Breathing In Children Research Articles

Sleep Disordered Breathing in Children

Sleep disordered breathing (SDB) is a disease characterized by repeated hypopnea and apnea during sleep due to complete or partial obstruction of upper airway. The prevalence of pediatric SDB is approximately 12 - 15%, and the most common age group is preschool children aged 3 - 5 years. Children show more varied presentations, from snoring and frequent arousals to enuresis and hyperactivity. The main cause of pediatric SDB is obstruction of the upper airway related to enlarged tonsils and adenoids. If SDB is left untreated, it can cause complications such as learning difficulties, cognitive impairment, behavioral problems, cardiovascular disease, metabolic syndrome, and poor growth. Pediatric dentists are in a special position to identify children at risk for SDB. Pediatric dentists recognize clinical features related to SDB, and they should screen for SDB by using the pediatric sleep questionnaire (PSQ), lateral cephalometry radiograph, and portable sleep monitoring test and refer to sleep specialists. As a therapeutic approach, maxillary arch expansion treatment, mandible advancement device, and lingual frenectomy can be performed. Pediatric dentists should recognize that prolonged mouth breathing, lower tongue posture, and ankyloglossia can cause abnormal facial skeletal growth patterns and sleep problems. Pediatric dentists should be able to prevent these problems through early intervention.

Micro-characteristics of a naturally ventilated classroom air quality under varying air purifier placements

A naturally-ventilated operational classroom was instrumented at 18 locations to assess spatial variations of classroom air pollution (CRAP), thermal comfort and ventilation indicators under 10 different scenarios (base scenario without air purifier (AP); three single AP scenarios; three scenarios with two APs at same locations; three scenarios with two APs at different locations). Unlike PM2.5, monitored PM10 and CO2 concentrations followed the diurnal occupancy profile. Highest vertical variation (38%) in CO2 was at the classroom entry zone at 40–300 cm height. CO2 increased until 225 cm before stratifying further. PM10 increased to highest levels at children sitting height (100 cm) before decreasing to adult breathing height (150 cm). Highest horizontal variations in CO2 (PM10) were 29% (22%) at 40 cm height between the entry and occupied zones. Teachers' exposure to CO2 (PM10) in breathing zone varied by up to 6% (3%); the corresponding variations across monitored locations were up to 14% (19%). Teachers' exposure to CO2 was up to 13% higher than that of children and 18% lower for PM10. Traffic emissions (PM2.5 and NOx), secondary pollutants (VOCs and O3), thermal comfort parameters and noise level in the classroom varied insignificantly among scenarios. PM10 reduction was not doubled by using two air purifiers, which were most effective when placed within the highest PM concentration zone. Cross-comparisons of scenarios showed: use of AP reduced classroom's spatial average PM10 up to 14%; PM10 was reduced by increasing the AP's filtration capacity; and AP had insignificant impact on spatial average CO2. PM10 showed a maximum reduction of 46% (teacher zone), 62% (occupied zone) and 50% (entry zone) at children's breathing height, depending on usage scenario. This study produced high-resolution data for validating the detailed numerical models for classrooms and informing decision-making on AP's placement to minimise children's exposure to CRAP and re-breathed CO2.

A Descriptive Study of Speech Breathing in Children With Cerebral Palsy During Two Types of Connected Speech Tasks.

This study examined speech breathing during two connected speech tasks in children with cerebral palsy (CP) and typically developing (TD) peers. Understanding how the respiratory system supports speech production during various speech tasks can help researchers construct appropriate models of speech production and clinicians remediate speech disorders effectively. Four children with CP and four age- and sex-matched TD peers completed two speech tasks, reading and extemporaneous speech. Respiratory kinematic and acoustic data were collected. Dependent variables included utterance length, speech rate, sound pressure level, and lung volume variables. Based on descriptive results, children with CP and speech motor involvement demonstrated reduced utterance length and speech rate, equivalent intensity levels, and changes in lung volume variables indicative of respiratory physiological impairment as compared to their TD peers. However, children with CP and no speech motor involvement exhibited speech production and speech breathing variables in the more typical range. In relation to task effects, the majority of children (CP and TD) produced shorter utterances, slower speech rates, equivalent intensity levels, higher lung volume initiation, termination, excursion, higher percent vital capacity per syllable, and longer inspiratory duration during extemporaneous speech as compared to reading. Two major themes emerged from the data: (a) Children with CP, particularly those with concomitant speech motor involvement, demonstrate different speech production and speech breathing patterns than their TD peers. (b) Speech task impacts speech production and speech breathing variables in both children with CP and their TD peers, but the extemporaneous speech task did not seem to exaggerate group differences.

