Mouth Breathing in Children, Babies, Toddlers, and Infants
Their causes, effects, treatment, and prevention
Children, babies,
toddlers, infants and newborn, who are mouth breathers, experience the
same pathological effects as adults (see Mouth
vs. Nose breathing in adults), that include abnormalities in
blood
gases, cell hypoxia (reduced body and brain oxygen content), reduced
perfusion of all vital organs, suppressed immune system and many other
"adult" effects. Apart from this, there are specific effects related to
children and their developmental dynamic.
Click on these titles to read abstracts cited on this page
below or
just investigate the titles:
Etiology,
clinical manifestations and concurrent findings in mouth-breathing
children (Abreu et al, 2008)
A
comparative study of effects of mouth breathing and nose breathing on
gingival health in children (Gulati, 1998)
Relationship
between mouth breathing and postural alterations of children: a
descriptive analysis (Krakauer et al, 2000)
Prevalence
of oral malodor and the relationship with habitual mouth breathing in
children (Kanehira et al, 2004)
Radiological
evaluation of facial types in mouth breathing children: a retrospective
study (Costa et al, 2008)
Prevalence of malocclusion among mouth breathing children: do
expectations meet reality? (Souki et al, 2009)
The
negative effect of mouth breathing on the body and development of the
child (Flutter, 2006)
Mouth breathing in adults remains one of 2 factors contributing to mortality in the severely sick due to chronic diseases. Statistically, early morning hours (from about 4 to 7 am) have highest death toll due to heart attacks or anginas, strokes, seizures, asthma attacks and many other acute episodes. This phenomenon and related medical articles are discussed on web page "Sleep Heavy Breathing Effect".
Is there any therapy or
organized group of medical professionals who
provide techniques to stop mouth breathing in adults, children, babies,
toddlers, infants and newborn, and who demand nose breathing as a
necessary quality of good health? To my knowledge, there is only one
medical therapy which provides solutions and techniques for mouth
breathing problems in adults and children of all ages, including
newborns and infants. This therapy also considers and demands nose
breathing 24/7 as a crucial factor for health and wellbeing. It has
been practiced by over 200 MDs in the USSR and Russia and was developed
by leading Soviet physiologist Dr. K. Buteyko. It is known as the
Buteyko breathing method.
Summary of causes and effects of mouth breathing in infants, babies, toddlers, and children
|
- Malocclusion (Article abstracts related to these medical research findings are also provided below.) |
Photo. Dr
Konstantin Buteyko, |
Typical clinical manifestations in children, toddles, and infants, who are mouth breathers- Sleeping with mouth
open |
Main causes of problems with nose breathing and poor health in children- Over-feeding of
children by parents |
Mouth breathing route in toddlers, babies,
infants, and children can
also intensify the development of any chronic pathology, including
obesity, cancer, diabetes, asthma, heart disease, and many other
conditions. Hence, oral breathing promotes "adult" diseases in
children. Breathing training is vital in order to experience all
benefits of breathing normalization and nose breathing, and stop mouth
breathing during day time, sleep, play, and at all other times.
How to treat, stop, and prevent mouth breathing in children, babies, toddlers, and infants with the Buteyko method
The main requirement for success in dealing with young mouth breathers, while using the Buteyko breathing method, is nose breathing parents and care-takers who also understood and learned the Buteyko method and applied its techniques on themselves. Only then kids can learn or rather copy their parents habits in relation to, for example, mouth taping during sleep, physical exercise with nose breathing only, and use other beneficial techniques and habits to increase body oxygen and improve health.
For further education, see the medical research article "Using the Buteyko Breathing Method For Children" (translation from Russian) written by Dr. Natalia Lapa, MD. The paper is provided below. She was trained as a Buteyko breathing practitioner by Dr. Konstantin Buteyko. The paper was published in the book "Buteyko method. Its application in medical practice", ed. by K. P. Buteyko, 2nd ed., 1991, p. 57-62, Titul, Odessa, USSR.
