Palatal expanders for 6 year old - any experience?

Hello parents,

Several doctors have recommended upper and lower palatal expanders for my 6 year old. She has moderate sleep apnea, even after having adenotonsillectomy and turbinate reduction. Expansion will be about 6 months and retainers for 4 years after that to retain the expansion. 

- Has anyone had their 6 y.o. wear expanders? (I know when the kids are slightly older like 7/8 it’s more tolerable and they’re just more mature...but how about for a younger child?)
- Was it painful to wear?
- How long did your child get “used to it”? The orthodontist said kids get used to it really quickly and it’s not a problem as long as there’s no “sensory issue”. 
However, I’m wondering how any child could not have sensory issues if there are tight pieces of metal in their mouths 24/7? How do you even rest your tongue?
- How much do expanders affect eating? 
- Did anyone’s young child do expansion SPECIFICALLY for sleep apnea? If so, did it work? 
- who was your orthodontist? 

I feel like we’re running out of options. I have heard of myofunctional therapy, but I don’t know how much “tangible result” we’ll get. Any feedback is greatly appreciated! Thank you!

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I can't speak to the sleep apnea issue, but I had an upper palatal beginning at age seven and did get used to it quite quickly. I remember vividly that when I stopped wearing it about nine months later, I really missed it and had trouble sleeping without it, as I'd grown used to the sensation of having it in my mouth. This was 30++ years ago, but I can still recall the feel of it against my tongue, which is kind of bizarre (!) The main negative memory is of cleaning it, which was a pain, and I imagine still is. At the time I took it out to eat--no idea what the practice is today around that. (But my seven-year-old just got referred to an orthodontist for the same issue I had the expander for--it's hereditary--so guessing we might be about to find out!)

Hello anonymous, thank you for replying to my post. It makes me feel somewhat better that you said it wasn’t too daughter LOVES to eat and I’m afraid having to cut out certain types of foods or having to clean it a lot will be a source of struggle. The ortho we saw days my daughter needs upper AND lower permanent expanders (not removable)...

If you wouldn’t mind sharing about your daughters soon to be experience, that would be greatly appreciated. Thank you so much and good luck to her!

Hi! I felt compelled to answer as I was the unlucky recipient of two(!) palate expanders in my youth, both upper. I received them for treatment of crossbite, not sleep apnea, so I cannot attest to that. I was in 2nd grade (so, 7 or 8) when I got the first one, and 13 when I had the second. For clarity, I underwent "rapid palatal expansion" as described here: Given the time frame you present, it seems likely that's what they're looking to do for your child as well. My expander was cemented to my teeth and was not removable until treatment was complete. The actual expander itself being in your mouth isn't painful, and you get used to it quickly. It's thin, so there's plenty of space for your tongue - there are also no sharp edges. I will not lie, though, the expansion does hurt. It basically fractures your palate, leaving you with a gap between your teeth that then must be closed with braces and chain rubber bands that shift all your upper teeth toward the front center. I remember dreading the key-turning. My mother dreaded it too. We found that a dose of ibuprofen 1-2 hours beforehand really helped with the discomfort, and the discomfort was only significant at the moment when my mother turned the key. I remember being much more upset about the discomfort when I was younger than when I was older, though I suspect I needed more expansion when I was younger. When I was older with the second one, I found the shifting of my teeth to close that front-tooth gap with braces and rubber bands to be the far more obnoxious and uncomfortable aspect of treatment. 

The palate expander really doesn't affect eating much at all. Food can get stuck under the little key-turning box at the top. A water pick helps immensely to keep things clean, and I highly recommend one.

This was also 25-30+ years ago, so your mileage may vary. My orthodontists are retired (and possibly deceased) at this point, so alas, I cannot provide any recommendations there. Happy to answer any other questions you might have. Best of luck to you and your child! 

Although my kid was 7, I will speak to the sensory aspect. My kid has autism and is very sensory sensitive and they were able to handle it with no problem.

Hi Rissa8,

Thank you for sharing your own experience! That gives me a better picture. Yes, my daughter may be doing the rapid maxillary expanders, the non-removable ones. 

I’m sorry it was painful for you...hopefully now (being decades later) the expanders are now designed to create less pain. 

As far as pain goes, it seems like people experience different levels of pain during the turning of the key. From what I’ve gathered online, some people think it was just uncomfortable while others think it’s painful. Perhaps it depends on the age of the person. I wonder if it would be LESS painful to do it when she’s 6? Aren’t the bones softer when you’re younger...?

