Children

Facing Up to the Problem of Childhood Mouth Breathing

Why your child’s oral breathing could lead to abnormal growth, a lifetime of health issues 
BY Patrick McKeown TIMEApril 22, 2022 PRINT

We see it all the time on social media—pictures of small children, soundly asleep, with their mouths wide open. Some parents think it’s sweet when their little one snores. But there’s a serious side to mouth breathing and snoring in children.

A growing body of scientific evidence confirms these children are heading for poor health, less attractive looks, and expensive dental problems.

Nose breathing draws air deeper into the lungs and has several physiological distinctions from the shallow, often quicker breaths taken through the mouth. The consequences of these differences are significant.

Mouth breathing during childhood has been proven to cause abnormal facial growth. When the mouth hangs open, gravity pulls the face down, displacing the tongue from its proper resting position. This results in narrow jaws and overcrowded teeth that become set back in the face, pushing the head forward and reducing the size of the upper airway. A narrow airway predicts a lifetime of sleep-disordered breathing, behavioral issues, poor academic performance, and a less attractive face. And the dry mouth that accompanies open-mouth breathing contributes to dental decay, early tooth loss, and halitosis.

Equally, snoring is a sign that breathing isn’t functioning as it should. The sound is caused by the fact something is blocking the airway. It’s a warning sign and may predict obstructive sleep apnea (OSA), a serious condition in which breathing temporarily stops multiple times a night, reducing oxygen saturation in the body and brain. OSA creates tired children who can’t think straight.

What’s more, there’s an 80 percent chance that a child left with untreated snoring at the age of just 8 will experience an irreversible 20 reduction in their mental capacity, according to a research review published in Current Trends in Otolaryngology and Rhinology. OSA is traditionally associated with obesity, but research shows it is the result of a long face, swollen adenoids or tonsils, a narrow palate, and crooked teeth—all symptoms of habitual mouth breathing. These anatomical traits are also known risk factors for sudden infant death syndrome.

I remember discovering the symptoms of mouth breathing described in an article in The Dental Cosmos that was published more than a century ago. In 1909, the article’s author, G.F. DeLong, wrote:

“The face is usually elongated, the bones of the face are underdeveloped, as the air spaces do not have the proper circulation, the nostrils are small.”

Long goes on to list other detrimental effects of mouth breathing. A recessed chin, crooked teeth, and a high narrow palate. These children look “dull” and tired and may be accused of inattentiveness in class.

When I first found this description, I felt a wave of disappointment that the impact of mouth breathing is still relatively unknown among parents. Even among pediatric health care professionals, the risk factors for mouth breathing aren’t always identified, and there is often inadequate attention to restoring nasal breathing.

Studies show that around 50 percent of children breathe through an open mouth. It’s more common for boys than girls (60 percent to 40 percent). It normally begins because the tonsils and/or adenoids are swollen, though other anatomical, environmental, lifestyle, and dietary factors also play a role.

Consequences of Mouth Breathing

Mouth breathing has far-reaching consequences. It contributes to problems including:

  • Abnormal development of the face, teeth, and airways
  • Dental decay
  • Postural issues
  • Decreased cognitive function
  • Poor speech and language development
  • Behavioral disorders, including ADHD
  • Compromised immunity
  • Asthma and upper respiratory infections
  • Sleep disorders

It’s no exaggeration to say mouth breathing can lead to a lifetime of ill health.

Early Intervention Is Key

Most facial growth occurs in the first five years of life. By 11 or 12 years old, the face is 90 percent developed. This means if mouth breathing isn’t corrected early, it can cause permanent deformities. It’s never too late to restore nasal breathing, but correction of misaligned jaws is much more complex later in life.

I have direct experience of the consequences of mouth breathing. Throughout my childhood, I breathed through an open mouth. I struggled at school. Just as Long described in 1909, my teachers regularly misinterpreted my exhaustion and brain fog as lack of application. No matter how hard I worked, I never achieved more than average grades. Moreover, my asthma was so bad, I sometimes ended up in the hospital. It wasn’t until my 20s, when I discovered some simple breathing exercises that helped me restore nasal breathing, that my life changed for the better.

