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My child has symptoms of sleep apnea, but her tonsils and adenoids look fine. Now what?

Posted on March 2nd, 2020

The current first line of treatment for pediatric sleep apnea is the removal of tonsils and adenoids. But what happens when your dentist and your ENT fail to find an issue with a child’s tonsils and adenoids?  

In some children, the obstruction is caused by swollen tonsils and adenoids, but other physical features can also lead to sleep apnea in children.   

Unresolved tongue tie  

A tethered tongue cannot rest in the roof of the mouth during sleep and instead blocks the windpipe. If your child had a tongue tie at birth but the pediatrician opted not to revise it, the tie could be contributing to your child’s sleep apnea issues. The good news is that, even at older ages, tongue tie surgery is simple and provides instant relief.  

However, older children may have developed bad habits because they were coping with a tongue tie. Your child may need an oral appliance or myofunctional therapy to learn how to rest their tongue on the roof of the mouth when sleeping.  

High narrow palate 

If your child had a tongue tie or has certain genetic conditions, the shape of the palate may be causing sleep apnea. A high, narrow palate changes the shape of the sinus cavity. That makes it harder for a child to get adequate oxygen while sleeping.  For many children, an oral appliance can spread the palate and help the sinus cavity achieve an appropriate shape. And a palate spreader can also prevent future orthodontic issues.

Allergies and asthma

Poorly controlled allergies and asthma can make it difficult for a child to get enough oxygen at night, cause microarousals, and impact their overall quality of life. If you suspect your child may need additional allergy and asthma treatments, a pediatric allergist can help diagnose and treat your child.

Sleep issues affect every aspect of a child’s life, and it can be frustrating when there isn’t an obvious tonsil issue during the initial examination. However, even if your child’s OSA isn’t caused by enlarged tonsils and adenoids, your child’s care team can help your track down the underlying issues and ensure that your child gets the right treatment.

Dr. Meghna Dassani has practiced dentistry for over two decades and is passionate about the role dentists play in whole-body health. You can learn more at her website:

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