Related web pages:
- Croup cough
- How to unblock
the blocked
nose (Article - Buteyko breathing exercise)
- "How to
maintain nose breathing 24/7" (Instructional Guide, which
describe
what to do at night during sleep to stop mouth breathing.* Children 3-4
years or older can follow and use many of these techniques, while
infants (less than 3 years) require different methods and strategies
(see the article below).
References
Prevalence
of malocclusion among mouth breathing children: do expectations meet
reality?
Souki BQ, Pimenta GB, Souki MQ, Franco LP, Becker HM, Pinto
JA,
Int J Pediatr Otorhinolaryngol. 2009 May; 73(5): p.767-773.
Federal University of Minas Gerais, Outpatient Clinic for
Mouth-Breathers, Belo Horizonte, Brazil
OBJECTIVE: The aim of this study was to report epidemiological data on
the prevalence of malocclusion among a group of children, consecutively
admitted at a referral mouth breathing otorhinolaryngological (ENT)
center. We assessed the association between the severity of the
obstruction by adenoids/tonsils hyperplasia or the presence of allergic
rhinitis and the prevalence of class II malocclusion, anterior open
bite and posterior crossbite. METHODS: Cross-sectional, descriptive
study, carried out at an Outpatient Clinic for Mouth-Breathers. Dental
inter-arch relationship and nasal obstructive variables were diagnosed
and the appropriate cross-tabulations were done. RESULTS: Four hundred
and one patients were included. Mean age was 6 years and 6 months
(S.D.: 2 years and 7 months), ranging from 2 to 12 years. All subjects
were evaluated by otorhinolaryngologists to confirm mouth breathing.
Adenoid/tonsil obstruction was detected in 71.8% of this sample,
regardless of the presence of rhinitis. Allergic rhinitis alone was
found in 18.7% of the children. Non-obstructive mouth breathing was
diagnosed in 9.5% of this sample. Posterior crossbite was detected in
almost 30% of the children during primary and mixed dentitions and 48%
in permanent dentition. During mixed and permanent dentitions, anterior
open bite and class II malocclusion were highly prevalent. More than
50% of the mouth breathing children carried a normal inter-arch
relationship in the sagital, transversal and vertical planes.
Univariate analysis showed no significant association between the type
of the obstruction (adenoids/tonsils obstructive hyperplasia or the
presence of allergic rhinitis) and malocclusions (class II, anterior
open bite and posterior crossbite). CONCLUSIONS: The
prevalence of
posterior crossbite is higher in mouth breathing children than in the
general population. During mixed and permanent dentitions, anterior
open bite and class II malocclusion were more likely to be present in
mouth breathers. Although more children showed these
malocclusions,
most mouth breathing children evaluated in this study did not match the
expected "mouth breathing dental stereotype". In this population of
mouth breathing children, the obstructive size of adenoids or tonsils
and the presence of rhinitis were not risk factors to the development
of class II malocclusion, anterior open bite or posterior crossbite.
Etiology,
clinical manifestations and concurrent findings in
mouth-breathing children. [Article in English, Portuguese]
Abreu RR, Rocha RL, Lamounier JA, Guerra AF,
J Pediatr (Rio J). 2008 Nov-Dec; 84(6): p.529-535.
Centro de Pós-Graduação, Faculdade de Medicina, Universidade Federal de
Minas Gerais, Belo Horizonte, MG, Brazil
OBJECTIVE: To investigate the etiology, main clinical manifestations
and other concurrent findings in mouth-breathing children aged 3 to 9
years and resident in the urban area of Abaeté (MG), Brazil. METHODS:
This study was based on a representative random sample of the town
population, of 23,596 inhabitants. Clinical diagnosis of
mouth-breathing was defined as a combination of snoring, sleeping with
mouth open, drooling on the pillow and frequent or intermittent nasal
obstruction. Children with a clinical diagnosis of mouth-breathing
underwent nasal endoscopy, allergy skin tests and X ray of the
rhinopharynx, full blood tests, eosinophil counts, total IgE assay and
fecal parasitology. Data were analyzed using SPSS version 10.5.
