I was at a meeting with a group of physicians, dentists, speech and physical therapists, other health care providers, and the public who work to educate and provide integrated care for children and adults. The focus of the meeting was airway and how it impacts the health and development of children.

What is airway?

  • Airway refers to the passage by which air reaches the lungs.
  • The issue is that airway can be affected by anatomical issues like large adenoids and tonsils or a deviated septum, congestion, allergies, asthma, and a narrow jaw. All these things contribute to a change from healthy nasal breathing through your nose, to mouth breathing. Mouth breathing is not as efficient because of the way the air flows.

Why is airway important?

  • Quite simply, your airway and the shape of it or anything that interferes with it, prevents good breathing and the flow of oxygen to the lungs, and therefore, the brain.
  • Many children (and adults) who have problems breathing due to allergies or large tonsils and adenoids may snore at night — a sign that their airway is interrupted. Some even have apnea, a situation where the breathing stops for up to a minute at a time, many times throughout the night. The stops in breathing lead to poor sleep.
  • Consider what happens to a developing child’s brain if there are regular interruptions in oxygen. Snoring in children has been associated with problems in memory, language, and poor academic performance.
  • The American Academy of Pediatrics thinks airway is so important that they have issued new guidelines for screening children and adolescents for snoring at routine visits.

What does any of this have to do with ADHD?

  • ADHD (attention deficit hyperactivity disorder) in children is characterized by impulsivity, hyperactivity, and difficulty focusing.
  • If a child is not sleeping well because of problems with their airway (or any other reason for that matter) they will be tired. A sleepy child acts differently than a sleepy adult. Adults who are tired become withdrawn, and quiet and consider taking a nap. Children, on the other hand, try to keep themselves awake! To do this, they try to move around a lot, seem impulsive, or talk to themselves to stay awake. Many doctors believe that children are mistakenly diagnosed with ADHD when really they are suffering from sleep apnea and are just tired.

What are the signs that my child may have an issue with their airway?

There are both medical and physical changes that may occur with airway issues.


  • Allergies or asthma
  • Snoring
  • Large adenoids or tonsils
  • Bedwetting
  • Hyperactivity


Since breathing uses so many muscles, visible physical changes are common, many related to tooth and jaw position.

    • Narrow upper arch
    • Long, narrow face
    • Poor tongue posture
    • Crossbite
    • Small, poorly developed nostrils
    • Gummy smile
    • Open mouth posture (anterior open bite)
    • Short and turned-up upper lip

What do you do to treat airway issues?

  • Removal of adenoid and tonsils helps resolve about 90% of the issues.
  • Speech and myofunctional therapy that retrains tongue position and encourages nasal breathing.
  • Orthodontic intervention that expands the jaw and the airway.
  • Medication to treat allergies or asthma

The most important step in this process is diagnosis. If you suspect airway issues in your child, see their pediatrician, an ear-nose-throat specialist, or a dentist who understands these problems. Remember to be an advocate for your child. You know them better than anyone else so it’s your responsibility to find a professional who understands and can help you.

Dr Adams of Adams Dental

About the author

Dr. Allison M. Adams, recognized as one of the Top Dentists in New Jersey for the past 13 years by New Jersey Monthly Magazine, was born and raised in Madison, New Jersey, and is proud to deliver comprehensive dental care to her friends and neighbors. She completed her undergraduate studies in 1985 at the College of St. Elizabeth and went on to study dentistry at the UMDNJ-New Jersey Dental School, graduating in 1991. Over the past 25 years, she has traveled the country and spent thousands of hours attending continuing education courses in order to stay current in advances in the field. She has completed comprehensive post-graduate studies in orthodontics and implantology.