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Mouth Breathing: Things Every Parent Needs to Know Written By: Dr. Ankita Shah, February 2022

Tongue Tie

Did you know that 60% -70% of children suffer from mouth breathing? That’s right!

Mouth breathing refers to breathing through the mouth instead of the nose. If a child is a habitual mouth breather (partial or complete), they may keep their lips open most of the time while sleeping or even throughout the day. In both kids and adults, mouth breathing is often an early sign of sleep-disordered breathing, which can eventually lead to sleep apnea.

A sedentary lifestyle is one of the reasons why there has been an increase in mouth breathing in children. Mouth breathing could be a result of several other reasons too. Thus, if you want to learn more about the signs and symptoms of mouth breathing and its health effects in children, continue reading below.

A] Signs/Symptoms That Indicate Your Child Breathes Through the Mouth

1. Dry Mouth and Lips

A classic sign that indicates a child is sleeping with his/her mouth open is dry mouth and cracked lips. They may also wake up frequently to drink water at night. Plus, dry mouth, which is a sign of lack of saliva, could increase the risk of inflamed gums and cavities.

2. Jaw and Teeth Changes

Mouth Breathing play icon play icon

This is another sign that indicates your child is breathing through the mouth instead of the nose. When the mouth is open, the tongue rests in a forward, downward position which puts pressure on the jaw, impacting the jaw alignment and the development of the teeth. Here, the palate (that is the upper jaw) narrows and in turn becomes high & deep, giving the appearance of a long-narrow face with a small receding chin.

3. Teeth Grinding

Mouth breathing makes you exhale out a lot of carbon dioxide and this signals your brain that you are breathing too much. Our body beautifully compensates this by narrowing the airway that signals the brain to move the lower jaw forward. This is an unstable position and causes a lot of muscle spasms which leads to teeth grinding. This is a sign that the brain is trying to open up the airway due to compromised breathing.

4. Frequent Cavities and Tooth decay

Mouth breathing can significantly affect your child's saliva production, putting them at an elevated risk of experiencing mouth dryness. A dry mouth, on the other hand, raises the acidity levels in the mouth, which increases the risk of tooth decay. In kids who mouth breath, tooth decay often develops along the gum line.

5. Bad Breath

Mouth breathing also increases the risk of bad breath. If your child is suffering from continuous bad breath, it could be a sign of mouth breathing.

6. Poor Sleep

An open mouth during sleep prevents your child from falling into deep stages of sleep. You may often feel “But my child sleeps well!” But have you noticed your child tossing and turning in sleep? This is one of the signs the child wouldn't be falling into deep stages of sleep. Most of the repair-regeneration process, hormone regulation takes place during the deep stages of sleep. So, when the child’s deep stages of sleep is disturbed, it is often noticed in:

Abnormal sleep positions

Tossing and turning in bed

Day time sleepiness

Early morning headaches

Lack of attention and concentration

Arthritis and Rheumatoid Arthritis

Moody or bullying behaviour

Open mouth posture

Habitual snoring

Noisy breathing

Frequent Tonsils and Adenoids

Frequent cold, cough and allergies

Deep and narrow upper jaw

Retruded lower jaw

Crowded teeth

Bruxism i.e. clenching

Irritability

Bedwetting

Childhood obesity

Delayed growth

7. Snoring

Mouth breathing in children often progresses to snoring, and snoring at any age is not normal. Our airway is like a flexible pipe and any obstruction to the airway, either in the form of:

Tonsil or adenoids

Narrow upper jaw

Elongated soft palate

Tongue tone

Tongue tie

Backwardly positioned lower jaw

Can obstruct the free passage of airflow, causing turbulence to the air that is often heard as snoring.

8. Posture Changes

When the airway is blocked, our bodies naturally tend to get the neck and shoulders forward. Since the airway is a flexible pipe, bringing the neck forward will help in opening up the airway. Similarly while sleeping, one often sleeps with an extended neck or on the stomach like a frog; these positions open up the airway. It's a red flag that the child is having some form of airway obstruction. This leads to posture change, primarily a forward neck and shoulder posture. This eventually, over time, will affect their neck, shoulders, back and pelvis.

9. Difficulty in Swallowing

With an incorrect jaw development, breathing becomes difficult, which also affects swallowing. The tongue may move forward and develop into an abnormal tongue thrust swallow, which may lead to speech disorders in children. An open mouth posture can also be associated with weakness or shortening of lip muscles.

