Speech Therapy Hertfordshire

02/09/2026

Brooklynmyo Connected Page nice summary of why we promote nasal breathing 👏🏻🙌🏻🙏🏻

30/08/2026

25/08/2026

Allergic rhinitis is common in children and teaching them to blow their nose affectively and follow a nasal hygiene routine daily can help reduce environmental allergies . When it is related to food, pet hair (dander) , mould exposure, dust etc having allergy testing and then following a de immunisation program to expose and reduce reactions can help a child/adult be able to breath better through their nose , if there are no other underlying causes . Dr David McIntosh explains further below

Can allergic rhinitis contribute to sleep-disordered breathing in children?

Yes—and I think it is often underestimated.

Allergic rhinitis is not simply a daytime problem of sneezing, itching and a blocked nose.

For some children, nasal inflammation can become a sleep problem.

When the nasal passages are persistently inflamed and congested, nasal airflow can be reduced.

A child may then develop:

• Nasal obstruction
• Mouth breathing
• Snoring
• Increased upper-airway resistance
• Restless sleep
• Sleep fragmentation
• Sleep-disordered breathing

Research has consistently found an association between allergic rhinitis and sleep-disordered breathing in children.

A 2026 meta-analysis involving 32,907 children found that allergic rhinitis was associated with habitual snoring, sleep-disordered breathing and obstructive sleep apnoea.
https://pubmed.ncbi.nlm.nih.gov/42302637/

But there is an important distinction:

Association does not mean that allergic rhinitis causes OSA in every child.

Sleep-disordered breathing is multifactorial.

A child may have allergic rhinitis plus:

• Enlarged adenoids
• Enlarged tonsils
• Turbinate hypertrophy
• Craniofacial narrowing
• Obesity
• Other causes of upper-airway obstruction

The allergy may therefore be one component of a much larger airway problem.

This is clinically important because nasal obstruction is sometimes treated as an inconvenience rather than part of the airway assessment.

If a child has:

allergic rhinitis + chronic nasal obstruction + mouth breathing + snoring

I don’t think we should simply treat each symptom independently.

We should ask:

“How is the child’s nasal airway affecting their breathing during sleep?”

So before we accept chronic mouth breathing and poor sleep as “just the way the child is”, we should look at the nose.

The airway begins at the nose.

And sometimes improving nasal breathing is an important part of improving the child’s sleep.

To learn more, visit:

training.airwaybreathingacademy.com

Dr David McIntosh
ENT Surgeon
Paediatric ENT | Sleep-Disordered Breathing | Airway

20/08/2026

Dr David McIntoshthank you for this useful explanation connecting sleep disordered breathing and ADHD to research findings 🙌🏻🙏🏻

Can treating sleep-disordered breathing improve ADHD-like symptoms in children?

Yes—but we need to be precise about what the evidence actually shows.

Children with sleep-disordered breathing (SDB) can develop symptoms that overlap with ADHD, including:

• Inattention
• Hyperactivity
• Impulsivity
• Irritability
• Poor concentration
• Emotional dysregulation

So what happens when the underlying sleep-disordered breathing is treated?

One of the most important studies in this area was the Childhood Adenotonsillectomy Trial (CHAT).

The study randomised 464 children with obstructive sleep apnoea to early adenotonsillectomy or watchful waiting.

Surgery produced significantly greater improvements in:

• Behaviour
• Sleep-related symptoms
• Quality of life
• Polysomnographic findings

But there was not a statistically significant improvement in the primary objective measure of attention and executive function.

https://www.nejm.org/doi/abs/10.1056/NEjmoa1215881

This distinction is important.

It would be incorrect to say:

“Adenotonsillectomy treats ADHD.”

The evidence does not support that statement.

But it is equally inappropriate to ignore the possibility that untreated sleep-disordered breathing can contribute to behavioural and attentional difficulties.

A 2026 systematic review and meta-analysis found moderate improvement in parent-reported behavioural measures and a smaller improvement in executive function following adenotonsillectomy, while objective ADHD-related measures did not reach statistical significance.

https://pubmed.ncbi.nlm.nih.gov/42456309/

So perhaps the better clinical question is

“Does this child have ADHD, sleep-disordered breathing, or both?”

