Mouth breathing is more common in children than in adults, affecting up to 50% of children. This is because they are more susceptible to having an anatomically insufficient airway.
Children’s airways tend to be smaller in diameter than adults, their tongue is relatively larger and it takes up more space in the part of the upper airway called the oropharynx. Also many children have enlarged adenoids and tonsils which further limits the size of their airway.
Mouth breathing can in some cases make the problem worse because it makes the upper airway narrow and more collapsible, particularly during sleep. A child who does not sleep well is less likely to be calm and focused.
Decades of research has shown that children with sleep disordered breathing are much more likely to suffer from ADHD and other types of learning and behavioral issues. Children with sleep disordered breathing as toddlers are 40-100% more likely to develop behavioural problems by age 7, compared with children who breathe normally during sleep [1]. Mouth breathing is also a risk factor and has been linked with sleep difficulties as well as symptoms of ADHD [2].
In my experience mouth breathing children whose airways are narrow and collapsible and who have poor sleep are also more likely to have other breathing dysfunctions such as breathing pattern disorders and hyperventilation. Breathing pattern disorders in children are much more common than most people realise and are often overlooked [3]. So it helps to know what they look like in children.
They often show up as:
- Irregular breathing patterns – (breath holding and forced exhalation, excessive sighing and yawning)
- Rapid shallow breathing
- Unexplained breathlessness
- Upper chest breathing
- Exercise intolerance/avoidance
Some children with upper airway problems and mouth breathing also present with chronic hyperventilation (low CO2 due to over breathing) or with hypoventilation (high CO2 and low O2) [4].
There are also other aspects of a child’s anatomy, apart from those affecting the upper airway, that makes them susceptible to inefficient breathing mechanics. They naturally tend to have a faster breathing rate, a weaker diaphragm and their lungs are less elastic and more easily overinflated. In infants and younger children the fact that ribs are angled more horizontally makes it harder for them to get extra air in.
The hyperarousal of the nervous system that occurs in children with sleep disordered breathing might be another factor that leads to dysfunctional breathing in children.
Knowing about these issues in a child is the first step to correcting them. Children who are mouth breathing and who have other signs of abnormal and dysfunctional breathing may need to be evaluated by an ear nose and throat physician or pediatrician to see if medication and/or surgery is necessary or have a sleep study to see if they have sleep apnea.
Then they may need to see a dentist to evaluate the jaws and teeth.
Breathing retraining and orofacial myofunctional therapy might also be very helpful and essential for some children.
My ‘Healthy Breathing, Healthy Child’ program is a 6 week online program that helps children to improve their breathing, airway and oral motor function. Children are also taught how to use breathing in combination with mindfulness, relaxation and body awareness to calm and regulate their nervous system.
For more info on this program… click here
- Bonuck, K., et al., Sleep-disordered breathing in a population based cohort: behavioural outcomes at 4 and 7 years. Pediatrics, 2012. 129(4): p. 1-9.
- Kalaskar, R., et al., Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Children with Mouth Breathing. Int J Clin Pediatr Dent, 2021. 14(5): p. 604-609.
- Barker, N.J., H. Elphick, and M.L. Everard, The impact of a dedicated physiotherapist clinic for children with dysfunctional breathing. ERJ Open Res, 2016. 2(3).
- Khalifa, M.S., et al., Effect of enlarged adenoids on arterial blood gases in children. Journal of Laryngology and Otology, 1991. 105: p. 436-438.