Commentary on the First-Line Support for Assistance in Breathing in Children Trials on Noninvasive Respiratory Support: Taking a Closer Look.

Noninvasive respiratory support modalities such as high-flow nasal cannula (HFNC) therapy and continuous positive airway pressure (CPAP) are used frequently in pediatric critical care to support acutely ill children with respiratory failure (step-up management) and children following extubation (step-down management). Although there are several observational studies and database analyses comparing the efficacy of HFNC and CPAP, and a few small randomized clinical trials (RCTs), until recently, there were no large RCTs comparing the two modalities in a mixed group of critically ill children. In the first half of 2022, results from the First-Line Support for Assistance in Breathing in Children (FIRST-ABC) trials were published; these comprised a master protocol of two trials: one in acutely ill children (step-up RCT) and one in extubated children (step-down RCT). Each of these pragmatic trials randomized 600 children to either HFNC or CPAP when the treating clinician decided that noninvasive respiratory support beyond standard oxygen therapy was required. The primary outcome was time to liberation from all forms of respiratory support (invasive and noninvasive), excluding supplemental oxygen. The FIRST-ABC trials represent a significant advance in the field of noninvasive respiratory support, which has traditionally been evidence-poor and associated with considerable variability in clinical practice. In this article, we provide an overview of how the FIRST-ABC trials were conceived and conducted, our view on the results, and how the trial findings have changed our clinical practice.

Aerosol generation during paediatric procedural sedation with continuous-flow nitrous oxide suggests a low risk of airborne viral transmission to health-care workers.

Inhaled nitrous oxide is a common form of procedural sedation in paediatric care. During the COVID-19 pandemic, concerns about potential aerosol generation and associated viral transmission to health-care workers have led to controversy regarding its use. We aimed to measure the degree of aerosol generation during continuous flow nitrous oxide sedation to inform future guidelines. Aerosol numbers in the respirable range were measured using a particle counter during 30 procedures undertaken in children under nitrous oxide sedation in the Emergency Department. Changes from baseline measurements were greatest in particles in the 0.3μm range. The mean increase from baseline in 0.3μm particles per cubic metre was 18 022 (95% confidence interval (CI) 5949-30 096) after the child entered the room, and 2931 (95% CI -4407 to 10 269) during nitrous oxide administration. Variation of respirable particle numbers from baseline levels was no greater during nitrous oxide administration than for breathing and talking asymptomatic children. These results suggest the additional risk of airborne viral transmission to staff during inhaled nitrous oxide sedation is low.

50% effective concentration of sevoflurane for immobility in cerebral palsy children undergoing botulinum toxin injection.

