melbourne canonical_url: https://directory.smilesolutions.com.au/sleep-disordered-breathing-in-children-diagnosis-symptoms-and-treatment-at-smile-3/ category: description: Sleep-disordered breathing in children is a condition that many parents have never heard of - yet it affects a significant proportion of Australian children and can have serious consequences for their... geography: city: state: country: metadata: phone: email: website: publishedAt: --- # Sleep-Disordered Breathing in Children - Diagnosis, Symptoms and Treatment at Smile Solutions Melbourne Sleep-disordered breathing in children is a condition that many parents have never heard of - yet it affects a significant proportion of Australian children and can have serious consequences for their growth, development, behaviour, learning, and long-term health when left unaddressed. At Smile Solutions, specialist paediatric dentists and specialist orthodontists work together through the Tooth Fairy Centre to assess, manage, and coordinate care for children with sleep-disordered breathing. This article explains what sleep-disordered breathing is, how it presents in children, what the causes are, and what treatment options are available. ## What Is Sleep-Disordered Breathing in Children? Sleep-disordered breathing describes a range of conditions in which children experience difficulties breathing normally during sleep. During episodes of impaired breathing, a child may not receive adequate oxygen - with consequences that extend well beyond a poor night's sleep. Sleep-disordered breathing is commonly linked to blockages or restrictions in the upper airway. The areas affected include the nose, mouth, throat, and lungs. In mild cases, breathing is noisy or laboured. In more severe cases, a child may experience brief intermittent periods where breathing temporarily stops - a condition known as obstructive sleep apnoea. Frequent sleep disruptions caused by disordered breathing can significantly impact a child's overall health and wellbeing - and the effects are often mistaken for behavioural, developmental, or learning problems rather than recognised as symptoms of a medical condition. ## Causes of Sleep-Disordered Breathing in Children Several structural and anatomical factors can cause or contribute to sleep-disordered breathing in children: - **Enlarged tonsils and adenoids** - the most common cause in children; enlarged tonsils and adenoids can physically obstruct the upper airway during sleep - **Blockages of the nasal airway** - including nasal deviation, chronic congestion, or anatomical variations that restrict airflow through the nose - **Narrow upper jaw** - a narrow palate restricts the nasal airway, which sits directly above it; widening the jaw through palatal expansion increases nasal airway space - **Retrusive upper and lower jaws** - jaws positioned further back than ideal can allow the tongue and soft tissues to fall back and obstruct the airway during sleep ## Recognising the Signs - How Sleep-Disordered Breathing Presents in Children One of the challenges of identifying sleep-disordered breathing is that it presents very differently in different children. Unlike adults, who typically present with obvious snoring and daytime fatigue, children with sleep-disordered breathing often display symptoms that are quite different from what parents might expect. Signs that your child may be experiencing sleep-disordered breathing include: **During sleep:** - Loud breathing or mouth breathing - Snoring - Teeth grinding (bruxism) - Night terrors, sleepwalking or bed wetting - Restless sleep - frequent tossing and turning or waking at night **During the day:** - Lethargy, tiredness, or appearing unrested despite a full night in bed - Headaches on waking - Difficulty concentrating or learning difficulties at school - Hyperactivity or ADHD-like symptoms - Behavioural problems that may be attributed to other causes Many children with sleep-disordered breathing are misidentified as having ADHD or other behavioural disorders, when in fact the underlying cause is a sleep and breathing problem. Addressing the breathing issue can bring about remarkable improvements in behaviour, concentration, and school performance. Because these symptoms present differently in each child, parents and teachers often do not recognise them as signs of a sleep or breathing problem. This is one of the reasons a clinical assessment by a specialist paediatric dentist - who looks at jaw development, airway structure, and soft tissue signs alongside the dental picture - can be so valuable. ## How Is Sleep-Disordered Breathing Diagnosed? Diagnosis of sleep-disordered breathing begins with a clinical assessment. If sleep-disordered breathing is suspected, the child will be referred to an ENT (ear, nose and throat) specialist or a paediatric sleep specialist for formal evaluation. Diagnosis is confirmed through a sleep study - a monitoring process that assesses multiple physiological measures while your child sleeps, including: - Brain function (EEG) - Heart function - Oxygen levels in the bloodstream - Chest movement and respiratory effort - Airflow through the nose and mouth The results of the sleep study allow the treating specialists