I feel lucky to have made this change. Better late than never. Because the fact is, no matter how many “Mozart for Babies” tracks you stream, if your child breathes through an open mouth, part or all of the time, they will always struggle to reach their potential.

Nasal Breathing Influences a Healthy Life

In a 2018 review article, the renowned airway orthodontist Dr. John Walker, and his colleague, the ENT specialist Dr. Peter Catalano state: “Nasal breathing is a basic and critical function that we rarely think much about, and most would be quite surprised to learn how important and influential it is in growth and development, and a healthy productive life.”

When nasal breathing is disrupted, Drs. Catalano and Walker explain, a child is “forced to live with a host of acquired health issues as a consequence of chronic or intermittent mouth breathing.”

Another recent review in the European Journal of Paediatric Dentistry explains that nasal breathing during early development and throughout childhood promotes proper development of the face, teeth, and breathing apparatus. It’s also vital for “neurobehavioral development and the brain… correct dental occlusion, proper and restful sleep, and to improve performance and life overall.”

With the restoration of nasal breathing, along with therapies including myofunctional therapy, the review concludes: “Quality of life will improve with more energy, better mood, and enhanced performance. If that’s not enough, smiles and facial esthetics are also greatly improved.”

Why Is Nasal Breathing So Important?

Mouth breathing is considered a pathological condition. It is related to disease states. On the other hand, a healthy, full-term baby will naturally breathe through the nose from birth.

The nose performs around 30 functions on behalf of the body. It warms and humidifies air, filtering it of impurities and pathogens in the process. Mouth breathing involves taking cold, unfiltered air directly into the lungs. This leaves your child more vulnerable to airway irritation, inflammation, asthma, and upper respiratory tract infections. Nose breathing harnesses the gas nitric oxide (NO), which is produced in the sinuses around the nasal cavity. NO has proven antiviral, antibacterial, anti-allergenic, and antifungal qualities. It is known to prevent viral replication in upper airway diseases including COVID-19.

It further supports immunity by adding greater resistance to airflow. This slows the breathing rate, which helps keep the stress response in balance. Stress is a known risk factor in 75 to 90 percent of all human diseases.

Nose breathing enhances circulation and oxygen absorption to the tissues, and to organs—including the brain. When a child habitually breathes through the mouth, their body must compromise to get enough oxygen into the blood. The head is thrust forward, producing postural changes. Eating becomes noisy and difficult. And because the nasal airway is underused, it doesn’t develop properly.

When I talk about a “more attractive face,” I’m not merely concerned with esthetics. The well-developed jaws and nasal airways of nose breathers produce healthier adults. From an evolutionary perspective, we perceive those with a wide, properly aligned jaw and straight teeth to be more attractive. An interesting study recently demonstrated that people with more attractive faces have greater immunity to COVID-19. This is perhaps due to the fact these people are nasal breathers.

What Causes Mouth Breathing in Children?

Mouth breathing occurs because there is an obstruction in the airway, or when the airway is narrow. This is often the result of enlarged tonsils and/or adenoids. When soft tissues at the back of the throat are swollen, the airway becomes much narrower. And when a nasal obstruction is present, a child is more than five times more likely to breathe through an open mouth. Mouth breathing irritates the airway, and can perpetuate tonsil and adenoid problems, causing a vicious cycle of mouth breathing that becomes habitual.

Mouth breathing may also be the result of:

  • Breathing disorders including asthma and allergies
  • Anatomical traits such as a high narrow palate, deviated septum, or small nose
  • Tongue-tie and lip-tie
  • Excessive bottle-feeding and pacifier use
  • An over-heated, poorly ventilated home

Tongue and lip ties are easily resolved but often left undiagnosed. Not all doctors look under the tongue, and even the consensus on what constitutes a tongue or lip-tie is still unclear. However, left untreated the extra tissue that tethers the tongue or lip can prevent the baby from suckling and compromise the position of the tongue. Tongue position is important because it ideally supports proper growth of the jaws and teeth. It molds the upper jaw into a wide U-shape, making space for all the adult teeth to grow straight in both jaws.