Background:This prospective study aimed to determine the optimum end-tidal sevoflurane concentration required for immobility during botulinum toxin injection in spontaneously breathing children with cerebral palsy (CP).Methods:Twenty-three children with spastic CP, aged 3 to 12 years, with American Society of Anesthesiologists (ASA) physical status I and II, scheduled to receive botulinum toxin type A injection were enrolled in the study. After induction of deep sedation using pre-filled 8% sevoflurane in oxygen and maintenance of the predetermined end-tidal sevoflurane concentration, the botulinum toxin was injected in spontaneously breathing children. The response to the botulinum toxin injection was classified as “movement” or “no movement” by an independent investigator who was blinded to the predetermined end-tidal sevoflurane concentration and bispectral index (BIS) value. The end-tidal sevoflurane concentration was predetermined, initiating at 2.0% with 0.2% as a step size in the next patient depending on the previous patient’s response using the modified Dixon’s up-and-down method.Results:Of 21 children, 12 (57.1%) showed “no movement” in response to the botulinum toxin injection. By Dixon’s up-and-down method, the 50% effective end-tidal concentration (EC50) of sevoflurane for successful botulinum toxin injection was 1.76 ± 0.15% (95% CI 1.62–1.90). Based on the dose‐response curve using probit analysis, the predicted EC50 and 95% effective end-tidal concentrations (EC95) of sevoflurane without movement were 1.77% (95% CI 1.59–2.35) and 2.09% (95% CI 1.89–5.80), respectively.Conclusion:Botulinum toxin injection can be successfully accomplished at an end-tidal sevoflurane concentration of 1.76 ± 0.15% in 50% of spontaneously breathing children with CP aged 3–12 years.

Point-of-care ultrasonography to predict fluid responsiveness in children: A systematic review and meta-analysis.

Point-of-care ultrasonography (POCUS) is proposed as a valuable method for hemodynamic monitoring and several ultrasound-based predictors of fluid responsiveness have been studied. The main objective of this study was to assess the accuracy of these predictors in children. PubMed, Embase, Scopus, ClinicalTrials.gov, and Cochrane Library databases were searched for relevant publications through July 2022. Pediatric studies reporting accuracy estimates of ultrasonographic predictors of fluid responsiveness were included since they had used a standard definition of fluid responsiveness and had performed an adequate fluid challenge. Twenty-three studies involving 1028 fluid boluses were included, and 12 predictors were identified. A positive response to fluid infusion was observed in 59.7% of cases. The vast majority of participants were mechanically ventilated (93.4%). The respiratory variation in aortic blood flow peak velocity (∆Vpeak) was the most studied predictor, followed by the respiratory variation in inferior vena cava diameter (∆IVC). The pooled sensitivity and specificity of ∆Vpeak were 0.84 (95% CI, 0.76-0.90) and 0.82 (95% CI, 0.75-0.87), respectively, and the area under the summary receiver operating characteristic curve (AUSROC) was 0.89 (95% CI, 0.86-0.92). The ∆IVC presented a pooled sensitivity and specificity of 0.79 (95% CI, 0.62-0.90) and 0.70 (95% CI, 0.51-0.84), respectively, and an AUSROC of 0.81 (95% CI, 0.78-0.85). Significant heterogeneity in accuracy estimates across studies was observed. POCUS has the potential to accurately predict fluid responsiveness in children. However, only ∆Vpeak was found to be a reliable predictor. There is a lack of evidence supporting the use of POCUS to guide fluid therapy in spontaneously breathing children.

THE INFLUENCE OF MUSIC ART ON SPEECH DEVELOPMENT OF ELEMENTARY SCHOOL STUDENTS

The author substantiates the role and importance of music in encouraging child’s speech and language development. The purpose of this article is to determine the effect of music presence in learning process, analyse the changes in speech development of elementary school students through musical interaction and justify the need for computer music technologies.This paper highlights the importance of developing the foundational skills (reading, writing, listening, speaking) and sub-skills (grammar, stylistic, pronunciation and vocabulary) by using a wide range of music technologies. The use of computer music technologies stimulates brain function that leads to an improvement students’ mental health and well-being, increasing cognitive function (concentration, attention, imagination, memory and thinking), developing important social skills.The article defines the use of logarithmics in preparation child's breathing, an auditory analyzer and speech production system for child's speech and language activity. Logopedic rhythmics is an effective method of development of mental cognitive processes, internal sense of rhythm, gross and fine motor skills, improving coordination and the personality spheres. Logarithmics is a correctional technique, which include speech and motor exercises, psychogymnastics and dance-rhythmic exercises. It was recommended to use this method not only in the treatment for children with speech disorders, psychomotor poverty or intellectual disability.The author has been making recommendations aimed at creating a positive psychological microclimate, activation of cognitive activity of children, engaging in creative self-expression and exploration of their capabilities, which help to accelerate the language development.
 Keywords: language development; music art; music computer technologies; speech development; speech skills; logarithmics; psychogymnastics; dance-rhythmic exercises; elementary school students; speech production system.

