We’ve all reminded our kids to chew with their mouths closed, but they should be breathing with their mouths closed, too. It’s something that over half of kids struggle with, according to Dr. Mandeep Johal, a Guelph, Ont-based dentist and holistic wellness advocate who specializes in paediatric care. And while it may seem like a harmless quirk, mouth breathing can actually be a sign of an underlying health condition that requires intervention. Here’s what you need to know about mouth breathing, including signs to watch for, what it may reveal about your child’s health and when to talk to your doctor.
Just like it sounds, mouth breathing is the habit of taking in air through the mouth rather than the nose (the optimal method).
If it’s happening occasionally and with obvious reason—a nasty cold with sinus congestion, for example—mouth breathing isn’t a problem. However, if you notice that your child is breathing through their mouth on a regular basis, that’s a yellow flag. “We’re not meant to breathe through the mouth,” says Johal. “If a child is habitually mouth breathing, we should get to the cause.”
Mouth breathing in children has been linked to a number of medical conditions including sleep apnea, dental decay and malocclusion, a.k.a. misaligned teeth (one of the main causes for braces). Respiratory issues like mouth breathing also up the risk of heart disease and type two diabetes later in life. What's more, over long stretches of time, mouth breathing can affect facial development, resulting in a retreated or “weak” jaw (when the jaw or chin slopes backward). It also indicates a narrow airway.
Breathing in and out through the mouth can also impede the natural flow of nitric acid, a chemical that aids the respiratory system and is produced in the nasal passage. Nasal breathing also takes in much more oxygen, which means improved rest and brain activity. When you aren’t breathing properly, the immune system and other functions can suffer. “Mouth breathers are prone to shallow breathing and upper respiratory problems,” Johal says, noting that this deep breathing is particularly important for infants, because their brains are rapidly developing.
Digestive issues can result, too. “When you see mouth breathing in children and they have cavities, it may lead to gut issues because 50 percent of the biome in the mouth needs to get to the gut,” Johal says. Essentially, if a person isn’t breathing the way nature intended—in and out through the nasal passages—it disrupts the body’s rhythm and prevents organisms in the body from ending up where they should. “Parents should be concerned because it’s not only affecting their dental health, but their whole body,” Johal says.
Johal gives families a list of indicators to look for, noting that many parents don’t notice mouth breathing until they’re actively looking for it. “I ask them to watch their kids when they’re watching television or doing homework, and to observe them when they’re sleeping,” she says. “Look at how they’re swallowing their food—if they’re mouth breathing, it impacts the way they eat as well. I give parents homework and ask them to take time and look for specific things.”
Johal often does a wellness check on infants that involves checking the airways, nasal cavities and tongue position. In older children, she looks for cavities and plaque build-up as a sign that they’re breathing through the mouth.
Parents may also notice physical characteristics that are the result of mouth breathing. If a child has a retreated jaw, it likely means they have a narrow airway. A dentist will be able to determine if a child’s “bite” (the way their jaw closes) is showing signs of a problem. And in many cases, a child’s overall posture may suffer. “Mouth breathing can affect a child from head to toe,” Johal asserts, noting that many parents attribute forward head posture and neck issues to too much screen time, but mouth breathing is often the actual cause.
A lot of parents are reluctant to address these concerns with their child’s doctor, Johal says, due to negative connotations of the term ‘mouth-breather.’ (“Stranger Things hasn’t helped with that,” Johal laments with a laugh.) However, because the habit can be related to everything from dental issues and poor sleep to gut health, it’s important to broach the subject with a medical professional.
“Get a referral to an ENT,” Johal advises. “Is there an obstruction in the nose? In the throat? What is causing this?” She notes that one of the most common reasons for mouth breathing in children is low tongue posture, with or without a tongue tie.
Once you’ve ruled out ear, nose and throat issues with a specialist, a dental professional can coach kids to breathe correctly. “It takes training, like physical therapy, [and] patience and effort,” she says. This may involve breath and facial muscle exercises, as well as movements that tone the tongue, lips and soft palette. Additional treatment may include saline nasal irrigation to open up the nasal passages. “We have these programs and we can start really young,” Johal says.
After hearing the long list of medical issues associated with mouth breathing, parents may be feeling concerned or overwhelmed. Knowing this, Dr. Johan often shares that she herself was a childhood mouth-breather who dealt with sleep issues for decades. “I didn’t know I had poor sleep until I got into wellness,” she says, noting that it impacted her health and ability to function optimally. “I had to work so much harder at concentrating than the student next to me.”
As a dentist—and now a healthy, thriving adult—Johal hopes to spread the message about this common, but commonly overlooked, condition. “Dental health is a window to your overall health,” Johal says. And if your child is a mouth breather? Don’t panic.
“There are solutions.”