Optimized Growth, Development and Function

Age group: 3 Years – 5 Years Old

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Key Signs and Symptoms that You can Assess

If you have answered Yes to 1 or more items in the checklist below, this may indicate an opportunity to improve the growth, development and function of your loved one.

We would encourage you to schedule a caring & comprehensive assessment at Little Bird Pediatric Dentistry by calling 905-876-2473 (BIRD) or through the “Schedule an Appointment” button on our website (www.littlebirddental.ca).

*For specific findings, click on “” to see a picture example and the reasoning (or why) behind.

*For specific findings, click on to see a picture example and the reasoning (or why) behind.

While Child is Awake

 Mouth open (lips apart) most of the day or routinely throughout the day for over 30 seconds at a time

3-5 year old awake mouth openWhy: At rest (when not eating or speaking, etc.), our mouths should be closed with lips sealed. If mouths are open routinely, it increases the tendency to mouth breathe. Learn more about the importance of nasal breathing.

 Chronic running/congested nose

 Difficulty breathing through nose

 Dry, cracked lips and/or habit of licking lips

 Any history of frequent infections (Ear infections, Strep throat, Tonsillitis, etc.)

 Speech difficulties (mumbling, lisp, and/or hard to understand)

 Regularly have bags (dark circles) under eyes

Bags under eyesbags under eyes - circles under eyes

Why: Bags or dark circles under eyes are due to venous pooling, and is a sign that a child is not attaining a necessary length of quality (deep) sleep. This may be found in association with open mouth posture (mouth breathing while sleeping), snoring and/or heavy breathing (aka. breathing disordered sleep). Please see sleeping section below for further signs and symptoms that you can assess.

 Difficulty waking up in the morning and/or always tired, not rested

 Avoidance crunchy/fibrous foods (picky eater)

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.

picky eater 4 year oldchild 5 years old picky eater

 Smacking sounds when chewing/swallowing

 Crowding of teeth and/or anterior open bite (space between front teeth when back teeth are touching)

 Hyperactivity throughout the day

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.

 Limited attention span (difficulty concentrating/focusing, etc.)

 Any history of breastfeeding difficulties

While Child is Sleeping

 Mouth open (lips apart)

Toddler sleeping mouth openWhy: 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 or heavy noisy breathing (more than 3x/week)

 Gasp/stop breathing

 Drool on pillow (regularly)

 Audible teeth grinding

 Restless sleep (always moving around and/or restless legs/arms)

 Regular nightmares and/or night terrors (more than 1/week)

3-5 year old night terrorsWhy: 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.

 Sweating heavily while sleeping (pajamas and/or sheets damp)

 Bedwetting

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.

Primary teeth anterior open bite

Child with all their baby (primary) teeth, demonstrating an anterior open bite (space between upper and lower front teeth, when back teeth are together)

Why: If a child’s tongue rest posture and function are optimized along with lips sealed and nasal breathing, 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: Teeth grinding, restless sleep and/or sweating heavily can all be possible indications that the child’s sympathetic nervous system (fight or flight) is being activated causing micro (small) arousals (that typically do not awake the child) in attempt to maintain their airway (breathing). If this is occurring, 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.

Primary teeth grinding

Upper baby teeth of child with generalized tooth grinding, showing even/flat wear across all upper teeth

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