RESULTS: The main causes of mouth-breathing were: allergic rhinitis
(81.4%), enlarged adenoids (79.2%), enlarged tonsils (12.6%), and
obstructive deviation of the nasal septum (1.0%). The main
clinical
manifestations of mouth breathers were: sleeping with mouth open (86%),
snoring (79%), itchy nose (77%), drooling on the pillow (62%),
nocturnal sleep problems or agitated sleep (62%), nasal obstruction
(49%), and irritability during the day (43%). CONCLUSION:
Certain
clinical manifestations are very common among mouth-breathing children.
These manifestations must be recognized and considered in the clinical
diagnosis of mouth-breathing.
Relationship
between mouth breathing and postural alterations of children: a
descriptive analysis,
Krakauer LH, Guilherme A,
Int J Orofacial Myology. 2000 Nov; 26: p.13-23.
The research within this article seeks to verify and demonstrate the
consequences of mouth breathing versus nasal respiration and to view
supposed postural alterations in groups of children within specific age
ranges. The authors state that children with nasal
respiration, age
8 and above, present with better posture than those who continue oral
breathing beyond age 8. The importance of picture
documentation is
stressed in order to provide the most information regarding postural
changes. A review of research and literature is provided in the article.
Radiological
evaluation of facial types in mouth breathing children: a retrospective
study,
Costa JR, Pereira SR, Weckx LL, Pignatari SN, Uema SF,
Int J Orthod Milwaukee. 2008 Winter; 19(4): p.13-16.
Federal University of São Paulo, São Paulo, Brazil.
Mouth breathing is a condition often associated with a long
face,
half-open mouth and increased anterior facial height. We
performed
conventional lateral and frontal cephalograms of eighty-nine children
with nasal and mouth breathing and independently measured Total Facial
Height using the analysis technique of Ricketts, and the Morphologic
Facial Index employing the technique of Avila. It was
concluded that
dolicofacial following mesofacial were the most frequent patterns found
in mouth-breathing children and this suggests that both analyses can be
used independently.
[Indicative
factors of early facial aging in mouth breathing adults]
[Article in Portuguese]
Oliveira AC, Dos Anjos CA, Silva EH, Menezes Pde L,
Pro Fono. 2007 Jul-Sep; 19(3): p.305-312.
Associação Brasileira de Otorrinolaringologia e Cirurgia
Cérvico-Facial, Brazil.
BACKGROUND: Early facial aging in mouth breathing adults. AIM: To
verify the presence of indicative factors of early facial aging and to
characterize the measurements of the projection of the nasogeniane fold
to the tragus and of the face width in mouth and nose breathing adults.
METHOD: Aspects of early facial aging were observed in 60 individuals
(presence of dark circles and wrinkles under the eyes, mentual wrinkles
and mentual ridges). Measurements of the projection of the nasogeniane
fold to the tragus and of the face width (distance between the
buccinators) were taken using a digital caliper. Later, the volunteers
were submitted to speech-language evaluations (anamneses and orofacial
myofuntional assessment) and to an otolaryngology inspection in order
to establish the diagnosis of mouth breathing (anamneses, clinical
evaluation and video laryngoscopy). The obtained data were analyzed
according to descriptive statistics and to the following statistic
tests: Kolmogorov-Smirnov, Shapiro-Wilk, Qui-square, Mann-Withney and
the T-Student test for independent variables. Differences were
considered significant when the p value was inferior to .05 and the
accepted beta error was of .1. RESULTS: The research sample consisted
only of female volunteers. For the research group (mouth breathers) the
age average was of 22.04 +/- 2.25 years and, for the control group
(nose breathers) the age average was of 21.94 +/- 2.03 years. The
presence of a high percentage of indicative factors of early facial
aging was observed for the group of mouth breathers when compared to
the group of nose breathers. Greater differences between the
projections of the nasogenianos ridges in right and left side of the
face was also observed for the group of mouth breathers. However,
higher values of face widths were observed for the nose breathing
individuals, configuring a discreetly more widened face in the cheek
region. CONCLUSIONS: In the present study there was a higher
indication of early facial aging for the group of mouth breathers.