Because if a child has an underlying sleep disorder, treating the sleep disorder may improve some of the behaviours that brought the child to medical attention in the first place.

And that can be a very meaningful outcome—even if the child still meets criteria for ADHD.

We need to be asking:

“How well is this child actually sleeping?”

To learn more, visit:

training.airwaybreathingacademy.com

Dr David McIntosh
ENT Surgeon
Paediatric ENT | Sleep-Disordered Breathing | Airway

10/08/2026

Agreed 💯 a parents gut is always right and children don’t grow out of it they grow around it

Most parents spend months or even years searching for answers to their child’s breathing and sleep and behavioral issues. Our goal is to help you recognise the signs in minutes.

We know that parents frequently search online for explanations of symptoms before seeking medical help, particularly for chronic childhood conditions.

We also know that many often recognise symptoms such as snoring, restless sleep, mouth breathing, or pauses in breathing but may not connect them with sleep disordered breathing.

The reality is that sleep disordered breathing in children is substantially under recognised, and many parents report that they were the ones who initiated discussions with healthcare providers rather than being asked about sleep.

So if you have spent hours over several weeks or months reading articles, watching videos, searching social media, and participating in online forums and are still confused or concerned, then let us help you

Airway breathing academy is a professionally developed resource that has videos, checklists, and links to valuable resources designed to help a family navigate their way through an ever growing range of misinformation. We have seen what’s out there and parents and their children deserve proper answers.

Just follow the link, connect with us via the parents option and start making a real difference to the health and wellbeing of your own child.

training.airwaybreathingacademy.com

08/08/2026

Great summary of sleep disordered breathing SDB and obstructive sleep apnoea OSA from David McIntosh ENT 👏🏻🙏🏻

What is the difference between sleep-disordered breathing and obstructive sleep apnoea in children?

This is one of the most important distinctions in paediatric airway medicine.

Obstructive sleep apnoea (OSA) is not synonymous with sleep-disordered breathing (SDB).

Paediatric sleep-disordered breathing exists on a spectrum.

A child may have significant upper-airway obstruction during sleep, increased respiratory effort, flow limitation, snoring, restless sleep, frequent arousals, mouth breathing or disrupted sleep architecture without necessarily meeting conventional diagnostic criteria for obstructive sleep apnoea.

This matters because the apnoea-hypopnoea index (AHI) measures only part of the problem.

A child can have a relatively low AHI and still have clinically important sleep disruption and upper-airway dysfunction.

So when assessing a child who snores, mouth breathes, sleeps restlessly, has behavioural difficulties, struggles at school or has unexplained daytime fatigue, I believe we need to ask a broader question:

Does this child have obstructive sleep apnoea?

But also:

Does this child have sleep-disordered breathing?

Those are not necessarily the same question.

The clinical assessment should integrate the child’s symptoms, sleep, airway anatomy, nasal obstruction, tonsils and adenoids, craniofacial development and, where appropriate, objective sleep testing.

A sleep study is an important tool—but it should not necessarily be regarded as the entire diagnosis.

This distinction is particularly important when we are trying to identify children earlier, before years of disrupted sleep and impaired daytime function become normalised.

I believe paediatric sleep-disordered breathing deserves to be recognised as a clinical condition in its own right, rather than simply as a synonym for OSA.

More information:
training.airwaybreathingacademy.com

Dr David McIntosh
ENT Surgeon
Paediatric ENT | Sleep-Disordered Breathing | Airway

31/07/2026

Excited to be apart of the next cohort of airway circle Myocircle but as a mentor this time 🤗 Looking forward to supporting others on their oromyofunctional journey Airway Circle with a fantastic group of mentors 🙌🏻

Tomorrow, it begins.

Tomorrow, a new group of providers will begin seeing cases differently.

Not because they’ve learned more exercises. Because they’ll understand the why behind them.

For the next 16 weeks, they’ll strengthen their clinical reasoning, connect the dots between complex cases, and grow alongside a community of providers committed to better patient outcomes.
If you’ve been waiting for the right time to join Myo Circle, this is your final opportunity.

Cohort 7.0 starts tomorrow. We’ll be welcoming one final provider into the room.

Will it be you?

https://www.airwaycircle.com/myo-circle