I know you have been waiting so without further ado, here are the final results of Miss F’s sleep tests.
“Miss F snores during sleep, HOWEVER there was NO evidence of Obstructive Sleep Apnoea. Miss F has SIGNIFICANTLY restless sleep. There is fragmentation of sleep with frequent arousals of 10.8 an hour. Significant episodes of coughing and bruxing (tooth grinding) in sleep, consistent with GASTRO-EOSOPHAGEAL REFLUX DISTURBING SLEEP.
The was record of nasal airflow limitation and mouth breathing was prominent. Possible allergies causing mouth breathing and poor nasal airway.”
Surely an almost 3 year old wouldn’t STILL have problems with reflux????
In fact, according to Dr Jonathan Aviv, Clinical Professor of Otolaryngology and author of the book, The Acid Watcher diet, reflux disease has more than doubled since 1995. In fact reflux disease affects up to 8 % of children in Australia with percentages higher in infants. That means close to 4 million children are affected by reflux disease in Australia. That’s a lot.
This is what fascinates me with her case. The fact that, even I, as a health clinician, had no idea that at age 3, my child could still be experiencing reflux. It is something I was told by many a doctor that most kids grow out of by age 1. And she wasn’t in any pain or obvious discomfort. So if I don’t know, how does the average parent know these things?
What is also amazing to me also is that, despite surgery, my child still has significant issues that is causing her to wake almost 11 times an hour and continue to mouth breathe. I mean, doesn’t surgery fix everything?
So how does reflux affect the airway and sleep you ask?
Well, as reflux comes up the back of the throat, it burns the back the esophagus and can cause swelling and inflammation of tonsil and adenoid tissue over time. Not only that, it can cause central apnoeas as the brain tells the body to stop breathing so the lungs don’t ingest stomach acid.
Well that explains the “cough cough choke” thing we had been watching her endure.
So consequently, these children have a high risk of poor sleep and restless sleep.
But guess what makes it feel better?
You got it. Thumb sucking.
As the reflux comes up the back of the throat, Miss F can suck her thumb and swallow it back down. Sucking helps the digestive tract move the acidic juices back down the tract into the stomach and protect the airway. Also, the thumb produces “happy hormones’ which helps her to soothe herself back into her sleep cycle.
Pretty helpful when you wake up 11 times an hour, right?
Not only that, putting her thumb in her mouth helps her bring her bottom jaw forward, almost like a sleep appliance. This allows her tongue to come forward out of the back of her throat and create a bigger airway space. How clever of her! Imagine how much her little thumb has been helping her all this time!
And what did the doctor thinks could be contributing to her mouth breathing and poor nasal airway?
Having two older kids with significant allergies to grass, dust mites and animals, it makes sense that the apple wouldn’t fall far from the tree, and this may be affecting Miss F’s nasal breathing, even after surgery.
So, for now, its dust mite covers for Miss F, and a nasal spray before bed. She’s too little just yet for the immunotherapy, which is the only known way to desensitise children’s immune systems to allergens. (Also, just so you know, if your child is ever prescribed a nasal spray, it takes at least 6 weeks to take effect, so hang in there!)
Also, you might recall from Part 3, little Miss has very small airways (remember the doctor had to use infant intubation for her general anaesthetic?)
Lucky for her, her mother is an Orofacial Myologist. I’ve been working with her facial, tongue and throat muscles and try to help her build more muscle tone to promote lip seal and tongue position which will encourage her to nasal breathe. For this, we have a fun program especially for little ones that involves lots of chewy toys and eating exercises to keep it fun.
But what has been helping her all this time?
So the big question. As Carla from The Thumbsucking Clinic, am I making her stop sucking her thumb right now?
Will she need to?
Yes. Its not good for her oral, facial and jaw development in the long term.
Is it ok for now?
Yes. Because we have other things to get right first, and until then, little one must BREATHE and FUNCTION and be her best self.
So what about all this “Stop Thumbsucking” stuff?
Yes its important, it must stop. All kids should stop. BUT first we need to work out WHY the sucking is happening in the first place. Then, and only then, are we truly doing the right thing by each and every child.
So the answer is Yes. Yes we will. But in due course.
And we can help YOUR child too.
But please, let us ensure that first, these kids are healthy.
And once that bit is sorted, the thumb will be the easy part.
Trust me. xx
A further update on Miss F here