Three-dimensional evaluation of pharyngeal airway and maxillary arch in mouth and nasal breathing children with skeletal Class I and II

ObjectiveThis study aimed to investigate whether the subjects with mouth breathing (MB) or nasal breathing (NB) with different sagittal skeletal patterns showed different maxillary arch and pharyngeal airway characteristics.MethodsCone-beam computed tomography scans from 70 children aged 10 to 12 years with sagittal skeletal Classes I and II were used to measure the pharyngeal airway, maxillary width, palatal area, and height. The independent t-test and the Mann–Whitney U test were used for the intragroup analysis of pharyngeal airway and maxillary arch parameters.ResultsIn the Skeletal Class I group, nasopharyngeal airway volume (P < 0.01), oropharyngeal airway volume (OPV), and total pharyngeal airway volume (TPV) (all P < 0.001) were significantly greater in subjects with NB than in those with MB. Furthermore, intermolar width, maxillary width at the molars, intercanine width, maxillary width at the canines, and palatal area were significantly larger in subjects with NB than in those with MB (all P < 0.001). In the Skeletal Class II group, OPV, TPV (both P < 0.05) were significantly greater in subjects with NB than in those with MB. No significant differences in pharyngeal airway parameters in the MB group between subjects with Skeletal Class I and those with Skeletal Class II.ConclusionRegardless of sagittal Skeletal Class I or II, the pharyngeal airway and maxillary arch in children with MB differ from those with NB. However, the pharyngeal airway was not significantly different between Skeletal Class I and II in children with MB.

Craniofacial Sleep Medicine: The Important Role of Dental Providers in Detecting and Treating Sleep Disordered Breathing in Children.

Obstructive sleep apnea (OSA) is a clinical disorder within the spectrum of sleep-related breathing disorders (SRDB) which is used to describe abnormal breathing during sleep resulting in gas exchange abnormalities and/or sleep disruption. OSA is a highly prevalent disorder with associated sequelae across multiple physical domains, overlapping with other chronic diseases, affecting development in children as well as increased health care utilization. More precise and personalized approaches are required to treat the complex constellation of symptoms with its associated comorbidities since not all children are cured by surgery (removal of the adenoids and tonsils). Given that dentists manage the teeth throughout the lifespan and have an important understanding of the anatomy and physiology involved with the airway from a dental perspective, it seems reasonable that better understanding and management from their field will give the opportunity to provide better integrated and optimized outcomes for children affected by OSA. With the emergence of therapies such as mandibular advancement devices and maxillary expansion, etc., dentists can be involved in providing care for OSA along with sleep medicine doctors. Furthermore, the evolving role of myofunctional therapy may also be indicated as adjunctive therapy in the management of children with OSA. The objective of this article is to discuss the important role of dentists and the collaborative approach between dentists, allied dental professionals such as myofunctional therapists, and sleep medicine specialists for identifying and managing children with OSA. Prevention and anticipatory guidance will also be addressed.

Correlation of Ultrasound-Based Hydration Assessment Measures with CVP and Clinical Hydration Status among Children Admitted to the PICU: A Prospective Observational Study