Prevalence
of oral malodor and the relationship with habitual mouth breathing in
children,
Kanehira T, Takehara J, Takahashi D, Honda O, Morita M,
J Clin Pediatr Dent. 2004 Summer; 28(4): p.285-288.
Department of Oral Health Science, Hokkaido University, Graduate School
of Dental Medicine, Sapporo, Japan.
The prevalence of oral malodor and association of habitual mouth
breathing with oral malodor were investigated in children residing in
rural areas. One hundred and nineteen children participated in this
study. A sulfide monitor and organoleptic method were used to evaluate
oral malodor. About 8% of children had a sulfide level in mouth air
above the socially acceptable limit (75 ppb). Habitual mouth
breathing was a factor contributing to oral malodor. Oral malodor was
not significantly correlated with plaque index, history of caries or
frequency of toothbrushing.
A
comparative study of effects of mouth breathing and normal breathing on
gingival health in children,
Gulati MS, Grewal N, Kaur A,
J Indian Soc Pedod Prev Dent. 1998 Sep; 16(3): p.72-83.
Department of Pedodontia and Preventive Dentistry, Pb. Govt. Dental
College and Hospital, Amritsar.
The present study was conducted to assess the effects of mouth
breathing, lip seal and upper lip coverage on gingival health of
children. 240 school children aged 10-14 years were selected
irrespective of sex race and socioeconomic status. They were divided
into two major groups i.e. mouth breathers and normal breathers. These
groups were further subdivided into six sub-groups or categories on the
basis of lip seal and upper incisor coverage. Gingival index
was
found to be higher in the mouth breathers than in the normal breathers
in the subjects with incompetent lip seal. Increased lip separation and
decreased upper lip coverage were all associated with higher levels of
Plaque index and Gingival index. No statistical difference
existed
between mouth breathers and normal breathers with respect to Plaque
index.
The
negative effect of mouth breathing on the body and development of the
child,
Flutter J,
Int J Orthod Milwaukee. 2006 Summer; 17(2): p.31-37. No abstract
available.
Reference article
Using the Buteyko Breathing Method For Children
Dr. Natalia Lapa, MD, Specialist in Remedial Gymnastics
Children Hospital No. 8, Novosibirsk, USSR, 1991
The paper was published in the book "Buteyko method. Its application in medical practice", ed. by K. P. Buteyko, 2nd ed., 1991, Titul, Odessa, USSR [in Russian].
To run the Buteyko breathing method sessions with children is a kind of professional test on how well one knows the Buteyko method as doctor-practitioner and also it is a serious exam for parents. This is creative and exciting work, promising even with very ill children. They have a strong capacity to acquire new information, their bodies contain less poisons and toxins, their compensatory body function is not completely destroyed, metabolism is flexible and the ability to regenerate is high. Working with children means to care about our future generations as they will later become parents themselves.
Unlike adults, children are not familiar with popular medical views. They are more instinctive, their inborn reflexes are correct, and that explains why alternative medicine notions are more in tune with children's needs and wishes. Children do not want to cough phlegm out but they are forced to do that. Many of them do not want to drink after meals, and they do not like sandwiches. They prefer natural vegetables to salads, but gradually get trained to eat them. I have never met children who don't cry in the doctor's office or while some tests are taken. But they are very happy with non-medicinal treatment especially when some physical or water activities are included.
