On last week’s group coaching call inside The Joint, a member asked me what I think is the optimal age to expand a child. Is around age 10 ideal, or is younger better?
Of course, I have two children now, so this is a question I’m thinking about, with the intent to act soon.
My answer: age 10 is definitely too late. By that time, the midpalatal suture is starting to harden and there will be too much dental and dentoalveolar flaring involved in toothborne expansion.
Also, waiting until 10 means losing out on several years of potential mandibular growth that would follow maxillary expansion at an even younger age (for children, the mandible actually can follow the maxilla).
Okay, so 10 is too late. Is age 5 better? Yes, the suture is much looser at that age.
At five, the child’s molars can take enough force from a tooth-borne expander that the mid-palatal suture will split before the teeth flare out. It’s a sweet-spot age where you can get skeletal expansion with dental anchorage.
But I wonder: is five young enough, or could we go even younger?
Note that the entire rationale for waiting until age five is that you are waiting on the teeth to strengthen, because it’s assumed that you will use a tooth-borne expander.
But what if you could avert the need for dental anchorage entirely, say, with a MARPE (a TAD-anchored skeletal expander such as MSE, FME or Custom MARPE)?
Doesn’t that mean you could expand a child younger than five?
This would be desirable primarily because there is critical mandibular growth that occurs during infancy and toddlerhood, which we must sit idly and watch pass by if we wait until age 5 to expand.
Additionally, expanding a struggling child at age 2 instead of age 5 would mean three more years of better nasal breathing, sleep (and therefore neurological development), fewer ear infections (and fewer antibiotics), etc.
So why not do it? Why not use a MARPE in a mouth-breathing 2 or 3 year old who is clearly maxillary-deficient?
Well, for the obvious reason: because getting an appliance screwed into the palate is a lot to ask of a kid.
You would need to put them to sleep to install it, and there are problems with that (ex. anesthesia in a developing brain). And then upon waking, they might freak out due to the sudden realization that there is this sharp, painful thing in their mouth.
Will the pain subside? Most likely within a few days. But will they get used to the discomfort of the MARPE? Adults do. But children? Who knows. No one’s ever tried it.
For my own kids, I’m taking a “wait-and-see” approach.
My older daughter is two and a half. She would definitely benefit from an expander. Her palate is high and vaulted and comes to a point at the front, like a triangle. She gets colds often, and breathes through her mouth whenever congested.
But all things considered, she’s stable and still thriving. That’s why I haven’t acted yet.
Fortunately my younger daughter has a much wider palate and likely won’t need an expander ever.
I’d love to expand my older daughter. I can just imagine the relief she’d feel if she could breathe better through her nose.
But I’m wary of having her be the first 2-year-old ever with a MARPE. Daddy was a guinea pig, but she doesn’t need to be.
What’s worse: a small child that has a narrow palate, mouth breathes, gets sick easily, and may have pediatric sleep-disordered breathing? Or subjecting that child to a MARPE?
I don’t know!