Abstract Purpose This article assesses the correlation of respiratory variation in inferior vena cava (IVC) with central venous pressure (CVP) in children. Secondary objective was to evaluate IVC variability with clinical hydration status. Methods IVC variability was assessed at the subcostal (SC) and right lateral (RL) region, and collapsibility index (CI) (spontaneously breathing) and distensibility index (DI) (positive pressure) and IVC/aortic ratio were calculated. Partial correlations were calculated between CI/DI with CVP adjusting for body mass index and age. Sensitivity of CI and DI to predict clinical dehydration was calculated using receiver operating characteristic curves. Results A total of 145 ultrasounds were performed on 72 patients (41% positive pressure). Only RL CI in spontaneously breathing patients strongly correlated with CVP (r = –0.65, p &lt; 0.001). A moderate correlation was observed between CI and DI from SC and RL regions (r's = 0.38 and 0.47). Among spontaneously breathing patients, a significant difference was observed in the SC CI based on hydration status. For patients on positive pressure, IVC/aortic ratio had a significant difference. SC CI had the highest area under the curve (0.82) to detect dehydration with 80% sensitivity/87% specificity for a cutoff of 40%. Conclusion SC CI is the most reliable measure to assess the hydration status of spontaneously breathing children, while the IVC/aortic ratio performs well for patients under positive pressure. RL CI has strong negative correlation with CVP in spontaneously breathing patients.

A Study on Factors Related to Sleep Disordered Breathing in Children

The aim of this study was to investigate the risk factors associated with sleep disordered breathing (SDB) by comparing intraoral factors, body mass index (BMI), and medical history with pediatric sleep questionnaire (PSQ) findings.Seven hundred eighty-seven subjects aged between 7 to 11 years old were included. Their caregivers were asked to complete questionnaires. Oral manifestations including Angle’s classification, overjet, and Brodsky tonsil grade were examined. Children with PSQ scores of more than 0.33 points were classified into the SDB high-risk group.Among the 787 subjects, 34 (4.3%) were classified into the SDB high-risk group. Children with allergic rhinitis, atopic dermatitis, excessive overjet, or large tonsil size had a significantly higher risk for SDB versus those without. Also, there was a significant difference in SDB risk according to BMI status. Gender, gestational age, breastfeeding, and Angle’s classification were not associated with SDB.Children at high risk for SDB were predisposed to tonsillar hypertrophy, allergic rhinitis, obesity, and atopic dermatitis. Children with these factors could be candidates for early intervention to prevent the progression of SDB.

Impact of Syndromes on Sleep-Disordered Breathing in Children After Cleft Palate Repair.

Prior research suggests that children with cleft palate (CP) are at increased risk of obstructive sleep-disordered breathing (SDB). However, few studies differentiate the effects of CP repair on SDB based on syndrome status. The goal of this study was to evaluate differences in SDB after palatoplasty among children with nonsyndromic CP, syndromic CP, and isolated Robin sequence (RS). Retrospective chart review. Tertiary academic children's hospital. A total of 145 children who underwent primary CP repair from 2014 to 2021. Post-palatoplasty SDB is defined as parent-reported symptoms and/or evidence of obstructive sleep apnea (OSA). Median age at palatoplasty was 11.1 [IQR 10.2-13.6] months. Most patients (61.4%) had nonsyndromic CP, 26.9% had a syndrome, and 11.7% had RS. Children with syndromic CP and RS had more post-palatoplasty SDB symptoms (56.4% vs 58.8% vs 30.3%, P = .006) and higher rates of OSA (25.6% vs 29.4% vs 5.6%, P = .001) compared to children with nonsyndromic CP after palatoplasty. Children with syndromic CP and RS had nearly 3 to 4 higher odds of post-palatoplasty SDB than children with nonsyndromic CP (adjusted odds ratio [aOR] 2.88, 95% CI 1.29-6.47, P = .010; aOR 3.73, 95% CI 1.19-11.70, P = .024). This study showed that children with CP experience higher rates of SDB after palatoplasty than the general pediatric population. Within the cohort, children with syndromic CP and isolated RS were more likely to have obstructive sleep disorders than nonsyndromic children after palatoplasty. Clinicians should counsel caregivers accordingly and closely monitor these groups for SDB after palate repair.

