Asthma is a long-term condition that affects the passageways carrying air to and from the lungs. In patients with asthma, these passageways react to triggers such as allergens, chemicals, and viruses by inflaming and narrowing the airways. This makes it difficult to breathe and often results in a high-pitched sound (wheezing) or frequent coughing.
In very small children, asthma is diagnosed by a physician based on symptoms or response to medication. The physician may prescribe medication that acts on the small airways, allowing them to open up and improve airflow (bronchodilator).
If your child is six years of age or older, the most common test used to diagnose asthma is a Pulmonary Function Test (or Spirometry), in which a computerized device will measure airflow while your child breaths in and out.
If a diagnosis of asthma is made, your child's physician will likely prescribe two kinds of medications: one to control the condition (controller medications) and another to treat sudden symptom attacks (rescue medications).
- Controller medications include inhaled steroids, which prevent inflammation and help to reduce symptom attacks. These medications are available alone or in combination with a long-acting bronchodilator.
- Rescue medications include inhaled bronchodilators that open up the smaller airways during a sudden symptom attack and oral steroids for when sudden worsening of symptoms are not controlled with the inhaled medications.
Obstructive sleep apnea (OSA) occurs when your child’s breathing becomes partially or completely blocked repeatedly during sleep. It is generally caused by narrowing of the upper airways. In children, the most common conditions leading to OSA are enlarged tonsils and adenoids.
Patients may present with one or more of the following signs and symptoms:
- Frequent nighttime awakenings or restlessness
- Difficulty awakening in the morning
- Excessive daytime sleepiness
- Hyperactivity/behavioral problems
In younger children, the diagnosis for sleep-disordered breathing may be given based on history and physical exam (showing large tonsils and/or adenoids). The only definitive test for OSA is an overnight sleep study where your child’s breathing will be watched throughout the night using special sensors and monitors.
While there can be multiple causes, for the majority of children, tonsillectomy and adenoidectomy are the first line treatment. For overweight or obese children, weight normalization can also have a substantial impact. A nutritional consult can be beneficial for these patients.
CPAP or BIPAP, which are machines that provide breathing assistance using pressure are an option, but most children have trouble using this treatment.
Finally, some children will still have sleep apnea, even after tonsillectomy and adenoidectomy. For these children, there can be other surgical options.
Current Ongoing Clinical Research
If your child has Down syndrome and severe OSA and has been unable to use CPAP or BIPAP, we are currently conducting a multi-centered trial for use of the hypoglossal nerve stimulator to help manage these patients. Read about how the hypoglossal nerve stimulator implant has impacted a patient and his family.
Hypoglossal nerve stimulator implantation in an adolescent with Down syndrome and sleep apnea
Modified surgical approach to hypoglossal nerve stimulator implantation in the pediatric population
Hypoglossal nerve stimulation in adolescents with Down syndrome and obstructive sleep apnea
Laryngomalacia is the most common cause of noisy breathing (stridor) in infants. It occurs due to a collapse of structures above the voice box, blocking the lower airway when breathing in. It usually presents in the first few days or weeks of life and resolves on its own by age 12 to 20 months in 90 percent of infants. However, in about 10 percent, it may be severe, requiring surgery.
The cause of laryngomalacia is not exactly known but is thought to be one of two things: a floppy voice box due to immaturity of the cartilage and/or reflux. There are no specific risk factors for this disorder, but premature infants may have more severe symptoms.
- Inspiratory stridor (high-pitched noise while breathing in) that is often worse with crying, laying on back, or feeding
- Cyanotic episodes (turning blue)
- Retractions (sucking in of chest/neck with each breath)
- Apneic episodes (stopping breathing)
- Coughing/choking with feeds
- Penetration/aspiration (liquids or solids head toward or into airway with swallowing)
- Slow feeding
- Poor weight gain/failure to thrive
Laryngomalacia is diagnosed by history and physical exam. On physical exam, a small, thin, flexible scope is passed through the nose and used to examine the voice box, the physician is able to look for floppiness of the larynx and signs of reflux.
Both medical and surgical treatment options are available. For mild cases, no treatment is indicated as it may likely resolve on its own. For moderate cases, most infants will do well with medical treatment of reflux alone using anti-reflux medications. Infants with more severe symptoms or those who do not improve despite medical treatment may require surgery.
The surgery for this disorder is known as a supraglottoplasty and it is performed under anesthesia using a microscope or endoscope. While the noisy breathing may not completely resolve, the goal of the surgery is to allow for easier breathing and feeding.
Overnight stay in the hospital following surgery is typically required to monitor for any problems with breathing following surgery.