Self-Assessment Checklist that may identify compromised growth, development, and function
Age group: 6 Years – 12 Years Old
Key Signs and Symptoms that You can Assess
If you have answered Yes to multiple items below, we would encourage you to schedule a comprehensive airway, tongue, and lip assessment for your loved one at Little Bird Pediatric Dentistry by calling 905-876-2473 (BIRD) or visit our website (www.littlebirddental.ca) for further information.
While Child is Awake
Difficulty breathing through nose and/or avoidance of breathing through nose
Dry, cracked lips and/or regularly licking lips
Current or history of frequent ear infections, strep throat, and/or tonsillitis
Surgical removal of tonsils and/or adenoids
Speech difficulties (mumbling, lisp, and/or hard to understand)
Difficulty waking up in the morning and/or always tired, not rested
Falls asleep inappropriately during the day
Why: Good, correct posture requires amongst other aspects, that your tongue’s position at rest is up against the roof of the mouth (palate) just behind your upper front teeth. One of the possible causes of forward head posture may be if the child has a tongue restriction (tie) and/or the tongue rests downwards towards the floor of mouth. For every inch that your ear is in front of the middle of your shoulder, 10 pounds of weight is added to your cervical (neck) spine. Over time, this weight may reveal itself as neck pain, stiffness, and/or neck spasms in addition to headaches and/or sore eyes.
Regular neck pain, stiffness, tension, and/or spasms
Suffers from frequent headaches and/or migraines
Why: Although there are various possibilities for hyperactivity, one must understand that this is a common feature of children whom are over-tired, and may be showing signs of breathing disordered sleep (i.e. mouth breathing, snoring, obstructive sleep apnea, etc.). Young children are not able to comprehend being over-tired, and instead may demonstrate hyperactivity and an inability to focus or concentrate. Older children, teenagers and adults differ, as they are able to understand when they are tired and act accordingly. For example, think of when you drive late at night and are feeling tired. In order to stay awake, you might turn the volume up on the radio, roll down the windows and/or move around.
This is precisely what younger children are doing when they are overtired, but many times do not know how to stop.
Highly spirited (poor emotional regulation)
While Child is Sleeping
Why: When sleeping our mouths should be closed with lips sealed, guaranteeing that we are breathing through our noses. Learn more about the importance of nasal breathing.
If mouths are open (whether due to muscle memory, tongues trained to be down, tongue and/or lip tie, nose obstruction, etc.), it increases the likelihood of mouth breathing. Mouth breathing, snoring and/or heavy breathing are all possible audible signs of a compromised airway. In order to achieve optimized growth, development and sleep, the lips must be sealed at rest with the tongue up against the roof of the mouth (aka. palate).
Snoring with mouth open (more than 3x/week)
Why: Amongst a list of possible causes that includes stress, etc. Regular nightmares or night terrors may also be an indication that the child’s sympathetic nervous system (fight or flight) is being activated causing a macro (large) arousal (that will awaken the child) in attempt to re-establish and maintain their airway (breathing). We must remember that the number one goal of our bodies is to keep us alive – keep us breathing; therefore if there is any airway compromise while asleep, our bodies will be triggered to awaken. If this is occurring on a regular basis, your child may not be achieving consistent deep sleep with full muscle relaxation (parasympathetic nervous system – rest and digest activation) that is necessary for their optimized growth and development.
Restless sleep (always moving around and/or restless legs/arms)
Sweating heavily (pajamas and/or sheets regularly damp)
Glass of water (or drink) at bedside, as frequently awakens thirsty (throughout night or in morning)
While Child is Feeding (Current or History of Challenges)
a) History of Breastfeeding and/or Bottle Feeding Challenges
E.g. poor/shallow latch, gumming, reflux symptoms, poor weight gain, etc.
b) History of Mom’s Breastfeeding Challenges (as applicable)
E.g. cracked/creased nipples, pain with latch or with nursing, poor/incomplete breast drainage, etc.
c) Eating and Drinking Signs/Symptoms
Smacking sounds when chewing/swallowing (mouth open when chewing)
Difficulty swallowing (e.g. tongue thrust swallow, pushing food out of mouth, sensitive gag, etc.)
Difficulty drinking from an open cup
Poor/slow weight gain and/or failure to thrive
Why: If a child’s tongue rest posture and function are optimized along with lips sealed, nasal breathing, and teeth slightly apart (~3-4mm), their palate (roof of mouth) will likely develop to be flat and wide, allowing for adequate space for teeth to erupt (without crowding).
However, if one of these elements is not followed (i.e. tongue resting low in the mouth, compromised tongue thrust swallow, open mouth tendency and/or mouth breathing), the palate (roof of mouth) will likely develop to be narrow, high arched (can fit a thumb up) without adequate space for teeth to erupt, resulting in crowding.
The same compromised elements may also lead to the presentation of an anterior open bite (as seen in the picture), where there is a space between the front upper and lower teeth.
Why: Amongst a list of possible causes, bedwetting may also be an indication that the child’s sympathetic nervous system (fight or flight) is being activated causing a macro (large) arousal (that will awaken the child) in attempt to re-establish and maintain their airway (breathing). We must remember that the number one goal of our bodies is to keep us alive – keep us breathing; therefore if there is any airway compromise while asleep, our bodies will be triggered to awaken.
If this is occurring on a regular basis, your child may not be achieving consistent deep sleep with full muscle relaxation (parasympathetic nervous system – rest and digest activation) that is necessary for their optimized growth and development.
Why: There are many possible reasons for picky eating, however one that must not be overlooked is if the child has a mouth-breathing (open mouth) tendency, commonly seen in conjunction with a restricted/tethered tongue (tie) and/or compromised tongue thrust swallowing pattern. In this case, the child will tend to prefer a soft food diet that does not require much chewing as it is very challenging to breathe and eat with our mouths (humans are designed to breathe through our noses and eat with our mouths). Recall the last time you were sick with a congested nose, your diet too, likely consisted of soups, eggs, and soft foods.
Another possibility is if the child’s diet following 6 months was limited to soft foods that did not require the use of their muscles for chewing, they may develop a preference towards these foods.