Effects of mouth breathing on maxillofacial and airway development in children and adolescents with different cervical vertebral maturation stages: a cross-sectional study

BackgroundTo examine the influence of mouth breathing on maxillofacial and airway development in children and adolescents with different cervical vertebral maturation stages.MethodsLateral cephalometric radiograph of a total of 120 children and adolescents, 64 girls and 56 boys (7–15 years old), diagnosed with mouth breathing were examined. Maxillofacial hard tissue, soft tissue and airway measurements were obtained using both manual and digital techniques. Independent samples t-test was performed to compare the difference between the measured indexes and the standard values.ResultsAs for maxillofacial hard tissue, SNB (CS1–CS5), GoGn (CS1–CS5), ArGoNa (CS1–CS5), ArGo (CS1–CS2) and SNA (CS1–CS2) in mouth breathing children and adolescents were below the standard values (P < 0.05). NGoMe (CS1–CS5), SN-MP (CS1–CS4), SN-PP (CS1–CS4), PP-MP (CS1–CS3) and SN-GoGn (CS1–CS2) in mouth breathing children and adolescents were above the standard values (P < 0.05). As for maxillofacial soft tissue measurements, H angle (CS1–CS5), lower lip length (CS1–CS5), upper lip protrusion (CS1–CS5), upper lip length (CS1–CS4), lower lip protrusion (CS1–CS3), surface Angle (CS2–CS3) and nasolabial angle (CS2) in mouth breathing children and adolescents were above the standard values with statistically significance (P < 0.05). As for airway measurements, PAS (CS1, CS2, CS5) in mouth breathing children and adolescents was above the standard value with statistical significance (P < 0.05).ConclusionsMouth breathing had a real effect on maxillofacial and airway development, which differed among mouth breathing children and adolescents with different cervical vertebral maturation.

Role of Oral Microbiota Biofilms in Recurrent Tonsillitis and Sleep‐Disordered Breathing in Children

Aims &amp; HypothesisThe palatine tonsils are aggregates of lymphoid tissue in the lateral oropharynx. In children, tonsillar enlargement can lead to upper airway obstruction and sleep‐disordered breathing (SDB). The reason for tonsillar enlargement in some children, and not others is unknown. We have investigated the role of the tonsillar microbiota in tonsillar enlargement. The role of bacterial biofilms in RT and SDB was investigated through comparisons of tonsil histopathology, mixed‐species biofilm's microbiota composition and biofilm phenotypes. We hypothesized that the SDB tonsillar phenotype has distinct biofilm forming bacterial communities driving tonsillar hyperplasia compared to recurrent tonsillitis.MethodsTonsils were acquired via tonsillectomy from children with RT or SDB. Tonsils were stained to assess florid reactive lymphoid hyperplasia (FRLH). In situ microbiota characterization was assessed by 16S rRNA gene sequencing and overall bacterial biomass was assessed by 16S qPCR. Tonsillar bacteria were extracted and grown in BHI media for in vitro assays. Oral microbiota biofilms were characterized using the Calgary Biofilm Device and “O’Toole” assay. Biofilm biomass was assessed by spectrophotometry using crystal violet staining. Bacterial adhesion/invasion assays were performed by infecting pharyngeal carcinoma cell lines Det‐562 with tonsil microbiota from RT and SDB groups. Immune profile of Det‐562 cells infected with RT and SDB microbiota (t=3 hours) was assessed by cytokine multiplex analysis.ResultsHistopathological analysis showed higher FRLH of the enlarged lymph node in the SDB group compared to RT group. Microbiota analysis has shown that the tonsil's microbiota composition and bacterial biomass did not significantly differ between tonsils that were taken out due to SDB and those taken out for recurrent tonsillitis. Calgary Biofilm Device biofilm assays indicated that the SDB multi‐species biofilms have higher biomass compared to RT biofilms. Microbiota from SDB group were more adhesive/invasive to Det‐562 cells compared to RT bacteria after 3 hours incubation. Cytokine profiling showed increased expression of granulocyte‐macrophage colony‐stimulating factor (GM‐CSF), pro‐inflammatory cytokines IL‐1β, IL‐2, IL‐12 and interferon gamma (IFNγ) in Det‐562 cells exposed to SDB microbiota compared to RT.ConclusionsOur results indicate that SDB and RT tonsils have distinct histopathological signatures. In situ tonsillar microbiota composition and bacterial load did not differ between SDB and RT groups. In vitro assays showed that SDB tonsils exhibit increases in both multi‐species biofilm mass and bacterial adhesion/invasion to epithelial surfaces. These results also suggest that SDB bacterial biofilms lead to greater inflammation of the tonsils, confirmed by the elevated levels of FRLH and increased expression of pro‐inflammatory mediators. This study sheds light on the role pathobionts released from dysbiotic oral microbiota biofilms in the development of tonsillitis.

