The issue of mouth breathing is different for adults and children. In children, there are several factors that complicate mouth breathing, namely the child’s airway is small, and it is still developing.
The clinical suspicion is raised with a child who mouth breathes as to whether they snore, and more importantly, if they have obstructive sleep apnea. Obstructive sleep apnea is a complex, potentially serious medical condition that usually has a better solution than in adults.
Many healthcare professionals become so familiar with seeing children who mouth breath, they can learn to recognize them by their facial appearance. There are characteristics of mouth breathers that are unmistakable.
We are born as what is known as “obligate nasal breathers.” This means our airways are built for us to breathe through our nose first to filter toxins. If the child’s breathing bypasses the nose, there is an effect on the transfer of oxygen, nitric acid release, and circulation, causing a number of issues which will be outlined in this article.
The habit of mouth breathing can be perpetuated even after the airway is improved. Mouth breathing is a cause of not just obstructive sleep apnea specifically, but an array of sleep disordered breathing during childhood.
What is the most common reason for mouth breathing in children?
By far, the most common reasons for mouth breathing in children are obstacles in the back of the throat, specifically in the nasopharynx, or behind the palate and uvula (dangling tissue in the center).
Obstruction in the nasopharynx or nasal passage is the most common cause of mouth breathing. This may include a deviated nasal septum, nasal polyps, enlarged bones or blood vessels or nasal lining called turbinates.
Other causes include enlargement of the tonsils and adenoids, rhinitis, or inflammation of the nasal lining from causes such as allergy, infections, or tumors or other types of inflammation.
Another possibility is that the child has tongue-tie or ankyloglossia. This is a relatively easy thing to fix and in infants does not even require anesthesia. Many ENT specialists will transect a newborn’s tongue tie or frenulum right at the bedside or in the doctor’s office.
However, even after these obstructions are removed, it is possible to still have a child who has mouth breathing. This can be a result of habit. It can also be a result of unbalanced facial musculature or structure involving changes in tooth positioning, lips, tongue, palate, and jaws.
In most cases, children adapt and relearn how to breath to counterbalance the new breathing pattern.
What is Sleep-Disordered Breathing?
Sleep-Disordered Breathing is a wide spectrum of clinical signs and symptoms. It includes snoring, upper airway resistance syndrome, and as mentioned above, obstructive sleep apnea in the most severe cases.
Snoring occurs in up to ¼ of children, but only about 1-2% truly have obstructive sleep apnea. Obstructive sleep apnea is defined as having episodes of not breathing while sleeping for 10 seconds or more. That is a long time, particularly for a child.
The findings for upper airway resistance syndrome are more nonspecific and variable. These children resemble chronic mouth breathers and those who have unrelenting nasal obstruction from causes such as allergy.
These allergic children can present with the characteristic nasal salute which is constantly pushing up their nose with the palm of their hands. Most of us have seen children do the nasal salute at some point in their young lives.
What can be done about children who are mouth breathers?
The first step in most children is to have them see a dentist. The importance of early detection and the need for appropriate treatment cannot be overstressed.
Many children first need orthodontics to either alter their growing facial structure or align their teeth. Prior to orthodontics many dentists will encourage working with the child’s pediatrician and have the child evaluated for enlarged tonsils and adenoids.
None of the orthodontics will be effective without going that next step in having the tonsils and/or adenoids removed first. In some cases, ENT doctors will discover other possible abnormalities that either need to be addressed first such as an unusual enlargement of nasal lining or inferior turbinates or concomitant allergy issues.
What are the parameters used in the clinical recognition of children who mouth breath?
Orthodontists look for the presence or absence of sealed lips with breathing and the overall posture of the child. The presence of sealed lips is called “lack of lip seal.” This lack of lip seal is prevalent in as many as 60% of children with mouth breathing.
The lack of lip seal suggests many of the following:
- Presence of vertical and sagittal facial discrepancies such as the long appearing face
- Inadequate lip length
- Increased lower facial height
- Abnormal breathing function
- Altered lip tonicity
The increased lower facial height is called the dolichofacial type and it is statistically significant in children who have mouth breathing. This facial structure can lead to the prevalence of malocclusions of the teeth and an anterior open bite.
The overall structure of the face leads to difficulty with the supporting tissue working properly with the normal neuromuscular activity of the face, including chewing and swallowing. When abnormal pressures affect the muscles of the face there can be an interference in facial growth and development.
The tongue can assume a low and forward position. This is the most common finding when there are enlarged palatine tonsils. The child adapts to try to increase the posterior airway space and ease their breathing.
The low position of the tongue decreases internal pressure of the upper arch of the palate. This causes the child to increase the external pressure of the perioral muscles, causing the palate to have decreased development or atresia.
What to do about your child whose mouth breathes?
- Consider having them evaluated by their dentist first for possible orthodontia
- Consider having them undergo evaluation for removal of their tonsils and adenoids
- Allergy evaluation
- Nasal and sinus evaluation
- Evaluate for tongue tie
- Rule out any nasal or throat obstruction
- Evaluation for appropriate height and weight. Increased weight can affect mouth breathing
You only need to breathe through your mouth when you have nasal congestion brought on by allergies or a cold.
The significance of your nose is frequently overlooked—until you are sick. Your quality of life may suffer if your nose is congested. Additionally, it may impair your capacity for sound sleep and general performance.
Particularly when you're sleeping, you might not be aware that you're breathing via your mouth instead of your nose.
Additionally, stress and anxiety might make someone breathe via their lips rather than their nose. Stress causes the sympathetic nervous system to become active, resulting in irregular, shallow, and fast breathing.
A single test does not exist for mouth breathing. When inspecting the nostrils during a physical examination or during a visit to determine the cause of recurrent nasal congestion, a doctor may identify mouth breathing.
The urgent and crucial issue of breathing adequate air might be resolved by mouth breathing. However, mouth breathing can develop into a difficult-to-break habit that can lead to sleep disturbances, dental issues, and variations in facial structure. If you believe that you or your child is beginning to mouth breathe, speak with your healthcare professional. To solve the issue, they'll suggest therapies or medications.