Self-Assessment Checklist that may identify compromised growth, development, and function

Age group: 6 Years – 12 Years Old

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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.

*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 at rest (when not talking, playing, etc.) most of the day or routinely throughout the day

Why: At rest (when not eating or speaking, etc.), our mouths should be closed with lips sealed, and teeth slightly apart (~3-4mm). If mouths are open routinely, it increases the tendency to mouth breathe. Learn more about the importance of nasal breathing.

Difficulty breathing through nose, regular nasal congestion, 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

 Regularly has bags (dark circles) under eyes and/or complains of sore 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.

 Crowding of teeth (no spaces) and/or anterior open bite (space between front teeth when back teeth are touching)

 Forward head posture (center of ear lobe in front of middle of shoulder)

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

 Hyperactivity throughout the day and/or limited attention span (difficulty concentrating/focusing, etc.)

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

 Mouth open/lips apart and/or drool on pillow (regular)

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)

 Gasp/stop breathing

 Regular teeth grinding and/or wears a night guard

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.

 Frequent awakenings, regular nightmares, and/or night terrors (more than 1/week)

Boy (5-7) screaming at shadows of monsters on wallWhy: 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)

Current or history of regular bedwetting

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

Picky eater (e.g. avoidance of crunchy/fibrous foods and/or specific food textures)

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

Gags easily and/or difficulty swallowing pills

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.

Crowding Mixed Dentition

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.

Why: One of the possible reasons that should be investigated if a child gags easily and/or has difficulty swallowing pills is if they have a restricted/tethered tongue (tie) and/or compromised swallowing pattern (tongue thrust). As the tongue’s ability to function optimally is compromised, the child may gag more easily and/or have difficulty swallowing pills. Upon attempting to swallow pills, the child may say, “the pill keeps coming forward, it won’t go back”.
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