Evaluating the effectiveness of using phytoncides to reduce microbial contamination of indoor air in order to minimize the risk of illnesses in preschool educational settings

Introduction. Due to the high prevalence of respiratory diseases in children attending pre-school educational settings, the problem of their prevention is especially important. Taking into account the fact that children spend between 6 and 8 hours a day in pre-school educational institutions, one of the risk factors of respiratory diseases is the microbial contamination of indoor air. The analysis of Russian and international scholarly literature revealed the positive impact of phytoncide properties of plants on the quality of indoor air and on the psycho-emotional state of a person, however, due to the lack of experimental evidence, the practices of using healing properties of plants in children's organized groups have not been widely adopted. The results of this study confirm that the rational placement of a certain range of plants in preschool classrooms can become a promising and low-cost direction in the structure of a health-saving approach in the modern system of preschool education. The purpose of the study is to evaluate the effectiveness of phytoncides of a particular range of plants and their placement in reducing microbial contamination of the air in pre-school education settings. Materials and Methods. To study the effect of phytoncide activity of plants the authors monitored the microbial contamination of air in preschool classrooms from two kindergartens in Novosibirsk, with the main focus on the leaf area of the established range of plants and conditions of their placement. For quantitative and qualitative analysis of air microflora composition we used standard differential-diagnostic nutrient media, methods of seeding and calculation of the proportion of total microbial count and facultative microflora. Air sampling points were located in the child's breathing zone (0.5, 1.5 and 3 m away from the plants at 0.8 m height). We monitored the effectiveness of phytoncide properties of plants on the risks of children's disease during the epidemiological rise based on attendance logs. The following theoretical research methods were used: formalization, generalization, comparison and system analysis. Results. It was found that phytoncides reduce microbiological insemination of preschool classrooms where a certain range of phytoncide plants were located. It was determined that the intensity of the phytoncide effect depends on the leaf surface area and their rational distribution, taking into account the effective radius of exposure. The study found a decrease in respiratory diseases among children at preschool educational settings where phytoncide plants were placed in the classrooms. Conclusions. The results of the study can be employed in recommendations for the use of a certain range of plants with pronounced phytoncide activity as one of the components of health-saving conditions in the modern education system.

Three-dimensional image study of accelerated maxillary expansion in oral breathing kids

ObjectiveTo evaluate, by a three-dimensional study, the volumetric and integumentary effects of rapid maxillary expansion on the nose, in mouth breathing kids with maxillary hypoplasia, in the short term, assessing the possible interference of gender, growth and age on the results achieved. Methods120 mouth breathing patients with maxilla hypoplasia were divided into an Experimental Group treated by rapid maxillary expansion (n = 104, 62 males and 42 females, mean age 10.1 years, SD = 2.10, ranging from 5.1 to 13.9 years); and Control Group, constituted by 16 patients (9 males and 7 females, mean age 9.3 years, SD = 2.1 years, ranging from 6.1 to 13.2 years). Patients in the experimental group underwent multislice computed tomography examinations at two different times: (T1) pre-expansion and (T2) post-expansion. The control group was submitted to the same tests at the same time intervals. Six soft tissue variables of the nose were studied, besides the volume and area of the nasal cavity, and the measurement and comparison of data between T1 and T2 were performed using the Dolphin Imaging 11.7 Premium software. ResultsThe experimental group showed significant mean increases in all soft tissue variables studied (p < 0.005), yet there were no significant changes in the control group. In the comparison between groups, only inclination of the nasal dorsum did not present any significant change. ConclusionRapid maxillary expansion may alter the nasal shape and physiology, by anatomical changes in the nose soft tissues, making it an important aid in the treatment of mouth breathing in childhood. Level of evidenceThe soft tissues of the nose play an important role in nasal shape and physiology and facial esthetics, and since they are directly related to the nasal valves, they are fundamental for maintenance and stability of the nasal breathing pattern.