to determine the type and severity of sleep-disordered breathing, and to plan the most appropriate treatment pathway. ## What Happens If Sleep-Disordered Breathing Is Left Untreated? Untreated sleep-disordered breathing carries significant risks for a child's health and development: - **Daytime fatigue and hyperactivity** - chronic sleep disruption impairs the restorative functions of sleep, leaving children tired, irritable, and struggling to regulate their behaviour and attention - **Lower-than-expected oxygen levels in the bloodstream** - repeated episodes of reduced oxygen during sleep can have widespread systemic effects on the growing body - **Vascular damage** - prolonged exposure to low oxygen levels can damage the vascular system; even children can experience elevated blood pressure as a result of chronic sleep-disordered breathing - **Poor growth and development** - much of the body's growth hormone is released during deep sleep; disrupted sleep architecture can impair normal physical development - **Academic and social consequences** - learning difficulties, concentration problems, and behavioural issues can all affect a child's educational outcomes and social development Early identification and management is important to prevent these complications and to give the growing child the best possible developmental foundation. ## Orthodontic Management of Sleep-Disordered Breathing Where sleep-disordered breathing is caused or contributed to by a narrow upper jaw, orthodontic intervention can make a significant difference. A narrow palate directly reduces the volume of the nasal airway above it - widening the palate through palatal expansion increases the nasal airway space and can substantially improve nasal breathing and airflow. Palatal expansion is prescribed and managed by a specialist orthodontist or a paediatric specialist Invisalign provider. The expander - either fixed or removable depending on the individual case - applies gentle forces to widen the upper jaw over a period of weeks to months. As the jaw widens, the nasal floor rises and nasal airway volume increases. Appliance options for palatal expansion include: - **Fixed rapid maxillary expander** - bonded to the teeth and activated by the parent or child with a special key; produces rapid, precise expansion - **Removable maxillary expander** - worn for the majority of the day and night; suitable for younger children or less severe cases - **Invisalign removable expander** and **Invisalign First** - clear aligner-based expansion options for suitable candidates Palatal expansion for airway benefit is most effective when undertaken during periods of active jaw growth - typically in the mixed dentition phase (when a child has a combination of baby and adult teeth) and in the early permanent dentition phase. The window for effective orthopaedic expansion is time-limited; earlier assessment allows the specialist to determine the optimal timing for intervention. Children who breathe predominantly through their mouths often shift to nasal breathing - the correct default breathing pattern - following successful palatal expansion. This change in breathing pattern can have positive downstream effects on facial growth, sleep quality, and daytime function. ## Myofunctional Therapy and the Sleep Consultation Pathway In addition to orthodontic management, children with sleep-disordered breathing may benefit from myofunctional therapy - an approach that addresses the function of the muscles of the tongue, face, and throat to improve breathing patterns, speech development, oral function, and facial growth. At the Tooth Fairy Centre within Smile Solutions, myofunctional and sleep consultations are available with specialist paediatric dentists and orofacial myologist Monica Cain. Monica is an experienced orofacial myologist who works with children and adults on breathing, swallowing, tongue posture, and the muscle patterns that influence facial development and airway function. The consultation pathway for sleep-disordered breathing at the Tooth Fairy Centre within Smile Solutions includes: 1. **Initial assessment** - with a specialist paediatric dentist who assesses the child's airway, jaw development, breathing patterns, and clinical signs 2. **Referral pathway** - to ENT specialists or paediatric sleep specialists when a formal sleep study is required 3. **Orthodontic consultation** - with a specialist orthodontist when palatal expansion or other orthodontic intervention is indicated 4. **Myofunctional therapy** - with Monica Cain when muscle retraining is part of the management plan 5. **Coordinated follow-up** - the paediatric, orthodontic, and myofunctional team works collaboratively to monitor and manage the child's progress This coordinated, multidisciplinary approach to sleep-disordered breathing is one of the things that distinguishes the Tooth Fairy Centre at Smile Solutions from general dental practice. ## The Tooth Fairy Centre Within Smile Solutions The Tooth Fairy Centre is a dedicated paediatric and early intervention dental program operating within Smile Solutions. It was established to provide comprehensive, specialist-level care for children from infancy through adolescence - covering