A doctor working with children has to be able to give them a clear and easy to understand explanation of the theory and practice of the Buteyko breathing method, or that which is causing the disease and how they can become free of it. Don't convert your teaching method into cliché and stereotypes.
Make it different for each individual!
It is very important to help parents to understand that the process of sanitation and keeping children healthy will last their whole lifetime. Remind them that children are individuals requiring respect and having their own desires.
The most serious damaging factors causing uncontrollable growth of the depth of breathing are over-feeding of kids, over-heating and a lack of physical activity. Children's development depends greatly on their environment. The smaller they are, the greater the dependency. That is why they often copy a character, views, habits of their parents, including their attitude to health. If mother and father do nothing to improve their health, any attempts to do something for children in this respect are taken by them as unjust and a constraint. The best encouraging motivation for kids is an example from parents, a competition with them. That means rehabilitation must be a family business.
During our sessions we tried to explain to both parents and children that health is a real treasure and to achieve it takes a great deal of effort. A child should comprehend what is the cause of his illness and how the Buteyko breathing method works. Otherwise, our teaching will become a set of clichés: sealing up a mouth at night, training is just 10 control pauses [body oxygen test], stopping an [asthma] attack is 5 breathing cycles, etc. For better motivation and consolidation of the method you can offer a kid to share his knowledge with newcomers, encouraging him to use examples from his personal experience.
Both parents and children have to learn a fresh approach to life. And in case they forget about something like nasal breathing, walking, proper nutrition, then it is up to a doctor to remind them gently.
In accordance to the particular features we can divide children into three age groups: up to one year old (infants), from one to three (toddlers), older than three year old.
First group (infants, up to one year old)
It is necessary to start training infant children with the Buteyko breathing method from the day they are born. Don't wait until an infant child will begin to understand your theory and recommendations. Parents have to expose their will power, patience and love in order to conquer their child's illness. Elimination of deep breathing can be performed on kids of that age by using a range of factors decreasing a breath and normalizing nasal breathing. This includes tight swaddling, mouth fixation by a dummy or patch, water and tempering procedures, physical exercises and rational nutrition. Also we can use - as a variation of the Buteyko breathing method training- I. B. Charkovsky method: diving in a bathtub, showering, and teaching babies to swim. This is a wonderful method. Every dive is a control pause. Their number should be gradually increased up to 100-200 times a day.
Second group (toddlers, from one to three years old)
This group is the most complex one with respect to the method's recommendations. To this time all children are admitted to a crèche where they are fed constantly with sweet porridge with milk. They are wearing shoes all the time and they spend a lot of time in stuffy rooms. But even under this condition parents and doctors have to control their nasal breathing day and night. If necessary, you have to seal the toddler's mouth up with a piece of tape at night. Toddlers must sleep on their tummies on a hard bed.
It is recommended to conduct the Buteyko breathing method sessions with toddlers using some elements of games:
1. Sitting in front of the mirror we are breathing "like mice" - one can't see or hear us.
2. The "Rabbits - wolves" game. After running around for 2-3 minutes we stop and hold our breath. Toddlers are "rabbits" and a doctor or a parent or one of the kids is "a wolf". The wolf is walking around and listening for rabbits' breathing. If he can hear it, then he "eats" that rabbit.
3. To cover a distance between two balls on the floor keeping a control pause, to climb a gymnastic ladder holding their breath, etc.
4. Sitting after a control pause we become "as soft as a cloth" and breathe "like mice" (a doctor checks their ability to relax).
For kids at the age of 1 to 3 a leading role in the adaptation to nasal breathing and a constant growth of CO2 belongs to physical exercise. We have to remember that at that age the ability to copy and imitate especially their parents is developed utmost. Therefore, sessions should be conducted together with parents who can participate in measuring a control pause, running around breathing through the nose, and dousing with cold water. It helps a lot if we seal child's mouth up with a piece of tape while running or doing physical exercises. Exercise programs can vary, but I prefer yoga, as each exercise in yoga is accompanied with a breath holding, many of them are performed with a significant relaxation of muscles-retractors which produces some general relaxing effect.
