Kids’ Habits: mouth breathing

Welcome to a huge topic. For ease, I have listed the headings, feel free to skip ahead:

• Dylan’s Story (an example of a child suffering from mouth breathing)
• Getting to the root of the problem (I also discuss symptoms of mouth breathing here)
• Prevention
• Summary and Further Info

This week’s Kids’ Habits Blog scratches the surface of ‘mouth breathing’. It is a summary I have made through reading papers and collaborating with GP’s, paediatricians, ENT specialists, teachers, speech pathologists, nutritionists and chiropractors. Let’s begin…

Dylan’s story

This is a story that I have heard across many families. Dylan has been mouth breathing since he was 2yo. See this video as an example. His parents trace this back to his ear aches which began at 2yo as well. They say he was all clogged up and could never breathe properly though his nose. As Dylan developed, his mouth breathing caused changes in his jaw joints. This happened because he was using new muscles which strained his jaw joints during mouth breathing. Visually, Dylan’s face started to become elongated and his parents became worried when some of his adult teeth came through crooked and some didn’t even come through at all. They were worried because all his friends had their adult teeth and he didn’t. So at the age of 14yo, Dylan presented to his local dentist because now he was of braces age. Unfortunately, by this stage the damage to his face and airway had already been done. Placing braces on his teeth would straighten them but his jaw shape would remain and he had a whole life of health-related problems ahead of him. A key example of problems later in life is Obstructive Sleep Apnoea (OSA). OSA is a sleep disorder where people stop breathing during their sleep. People who have OSA usually also grind their teeth at night – this habit places excessive forces on their teeth. What this means is that Dylan now has an increased risk of breaking teeth/implants due to him grinding his teeth during his sleep. Having OSA also means he is getting little oxygen during his sleep and can develop problems with his brain function, blood pressure, growth, mood and energy.

Getting to the root of the problem

There is a very strong chance this could have all been prevented when Dylan was 2yo. A referral to his GP may have found an underlying medical problem. This is why I take a proactive approach to early intervention. I take the time to screen and attend to early growth and development compensations. My recommendation for mums and dads is to check your little ones for the below symptoms:

• Snoring
• Teeth look short/worn down
• Teeth grinding sounds at night
• Dark circles under eyes
• Earaches and/or hearing problems
• Sore head during the day
• Slow developer
• Hyperactive
• Big tonsils (check the back of the mouth)
• Can’t concentrate during the day, not doing well at school
• Always has a runny nose
• Not a good sleeper
• Overweight
• Noisy breathing sounds
• Ongoing upper airway infections
• Nightmares/bed wetting

Often, a blocked nose from allergies, a cold or hay fever may cause transient mouth breathing. Your GP may prescribe a nasal spray and monitor your child’s response or refer to an ENT specialist. However, if more often than not, you find your kiddies’ mouth open at night or they snore or grind their teeth, then they may have an airway problem. They may need their tonsils or adenoids checked, as well as making sure they don’t have an anatomically small jaw (kids with Down’s Syndrome and Cerebral Palsy tend to have small jaws) or a tongue-tie, and have an adequate lip seal (lips are closed at rest).

Prevention

So how can we prevent these issues in the first place? There are 4 main areas to consider:

1. Posture: Try to imagine the tongue position in the mouth. In a mouth breather, instead of resting on the roof of the mouth, it rests on the floor of the mouth. Over time, this will affect the upper jaw development so it becomes narrow and constricted. Because of this, teeth become crowded and you get an uneven bite.
   • I ensure that kids do not have a tongue tie which can restrict their tongue movement.
   • I refer to GP, speech pathologist, orofacial myologist to help re-train the tongue.
2. Nutrition: breastfeeding is the best start to life and where possible should be used over formula. Early development is a very important time to establish good habits of eating nutrient-rich foods which help form a good pattern of chewing and swallowing early on in life. As well as this, foods which promote inflammation should be avoided – these are usually processed foods which have chemicals and added ingredients to prolong their shelf life. Our bodies mount an inflammatory response to these foreign substances.
   • I give diet advice to my patients, this also benefits their oral health. If further help is required, I refer to a nutritionist.
   • I advocate for mothers to try their best to breastfeed.
3. Breathing: early breathing problems must be recognised and attended to by your doctor. Breathing should be through the nose at all times. This means that the child can comfortably close their lips and breathe without any discomfort or straining. Also, at night you need to monitor for teeth grinding or snoring.
   • I ask parents how their child breathes during their sleep.
   • I observe the way a child breathes during their checkup and clean.
   • If I am concerned, I refer to a GP or ENT specialist.
4. Sleep: we all need adequate sleep to allow the proper functioning of our nervous system. Hyperactivity or tiredness can result from a lack of sleep.
   • I check in with parents to see how their kids are doing at school.
   • I observe for the signs of fatigue/hyperactivity in a child.
   • My medical history questionnaire covers medications so that I am aware if kids are suffering from ADHD or other behavioural conditions.
   • I ask parents to regularly check up on their kids and make sure they are not breathing through their mouth at night. Take a photo or video if you are unsure.

Summary & Further Info

Mouth breathing is a huge topic.

As more research comes through, I will keep you updated on any progress made to address this important issue.

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If you’re interested in learning more, these videos are a great place to start:

• How to stop mouth breathing in 5 easy steps

These articles are informative:

• Medically Indicated Orthodontic Care
• Untreated Sleep Apnea in Children Could Contribute to ADHD and Behavioral Problems
• Obstructive Sleep Apnea Causes Complications in Dental Implants 

In the news:

• Monash Medical Centre’s sleep laboratory helps kids who struggle through the night