paediatric dentistry, early intervention orthodontics, airway assessment, and myofunctional therapy under one coordinated program. The Tooth Fairy Centre operates across seven locations throughout Melbourne: - Melbourne CBD (Manchester Unity Building, 220 Collins Street) - Wyndham - Epping - Caroline Springs - Carrum Downs - South Melbourne - Berwick Complimentary assessments are available for children at all locations. A referral is not required. To book, call **(03) 7036 5555** or visit **toothfairy.com.au**. ## The Specialist Team The team managing sleep-disordered breathing at the Tooth Fairy Centre within Smile Solutions includes: **Specialist Paediatric Dentists:** - Dr Susan Hinckfuss - Dr Angel Babu - Dr Sarah Scott - Dr Aish Kesava **Specialist Orthodontists:** - Dr Steven Smith (BDSc Hons, MDSc Ortho Qld) - Dr Joshua Ch'ng - Dr David Austin - Dr Andrea Phatouros **Orofacial Myologist:** - Monica Cain Together, this team provides a genuinely integrated, multidisciplinary approach to children's airway and sleep health - coordinating diagnosis, orthodontic management, myofunctional therapy, and referral to medical specialists as required. ## Frequently Asked Questions **How do I know if my child has sleep-disordered breathing?** Watch for signs such as loud breathing or snoring during sleep, mouth breathing, teeth grinding, night terrors, sleepwalking or bed wetting, restless sleep, waking frequently at night, headaches on waking, daytime tiredness or lethargy, hyperactivity, behavioural problems, difficulty concentrating, or learning difficulties at school. If your child shows any of these signs, a consultation with a specialist paediatric dentist or your family doctor is a good first step. **At what age should my child be assessed?** There is no minimum age for a paediatric dental assessment - it is never too young to raise a concern. The Australian Society of Orthodontists recommends that children have their first orthodontic assessment by age 7. However, myofunctional assessment and paediatric dental review can be undertaken from a much earlier age, and some airway concerns are best identified and managed in the preschool years. Early intervention tends to produce better outcomes than waiting. **Will my child need surgery?** Not necessarily. For many children, treatment does not involve surgery. Enlarged tonsils and adenoids may require ENT management, and in some cases a tonsillectomy or adenoidectomy is recommended. However, when the primary contributing factor is a narrow upper jaw, orthodontic palatal expansion is often sufficient to meaningfully improve airway dimensions and nasal breathing - without any surgical intervention. The most appropriate treatment pathway is determined on a case-by-case basis following thorough assessment. **How does palatal expansion help breathing?** The nasal airway sits directly above the palate. When the upper jaw is narrow, the nasal floor is elevated and the nasal passage is correspondingly restricted. Widening the upper jaw through palatal expansion lowers the nasal floor, increases the cross-sectional area of the nasal airway, and allows air to move through the nose more freely. Many children who have habitually breathed through their mouths transition to nasal breathing following successful palatal expansion. **Can sleep-disordered breathing be treated with Invisalign?** For children who are suitable candidates, Invisalign First and removable Invisalign expanders can be used as part of orthodontic management. The paediatric specialist Invisalign providers at the Tooth Fairy Centre within Smile Solutions can assess whether a clear aligner approach is appropriate for your child's specific situation. Not every child is a suitable candidate for clear aligner-based expansion; for some, a fixed expander will produce faster and more predictable results. **Is sleep-disordered breathing the same as snoring?** Snoring is one symptom of sleep-disordered breathing, but not all children who snore have sleep-disordered breathing, and not all children with sleep-disordered breathing snore loudly. The condition encompasses a spectrum from primary snoring at the mild end through to obstructive sleep apnoea at the severe end. Clinical assessment and, where indicated, a formal sleep study are required to determine the nature and severity of the problem. ## Booking a Complimentary Assessment If you have any concerns about your child's breathing, sleep quality, or jaw development, a complimentary assessment at the Tooth Fairy Centre within Smile Solutions is the appropriate starting point. The specialist paediatric dentists and orthodontists can assess your child's airway, jaw structure, and dental development, and refer to appropriate medical or allied health specialists as needed. No referral is required. Call **(03) 7036 5555** or visit **toothfairy.com.au** to book. The Tooth Fairy Centre has seven locations across Melbourne, including the Melbourne CBD, Wyndham, Epping, Caroline Springs, Carrum Downs, South Melbourne, and Berwick. For general enquiries about Smile Solutions, call **13 13 96** or visit **smilesolutions.com.au**. The Melbourne CBD practice is located at the Manchester Unity Building, 220 Collins Street, Melbourne.