In my view, at this age a control pause does not play a role of a health index as it does for adults and does not reflect the stage of the disease. The longer the child's control pause, the better he comprehended your requirements. Certainly, their control pause can fluctuate greatly - from 2 to 20 and even to 60 and back. Thus, at that age we have to rely more on keeping nasal breathing up and the child's adaptability to a load. On that ground, I believe that to teach children the Buteyko breathing method without physical activities during the sessions, putting them in seated position as it is recommended by some practitioners, is a mistake.
Third group (children older than three years old)
At the age of three and above children begin to behave consciously and capable of acquiring the method at times even better than their parents.
We give children the following explanation. This is: 1 - the continuous (day and night); 2- decrease (holding chest and stomach still); 3 - of the depth of breathing (breathe so quietly nobody can notice anything); 4 - along with a relaxation (be soft "as a cloth"); 5 - until slight shortness of breath is felt (desire to inhale deeper).
We always measure a control pause after physical activities (walking, jogging, marching, squatting, etc.). Parents are taking part in our training sessions where we teach children to be relaxed walking and jogging, to keep a beautiful posture with shoulders lowered, chest and stomach "soft", movements light and free. It's a good idea to organize competitions between children and parents: the greater someone's control pause and the number of those pauses, the better marks one obtains. Some tests examining the knowledge related to the Buteyko breathing method and readiness to work independently on it also can be held in the middle and at the end of a session. In K. P. Buteyko's recommendations there are specific questions for such exams. For parents special attention should be paid to role playing.
Examples: 1. Seven year old child with bronchial asthma is using the Buteyko breathing method for two weeks; his control pause is 6-8 seconds, pulse 100-120 beat/min., shortness of breath occurs up to 4 times a day. The Buteyko breathing method helps to stop half of those attacks. What are your actions? 2. Four year old child with dysbacteriosis has been practicing the Buteyko breathing method for 10 days. His control pause has been doubled. He has the following symptoms: groundless diarrhea, vomits once, temperature rose to 39C. Your actions?
During the sessions parents should control their children and vice versa. Children should observe their parents at training, correct their mistakes, explain to them why, for example, over-holding of control pause is dangerous.
Duration of the course for kids is from two weeks to one month, better daily, at 30-60 minutes each followed by water procedures.
An example of the session with children aged from 2 to 7
1. Sit, shut the mouth, check posture, lower shoulders, make a breath quiet, relax chest and stomach. Count pulse and breath frequency, define a control pause. Check nasal breathing. If it does not work properly start the Buteyko breathing method or physical activities.
2. Measure a control pause, then breathe only through the nose "like mice". Remember that the mouth is for eating and talking, eyes for seeing, ears for listening, and a nose for breathing. How should we be breathing? Only through the nose and quietly.
3. Divide into groups of 2-3. Each group is measuring their control pauses. Children from other groups observe that and offer their comments. Then parents are measuring their control pauses and children are checking their breath after the pause.
4. Children with parents are walking in a circle slowly, watching their posture, breathing quietly through the nose. Gradually they are switching to sporting walking and jogging. 2-3 minutes-run keeping nasal breathing. Then all come to stop and start playing "rabbits and wolves".
5. Measure control pause while walking, running, squatting, jumping up, and turning on the right and left legs. During breaks breathe quietly and unnoticeably.
6. Several yoga exercises: "swing", "bow", "snake", "perfection", "fish", etc. Control your breath.
7. Exercises with dumb-bells. Control your breath.
8. Cold water sponge down.
9. Manual therapy or cups massage if required.
10. End of session: sit down and measure a control pause, pulse, respiratory rate.
11. 10-15 minutes of theory.
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