Does Your Child Breathe Through Their Mouth Often?

Have you noticed your child often breathes through their mouth or snores loudly at night? While these habits may seem harmless, they can be early indicators of pediatric sleep-disordered breathing (SDB)—a condition that can impact not only sleep quality but also growth, behavior, and long-term health.

Why Nasal Breathing Matters

Breathing through the nose does more than simply deliver oxygen. It filters and humidifies the air, reducing the number of airborne irritants reaching the lungs. Nasal breathing also enables the production of nitric oxide in the paranasal sinuses—a molecule with antimicrobial properties that improves oxygen uptake and supports immune function. Proper tongue posture—with the tongue resting against the roof of the mouth—helps guide the development of the upper jaw and midface, maintaining a healthy airway and dental arch formation.

Mouth breathing, in contrast, can impair facial growth, promote narrow dental arches, and increase the risk of airway collapse during sleep.

Consequences of Mouth Breathing

Chronic mouth breathing in children is linked to:

• Tonsil and adenoid hypertrophy, which can further block the airway;

• Dental crowding and malocclusion, due to altered jaw development;

• Upper respiratory infections, from bypassing the nose’s filtration system;

• Sleep apnea and poor sleep quality, which can impact growth, cognition, and behavior.

Children with untreated SDB may experience symptoms similar to ADHD, difficulty concentrating in school, and emotional dysregulation.

A Clinical Pathway Toward Early Intervention

A landmark paper published in Sleep (2023) presents a translational, age-based clinical pathway for pediatric SDB. This model emphasizes interdisciplinary collaboration and early action—often beginning with primary care, pediatric dentists, or ENT referrals.

Reprinted from Yoon et al.

Key stages of the pathway include:

• Prevention and awareness (birth–age 2): Promoting breastfeeding, nasal hygiene, and avoiding prolonged pacifier use (AAP/AAFP recommendation to discontinue by 18 months old).

• Screening and environmental optimization (ages 3–5): Addressing allergens (environmental and food), encouraging nasal hygiene, promoting anti-inflammatory nutrition and referring for ENT or feeding/myofunctional evaluation.

• Multidisciplinary assessment and therapy (ages 6–12): Including orthodontic interventions, behavioral sleep therapy, and ENT intervention when needed.

• Long-term monitoring (adolescents): Ensuring airway stability, retention of functional gains, and psychosocial support if needed.

Importantly, the study emphasizes that early intervention can reduce or delay the need for surgical procedures, and that environmental and behavioral factors—like diet, nasal breathing habits, and sleep posture—play a significant role in modifying risk over time.

If your child snores, breathes through their mouth, or has difficulty sleeping, these may be more than just sleep quirks. They could be signs of a developing airway disorder. Through early evaluation and intervention—focused on restoring nasal breathing, optimizing the sleep environment, and supporting craniofacial growth—we can significantly improve long-term outcomes.

A proactive approach today can spare your child from more invasive treatments tomorrow.

References

1. Camacho M, et al. (2022). Towards Restoration of Continuous Nasal Breathing as the Ultimate Treatment Goal in Pediatric Obstructive Sleep Apnea. Sleep and Breathing. Available from

2. Villa MP, Paolino MC, Castaldo R, Miano S. (2022). Environmental and Non-Surgical Interventions for Pediatric Obstructive Sleep Apnea. Children. 9(2):132. https://doi.org/10.3390/children9020132

3. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. (2012). Adenotonsillectomy Outcomes in Children with Obstructive Sleep Apnea Syndrome: A Multicenter Retrospective Study. Pediatrics. 129(3):e714–e722. https://doi.org/10.1542/peds.2011-1402

4. Gozal D, Hakim F, Kheirandish-Gozal L. (2022). Pediatric Sleep Disordered Breathing: Early Intervention and Personalized Medicine Are the Future. Children. 9(6):853. https://doi.org/10.3390/children9060853

5. Yoon A, Gozal D, Kushida C, et al. (2023). A Roadmap of Craniofacial Growth Modification for Children with Sleep Disordered Breathing: A Multidisciplinary Proposal. Sleep. 46(8):zsad095. https://doi.org/10.1093/sleep/zsad095