10. Enlarged tonsils and adenoids

Mouth breathing is common in children with enlarged tonsils & adenoids. When they mouth breathe, they exhale more carbon dioxide (CO2) which accelerates breathing. To decrease this, the body enlarges the tonsils & adenoids, resulting in the blocked nasal passage. Here, to establish continuous nasal breathing in children, the shape & position of the airway, nasal cavity and jaw needs to be corrected.

11. Asthma and Allergic Cold

Since the nose acts as a natural filter for the air we breathe, if your child breathes through the mouth instead of the nose, it may increase the risk of asthma and frequent allergic cold.

In nasal breathing, the air we breathe is filtered, warmed & humidified and reaches the lowermost part of the lungs, where a lot of blood vessels are present. This blood carries oxygen to the brain - the powerhouse of our body.

In contrast, when we mouth breathe, the air is neither filtered nor warmed and only reaches the upper part of the lungs. Plus, rather than taking in more oxygen, in mouth breathing, we end up breathing out a lot of carbon dioxide.

Nasal breathing, on the other hand, helps form Nitric Oxide that helps open up the airway and blood vessels. It helps facilitate oxygen to the brain and decreases inflammation & infections like tonsillitis and adenoids. It also helps fight viruses and bacteria, thus reducing the risk of asthma and frequent allergic cold and maintaining an optimum level of CO2 in the body.

12. Behaviour Changes

Lack of oxygen due to mouth breathing can put your child at risk of ADHD. Numerous children are often misdiagnosed with hyperactivity and attention deficit and maybe, in actuality, suffering from a sleep-breathing disorder.

B] Causes of Mouth Breathing in Children

Bottle Feeding

Bottle-feeding causes narrowing of the upper jaw, which pushes the lower jaw behind. It also alters the tongue position and makes it rest lower in the mouth, which results in mouth breathing.

Tongue Tie

As a condition present at birth, tongue tie can cause mouth breathing in children as it restricts the tongue's movements, which is crucial for breathing, swallowing, eating, drinking, chewing, talking, jaw growth, posture and digestion. Post thorough examination, a trained professional may recommend Functional Frenuloplasty to release tongue ties in children.

Blocked Nasal Passage

A complete or partial blocked nasal airway can also cause mouth breathing. In other words, if the nose is blocked, the body automatically resorts to other sources to receive oxygen a.k.a. the mouth. The primary cause of a blocked nasal passage is a tonsils and adenoids, incorrect tongue posture, deviated septum, enlarged turbinates, or an irregular shape of the nose.

Enlarged tonsils and adenoids

As mentioned above, mouth breathing is common in children with enlarged tonsils and adenoids. When a child breathes through the mouth, they exhale more carbon dioxide leading to too much breathing. To decrease breathing, the body enlarges the tonsils & adenoids, which results in the blocked nasal passage. To establish continuous nasal breathing, you need to check if your child suffers from mouth breathing and correct the shape and position of the airway, nasal cavity and jaw.

C] Health Effects of Mouth Breathing

1. Physical Development

Continuous mouth breathing shifts the child's facial structure leading to:

Overcrowding and crooked teeth

Jaw symmetry and uneven face

Long and narrow face

Venous pooling beneath the eyes

Gummy smile

A narrow mouth

Delayed growth &/or doesn’t match the ideal height and weight for the age

2. Cognitive Development

When the child's nasal passage is blocked, they cannot breathe properly, which affects brain functioning resulting in:

Difficulties with concentration and attention

Moody and aggressive behaviour

Disrupted emotional and social development

Misidentified issues like ADD and ADHD

Slower cognitive development

Unsatisfactory performance at school

D] Treatments For Mouth Breathing

Treating mouth breathing at the earliest is essential as it could cause serious issues in the long run such as poor facial growth, sleep disorders, among others. Losing the functioning of the nose has serious consequences, which could affect your general health and compromise the overall quality of life. Thus, get in touch with an oral myofunctional therapist or an airway focused paediatric dentist for the diagnosis of mouth breathing in your child.

The treatment approach depends on the cause. A possible treatment for mouth breathing in children can be oral myofunctional therapy i.e. mouth and tongue exercises that can be practised at home with some oral appliances to expand their upper jaw.

Is Your Child Mouth Breathing?

Check out these three methods that will help you determine whether or not your child is habitually mouth breathing.