We don’t generally think of kids as having sleep apnea, but in the April issue of Sleep Review, Dr. Dennis Rosen uncovers information about the “baby steps” required to help kids use their PAPs. OSA is prevalent in 1% to 4% of children. Before putting youngsters on a CPAP, doctors will first perform an adenotonsillectomy (removal of the tonsils and the adenoids) to help open the breathing pathways. According to KidsHealth.org, an adenotonsillectomy will cure or improve symptoms of OSA in 80% to 97% of cases. If it doesn’t, a doctor will suggest the child use a CPAP or BiPAP. Getting kids to use a PAP, though, can be frustrating and time consuming—for kids and parents.
In a study of 79 children 6 to 18 in age who were put on nasal CPAPs, 18% of the kids refused to use the device. Of the 82% who were willing to use a PAP, 48% took to it immediately but 52% gradually got used to the PAP over a span of time ranging between 9 and 295 days. Can you imagine the patience required of parents to go 295 days?
According to Dr. Rosen, the right combination matters to help kids become “compliance-minded.” This includes close monitoring, intervention, and follow-up by a sleep doctor and starts with a proper mask fitting. Then the child is allowed to take the mask home to play with it, put it on while watching TV or hearing a bedtime story. The intention is create positive associations with the mask. Once the child is used to the mask, a CPAP titration is conducted to introduce the child to therapy. Therapy is titrated to eliminate obstruction in 1-2 cm H2O increments and sometimes only after the child has fallen asleep.
Just like adult CPAP users, kids can experience dry mouth, condensation of water in the air hose, and skin irritation from the mask as well as other problems. And, it is not unusual for parents to underestimate the actual PAP use by their child. This can be further frustrating and discouraging. The follow-up appointments are very helpful for both kids and their parents.
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