I just wonder if my daughter is just too young and will get claustrophobic with them. I worry that once they’re in, they’re IN and we can’t take them out unless we want to possibly throw $6k down the drain. 

Did you have to wear retainers for a long time after the expansion therapy?

Thank you! 

My son had an expander for cross bite at about the same age. He had a lot of sensory issues, including about food, so I was surprised by how quickly and easily he got used to it. It didn't affect eating appreciably. Never needed any further orthodonture. This was a long time ago, and his provider is retired.

Hi Rissa8,

Thank you so much for your personal input; I’m sorry it was painful for you when you were a child! (I had responded earlier but not sure why it didn’t post.)

yes, my daughter would be doing the rapid palatal expansion - both upper and lower. It’s good to know that cleaning them won’t be too bad. I think my biggest concern is the permanency of it...yes it’ll be out after about six months, but during those expansion periods we won’t be able to take them out at all, even for a little break. We’ve been using the Cpap now and she hates it (feeling of claustrophobia), but at least we can stop whenever she feels overwhelmed. Plus there might be more period of expansion after the initial phase. But it’s also good to know that there’s plenty of room for your tongue. 

When the expanders were not being turned, would you forget that you had them on, or could you always feel some sort of pressure in your mouth 24/7?

Thank you for sharing your experience! :)

Hi Jets_girl,

I mostly recall being uncomfortable right after the key was turned. The rest of the time, the presence of the expander wasn't bothersome to me at all. You really get used to it being in your mouth. And yes, I wore retainers for quite some time after the fact, but not so much for the expansion as for the alignment of the rest of my teeth. I had a retainer for 1-2 years after my first expander, and then got braces. After braces, I wore my retainers at night until I graduated from college, at which point I thought "hey, I'm an adult, I can stop wearing these now!" Well, no. My teeth shifted a good bit, and I had to get new retainers to prevent further shift. 16 years, a professional career, and a kid later, and I still wear them at night! 

Both my 4 yo son and 8 yo daughter just started wearing a palate expander and I am floored at how well they have both taken to it. They do not have the kind that is cemented in. Their's is a removable acrylic appliance with minimal wires that we turn ever so slightly (.5 mm?) twice a week. My daughter says it's a little uncomfortable but we do it just before bed as recommended by the orthodontist and neither one really complains much. The literature on the effects on air circulation through the sinus passages as well as the airway is very compelling, and I'm excited to see what positive impacts this will have on behavior (impulsivity mainly) beyond addressing some serious crowding issues (my kids don't have sleep apnea but my daughter does breathe through her mouth and snores).

I HIGHLY recommend that you see Dr. Claire Ferrari in Kensington at least for a second opinion. She and her staff are top notch, and great with the kids, which is half the reason they are so compliant with the whole thing. We also see Virginia Downing for myofunctional therapy which is a really important component of palate expansion. She's in Oakland near Mills College area. She's fantastic, too--she's very booked ahead so best to get started soon if you want to pursue it. We started before my son's appliance went in, and the exercises very effective in giving him much greater range with his tongue among other things. 

To the OP: My 8 year old snores and has suspected sleep apnea (we haven't done a sleep test yet). His orthodontist suggested that he needs a palate expander for crossbite and said it might help with the snoring, but his ENT said there is little data that a palate expander helps sleep apnea. I wonder if you'd be able to share your research about how they are related? I'd like to read it up for myself, since the ENT disagrees. Thanks!

Hi Jets_girl, I have both (7yrs and 10 yrs) of my children in ortho treatment right now (Ferrari Orthodontics). Both have palatal expanders in. It took about 3 days to get some use to, and I've been impressed with how well they are doing with it in. Take a look at this article It talks about sleep apnea in children even after they've had T&A removed and how expansion could play a huge role in helping your 6 yr old. I do know that expanding before puberty is a lot easier than expanding afterward. I would suggest seeing a orthodontist for an evaluation (cant hurt). I know Dr. Ferrari's exams are no charge. Shes on Arlington and is knowledgeable about apnea and airways. 

Hello TZ, I just noticed your comment. I'm surprised your ENT said that. If you'd like me to share the ENT we see I can give you his name. For your research, check out the link I sent for jets_girl (above). This is a more detailed article, i hope its helpful. Maybe starting with a sleep study for your little guy would give more insight. 

Brian Hockel's practice in Walnut Creek uses the Crozat, but 6 may be too old. We expanded upper and lower jaw but the adjustments were to the appliance against the teeth at regular visit intervals, not nightly at the palate. To truly make a difference for airway it is likely the jaws will have to be moved foward. OMT is important. Right now Bay Area is served by Virginia Downing.