Myofunctional Issues in Children Aged 2 – 5

Previously, we’ve introduced myofunctional therapy generally and discussed the symptoms of myofunctional issues which can be observed in babies. Today, we’re looking at the symptoms which can be observed in children aged roughly 2 to 5. There are a variety of physical and social problems which can be caused by myofunctional issues, so if you child shows some of the issues or behaviors below, they may benefit from myofunctional therapy.

Issues with food and eating
One of the clearest indicators of myofunctional issues in children in the two to five year old range is problems with food and eating. Common complaints of parents whose children have these issues are, “He is such a picky eater!” or “I can’t get him to eat many fruits or vegetables or meats, except chicken nuggets!” Problems can also include the child gagging or even throwing up when eating, or being an extremely messy eater. If your child is sensitive to food texture, or seems to be a picky eater, then this can indicate a problem with their swallowing. This occurs when the child cannot form a proper bolus with their tongue correctly to move the food to the center of the tongue and then push it back. In extreme cases, children may even choke on food if they cannot swallow correctly.

These issues may not be obvious when the child is first introduced to solid foods (around 6 months), because parents will start with very soft pureed foods. However, once the child becomes a little older (around 1 year) and starts to eat harder solid foods, problems can become apparent. So parents should be aware that these issues may become visible only when the child is a little older.

Speech symptoms
Another possible indicator of myofunctional issues is a delay in your child’s speech, or other speech problems. The child may say very little, or be hard to understand when they do speak, which can indicate problems with the positioning of the tongue. While some children do start speaking later than others, if you notice that your child seems frustrated by their lack of communication, this may indicate a physical problem rather than them just being a late developer. If you are unsure about your child’s speech development, check advice from speech and language organizations such as ASHA, which will describe how many words your child should be using at various ages, and what percentage of those words should be intelligible to you or to someone else.

Speech problems can be due to a tongue-tie (where the tissue connecting the tongue to the bottom of the mouth is too short), and performing a tongue-tie release (see frenectomy blog post for more information) can show an almost instant improvement in speech. In fact, some children will begin to speak more often and/or more clearly on the very day that the tongue-tie release is performed. Tongue-ties are related to myofunctional issues, as both involve problems with the tongue and swallowing.

Habits that contribute to myofunctional issues in this age group
Habits related to myofunctional issues include using a pacifier, prolonged bottle use, sippy cups, sucking on clothes or blankets, or sucking on digits (fingers/thumbs). A low tongue posture can be the result of any of the above mentioned habits, which leads to an improper swallow. Children start to suck on pacifiers, fingers or other things in order to stimulate the release of endorphins, which should happen during proper tongue rest posture and proper swallowing. In the absence of correct tongue posture and swallowing, habits like digit-sucking meet a need. Such habits are hard to break unless you retrain the tongue, and they change the growth of the face and jaws.

Sleep challenges and resultant behavioral symptoms
Children in the toddler and early school years with myofunctional issues are sometimes prone to sleep disturbances like sleep apnea, night terrors, frequent waking, snoring and/or bed wetting after potty training. Myofunctional issues are strongly related to these concerns and as they can lead to breathing problems (mouth breathing), which result in poor sleep. With poor sleep, behavioral changes can be observed. If children are displaying ADD/ADHD symptoms such as inattention, impulsivity, or low tolerance for frustration, then this can be caused by them not getting deep, good sleep. Parents may think that such behaviors are due to the child’s personality, but in fact they can be caused by myofunctional issues leading to enlarged tonsils/adenoids (see below) and resultant insufficient oxygenation at night and disturbing their sleep.

Growth and development
There are certain developments of the face and underlying bone structure which occur in the 2 to 5 years age range, during which myofunctional issues become noticeable. Babies are most often born with a set-back lower jaw and a button chin. Through nursing, their upper jaw grows outwards and forwards, expanding the palate because nursing postitions the tongue correctly, with the lower jaw following. If babies are bottle-fed as opposed to breastfed, whether this is due to breast pain or work reasons, the child can develop a low tongue posture and the jaws do not develop sufficiently. The lack of development of the jaws will lead to poor tooth position, loss of airway space, and swallowing problems. Any noticeable incorrect positioning of the jaw, like an overbite or underbite, is indicative of myofunctional issues.

Ear and tonsil infections
A final common symptom of myofunctional issues in young children is that they frequently develop ear infections and present with enlarged tonsils and/or adenoids. When swallowing is performed correctly, it clears the auditory tubes, reducing risk of ear infections. If the child is having problems with swallowing, then the tubes are not cleared correctly, and they are more likely to develop infections.

Similarly, the tonsils or the adenoids can become enlarged, encroaching on airway space due to mouth breathing. As we previously discussed, breathing through the nose is preferable from a health perspective as it cleanses and humidifies the air before it passes through the airway, lessening the likelihood of infection. Children who have myofunctional issues are more likely to breathe through their mouth, and so are at a greater risk for infection. In some cases, the tonsils can become so swollen due to infection that they become very large (hypertrophic) and can block off much of the upper airway, making nasal breathing impossible. In these cases, it is necessary for the child to have the tonsils removed before they can be trained to breathe nasally.

It should be noted that the relapse rate for sleep apnea and airway constriction after tonsils and/or adenoids are removed is greater than 50%. When a child has surgery to remove tonsils and adenoids because of frequent infections/sleep apnea/inability to breathe through nose, immune tissue often regrows and airway becomes a problem again. This is why it’s helpful to check for myofunctional issues as young as possible, so that therapy can begin before more serious problems develop. In many cases, myofunctional therapy can be used to reverse hypertrophic tonsils and adenoids, as well as correcting issues that lead to chronic ear infections.

Conclusion
If your child is displaying any of the symptoms described here, then it would be a good idea to get them checked for myofunctional issues. Myofunctional therapy may be able to help with behavioral issues related to sleep problems, and can improve a child’s eating, speaking, and social interactions.
The earlier therapy is started, the more effective it is.

If your child exhibits any of the above behaviors, then you should seek out a dentist whose practice specializes in myofunctional therapy, as not all dentists are familiar with this approach. Do some research online to find a suitable dentist in your area – or if you are in the Katy, TX area then come to Kidstown Dental where your child can be assessed by experts in myofunctional therapy. Give us a call on 281-542-4521 to make an appointment.

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