Position and orientation of hyoid bone in mouth breathing children: a cephalometric study

Introduction: The importance of the hyoid bone is associated with its unique anatomical position. The hyoid bone is the only bone in the facial skeleton that attaches to other bones only with the help of muscles. Aim: The aim of this article is to make a cephalometric analysis of the craniofacial anatomy and position of the hyoid bone in children with mixed dentition who have difficult nasal breathing, habitual mouth breathing and a control group of nasal breathing children. Materials and methods: A total of 120 lateral cephalograms of children with mixed dentition were analyzed. The examined X-rays were divided into three groups: 50 lateral cephalograms of children with difficult nasal breathing; 18 lateral cephalograms of children with a habitual mouth breathing and 52 lateral cephalograms of nasal breathing children. To determine the position of the hyoid bone we used the method of Bibby and Preston.1 Results: When comparing the type of the hyoid triangle we found the presence of a statistically significant difference (χ2 = 24.97; p &lt;0.001). In 84% of the children with nasal breathing difficulties there is a negative hyoid triangle and in only 16.00% a positive hyoid triangle. In the nasal breathing children, the positive triangle occurs in 84.60% of cases. In children with habitual mouth breathing the distribution is almost even. A significant difference was found when comparing the height of the negative triangle in children with nasal breathing difficulties and nasal breathing children (t = 6.06; p &lt;0.001). Conclusion: In mouth breathing children there is a lower and posterior position of the hyoid bone compared to nasal breathing children. The negative triangle is characteristic for children, who have difficult nasal breathing, whereas the positive triangle is specific for nasal breathing children.

When Songs Don't Work: Western Tonalities and Korean Breath in Children's Songs of the Colonial Period

In the 1920s, colonial Korean children had different opportunities and materials to sing. Newly established missionary schools adapted hymns for children, and the colonial schools run by the Japanese regime considered song time to be essential to children's emotional and intellectual development. It is from this diverse ecology of musical offerings that original Korean sung poems, or tongyo, emerged. Tongyo were short poems written by often prominent writers that were then set to music by Korean composers, many of whom studied Western music in Japan. Tongyo composers wrote works that, unlike Christian hymns (ch'ansongga) and Japanese school songs (changga), were written in the Korean language and were intended for Korean voices but were structured by what was then novel Western musical conventions. Through an analysis of tongyo by two seminal figures, Yun Kŭgyŏng and Chŏng Sunch'ŏl, this paper illuminates the musical grammar by which Yun and Chŏng re-oriented the sensibilities of their young singers. This comparison reveals the challenges of fitting western tonalities to the Korean language, thereby questioning the prevalent assumption that tongyo were national forms whose value hinges on their effortless communication of authentic Korea emotions.

Advances in the Study of Upper Airway Characteristics in Children with Malocclusion

Malocclusion is the malformation of teeth, jaw and skull caused by congenital genetic factors or acquired environmental factors in the process of children's growth and development, such as diseases, bad oral habits, abnormal substitute teeth, such as irregular arrangement of teeth, abnormal relationship between upper and lower dental arch, abnormal jaw size and shape, etc. Malocclusion is also accompanied by respiratory diseases and dysfunction, such as obstructive sleep apnea (OSA). Conversely, abnormal occlusion also leads to respiratory tract developmental disorders and dysfunction. The cranio-maxillofacial morphology is closely related to the upper airway morphology. They are cause and effect each other. In recent years, it has been found that orthodontic treatment can not only improve the malocclusion, but also has a significant effect on the upper airway volume. The abnormal upper airway in childhood will affect children's breathing, cause children's sleep apnea, and affect children's growth and development. At the same time, with the development of society, we pay more attention to children's face. Therefore, at present, the upper airway morphological characteristics, influencing factors and correction methods of malocclusion have become the focus of research.