A study from 2017 concludes that surgical release of tongue-tie/lip-tie “results in significant improvement in breastfeeding outcomes,” reducing the need for bottle feeding. This is critical, because artificial teats make it easy for the baby to extract milk, and do not help the face and jaw muscles develop in the same way as breastfeeding. Once the baby is weaned, a diet overly focused on soft food also affects the forward growth of the face. Chewing is important for the development of the jaws and teeth too.

Why Mouth Breathing Persists

The problem with mouth breathing is that, while it acts as a backup, in situations where the child struggles to breathe enough air through the nose, it can quickly become habitual. Once the habit is formed, even if the root cause is addressed, mouth breathing persists. For instance, most children aren’t taught to restore nasal breathing after surgery to remove their tonsils or adenoids. Where the adenotonsillectomy is undertaken to fix sleep-disordered breathing, the problem tends to recur within three years of surgery.

In fact, sleep-disordered breathing is only completely resolved by adenotonsillectomy in 27 percent of cases. This is largely because the child continues to breathe through an open mouth.

How to Identify, Correct Your Child’s Mouth Breathing

The best thing you can do is to monitor the way your child breathes. Notice how they breathe when they are concentrating, doing homework, watching TV, and sleeping. Note how much time your child spends with his or her mouth open. If it’s 40 percent or more of the time, you must act.

Apart from looking out for your child’s open mouth, there are several signs indicative of mouth breathing that may not be so obvious. If the answer to any of the questions below is “yes,” your child may have sleep-disordered breathing including OSA.

  • Is sleep disrupted?
  • Does your child twist and turn during sleep, waking up with the bedclothes tangled?
  • Can you hear their breathing during sleep?
  • Do they snore or hold their breath at night?
  • Do they wake up needing the bathroom, wet the bed, or have nightmares?
  • Do they often feel tired in the morning?
  • Do they ever complain about having a stuffy nose and a dry mouth when they wake up?

Breathing Exercises for Children

With the information above, you should begin to have a fair idea of whether your child persistently breathes through an open mouth. If they do, it is essential to encourage nasal breathing, both day and night. Children younger than 5 will find it difficult to practice breathing exercises, so if you have young children, you can start by preventing factors that lead to mouth breathing. Avoid overdressing your child, and keep the home cool, dust-free, and well ventilated.

You can get further advice from your healthcare professional, or a myofunctional therapist. There are pediatricians who can work with your child to gently widen the palate in a non-invasive way, even with very young children. I would advise looking for a myofunctional therapist or specialist pediatric airway-centric dentist. Contact AOMTinfo.org to find a practitioner.

Slightly older children will benefit from my free program of children’s breathing exercises, which can be found at buteykoclinic.com/buteykochildren. These include a magic nose unblocking exercise that is invaluable if your child has nasal congestion.

You can help your child restore the habit of nasal breathing using mouth tape designed to encourage nose breathing. There are many variations available, including my own design, MYOTAPE, which goes around the mouth rather than over it and allows your child to communicate and hydrate while wearing it. If your child is aged 4 years or older, they can wear the tape for 30 minutes or more every day, and during sleep.

You will find lots more information about children’s breathing, and some tips on taping and teaching breathing exercises to your child in my books, “The Breathing Cure” and “Buteyko Meets Dr. Mew,” which explains healthy breathing through full-color comic book storytelling.

And if you have problems with dysfunctional breathing, or knock-on health conditions because you breathed through your mouth as a child, remember, it’s never too late to make the switch to nose breathing, and experience a better, healthier life.

Patrick McKeown is an internationally renowned breathing coach, author, and speaker. He’s the creator of Oxygen Advantage®, founder of Buteyko Clinic International, and a fellow of the Royal Society of Biology in the UK. His published works include research in the Journal of Clinical Medicine and books including “The Oxygen Advantage, “The Breathing Cure” and “Atomic Focus.”
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