What Every Parent Needs to Know

Most parents may be unaware of whether their children regularly mouth breathe or snore during sleep. While occasional mouth breathing due to a cold may be harmless, chronic mouth breathing and snoring can be detrimental to their physical and mental development, and may even contribute to the cause of obstructive sleep apnea later in life.

Newborns are “obligate nose breathers”. This means for the first few months of their life, they cannot breathe through their mouths. As they grow older, they can use their mouths to breathe when they need to, for example, when they have a cold or suffer from allergies. When their noses clear, they should return to nose breathing. However, when mouth breathing becomes a chronic habit, they will continue to mouth breathe even in the absence of nasal congestion. According to an important review study published in the 2012 Journal of Pediatrics, “It Takes a Mouth to Eat and a Nose to Breathe: Abnormal Respiration Affects Neonates’s Oral Competence and Systemic Adaptation”, such chronic mouth breathing habit contributes to abnormal facial growth, poor jaw development and dental crowding. It also leads to poor sleep due to obstructed airways, and in turn will adversely affect the child’s overall physical growth and school performance.

Signs and Symptoms of Mouth Breathing in Children

Children who are chronic mouth breathers will exhibit one or more of the followings:

  • Open mouth posture during most of the day and sleep
  • Snoring or teeth grinding during sleep
  • Smaller than children the same age
  • Sleep in strange position or with neck extended
  • Restless sleep, thrashing or turning
  • Brief awakening
  • Bed wetting
  • Drooling
  • Slow to rouse in the morning
  • Dry, cracked lips
  • Bad breath in the morning
  • Large tonsils
  • Irritability
  • Hyperactivity (oYen misdiagnosed as ADHD)

When mouth breathing and snoring are appropriately treated at a timely manner, children will quickly resume healthy growth, experience less symptoms, and improve their behavior and academic performance.

Children who are not treated, on the other hand, will also develop poor facial and dental features, collectively known as “adenoid facies”, so called because overgrown adenoids and tonsils are usually the main cause of mouth breathing and snoring. Features of adenoid facies include:

  • Long, narrow face
  • Dull tired expression
  • Dark circle under eyes
  • Gummy smile
  • Weak upper lip muscle, inability to keep lips together
  • Crooked teeth, large overbite and or overjet
  • Poor posture with head hunched forward
  • Underdeveloped upper and lower jaws
  • Underdeveloped airway

The longer mouth breathing is left unrecognized or untreated the more severe the features and these physical changes are difficult to correct. In addition, underdeveloped jaws and airway will reduce tongue space and airway space, which ultimately may lead to obstructive sleep apnea later in life.

Common Causes of Mouth Breathing

There are three common causes of nasal obstruction and mouth breathing.

Allergic Rhinitis. The mucous membrane in the nose swells due to allergic reactions to allergens such as dust mites, animal dander, grasses and pollens.

Deviated septum. This is when the bone and cartilage in the middle of the nose collapse and deviate to one side of the nose. This is common in people with narrow upper jaws. An ear-nose-throat specialist can perform a minor surgery to correct the deviation. However, in children and teens, it is possible to widen the upper jaw using a conservative non-surgical approach. Once the upper jaw grows bigger, the deviation tends to correct itself on its own without surgery.

Tonsils and adenoids. Tonsils and adenoids are part of the lymphatic system. Their sizes tend to enlarge between ages of 5 to 10, a ;me which also coincides with a sharp increase in mouth breathing in children. It is es;mated that about 25% of 6-year olds are chronic mouth breathers. Although tonsillectomy and adenoidectomy are effective way to correct nasal obstruction, many physicians tend to take the “wait and see” approach, siting that the tonsils
and adenoids will naturally shrink by the age of 13.

Source: Dr. Cecilia Ng