Episode 180: Effects of Mouth Breathing on Development

Hi and welcome to episode 180 of the Untethered Podcast. It is your host, Hadley Vulcan, and today we're going to be answering a question that I get a lot. Well, what's the big deal if my child is mouth breathing? So let's just dive right on in real quick. Before we dive in, I do want to let you know if you're an SLP or ot. We do have a free training this week. If you go to feedthepedes.com backslash/training, you can get access to the free 5 day training on how to screen your first pediatric feeding patient. And next week, that week of September 19th is the Open doors to feed the beads. So be sure to go ahead and check that out if you've been waiting. Again, the free training is September 12th through 16th at FeedThePeds.com backslash training and the course itself opens up on the 19th at FeedThePeds.Com all right, let's jump in.

Quick disclaimer. All information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered podcast. I am your host, Hallie Balkan.

I'm.

I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses.

Let's get started. So, breathing. We should be nasal breathers. Okay. We are obligatory nasal breathers. What does that mean? Humans should breathe through their nose. We should never breathe through our mouth. Now obviously we sometimes have to if we have structural issues, if we have inflammation, if we're sick and our nose becomes stuffed up. Right. There are. There are certain times where we do find that nasal breathing may not be very successful or possible. And so our bodies move to the path of least resistance, which then becomes mouth breathing. And in my course I talk about how we should never hear anyone breathe, and especially not snore. But that's a whole another story. Now, as I mentioned, there may be some exceptions to this rule. So if there are certain children who are obligatory mouth breathers because of their anatomy or their tone, you know, for example, one population that is often looked at are people with down Syndrome. Now, not to say that they can't be nasal breathers, because I have helped some become nasal breathers, but we have to also consider, you know, the patient in front of us and what is possible for them in this moment. The point that I'm making is that we should be breathing through our nose majority of the time, if not 100% of the time. Right. If our anatomy allows for it, if our tissues, our soft tissues allow for it. And our hard tissues. Right. Our bone and our soft tissues. Now, what is the. What's the reason that we want to be nasal breathing? Why is it so important? Well, for one, especially as it impacts children, young children, our nose, and this is important for everybody, regardless of your age. But I arguably say this for young children because children who are interacting with other adults or other children and maybe new environments where they don't have. They haven't built up their immune systems yet. Right? The nose is an extra layer. It's an extra. It's a filter, if you will. And it helps to keep out foreign bacteria. Right. We do need to build our immune systems, but a child who mouth breathes is going to be sick a lot more than a child who nasal breathes. And I've seen this firsthand. I used to ask the question, why are so many of the kids on my caseload? Why are they constantly sick? Why is. Why is everything just draining from their nose? They're constantly missing therapy, you know, And I started to look at it after I came back from my MYO course, and I realized a lot of these kids were mouth breathers. Maybe they had excessive drooling. Maybe their mouth was just kind of hinged open at rest. They were playing, and you could see their mouth was open. But the point is that they were missing out on the health benefits of nasal breathing. They're missing out on the nose filtering out certain foreign bacteria that we don't want entering our airway. The nasal cavity also softens air. It moistens air. It warms the air for smoother entry into your lungs. Essentially, it allows for us to take deeper breaths and. And it helps to engage our lower lungs. It allows more oxygen to be distributed throughout our body. There are a lot of health benefits to nasal breathing. Okay? And then having that, you know, oxygen flowing helps to keep our tissues and our organs healthy as well. So I did discuss this at length, nasal breathing at length with Patrick McKeown, who is a Buteyko instructor. And that, I believe, was like, episodes 47 to 48 way early on here on the podcast if you want to deep dive into, like, nasal breathing, even beyond what I've shared here, like, that would be a great place to, to listen and learn more. But those are some of the reasons why we don't want to see mouth breathing. Right? Why we want to encourage nasal breathing. Now, how do we do this? Becomes the next question. How do I help my child? Right, let's. I'm focusing more on, let's say birth to five right? Now, the younger ones, this can apply to older children and adults as well. How do I help them? Well, we have to see what, what's presenting, what are the signs and symptoms that we see in front of us? Okay. So we know there's an abnormal oral rest posture, meaning that mouth is open at rest there. The mouth is not closed when the mouth is open, typically that tongue is also low in the mouth. Sometimes it's low and forward. Sometimes it's sitting between the lips or down on top of the lower lip. Right. If the mouth is open, there's mouth breathing. Right. We're not nasal breathing. We are mouth breathing. But why, like, what else might be going on? And we have to start to look, like I said, to look at the picture, the whole picture. We have to look at the child sitting in front of us. What are the signs? What are the symptoms? Do they have a high narrow palate? Can their tongue not fit in their palate? If their tongue can't fit in their palate and there's a tongue space issue now, would it be fair to expect them to close their mouth and put their tongue up into the top of their mouth with their, you know, breathing through their nose? Or are they maybe mouth breathing because their anatomy does not allow them to nasal breathe? Right. Path of least resistance. Do they have enlarged tonsils or adenoids? Well, they do. The mouth is going to pop open. They're going to mouth breathe. Do they have tethered oral tissues? If we have a tongue that is tied to the floor of the mouth or a lip that is tense and tight and maybe even curls under a little bit because there is tethered tissue at the upper or lower lip, and it's making for, you know, it's making it hard to close the lips, we have to look at that. Right? We have to look at the anatomy. We have to look at the child sitting in front of us. Over time, this can impact things like sleep and feeding and speech and so on and so forth. Right. And then that snowballs into other signs and symptoms. And does a child present with oral habits? Right. Is the thumb in there? Do they need their pacifier to fall asleep? Are they. You know, I've talked about this before, but a child who has their thumb in their mouth is using their thumb as a mandibular advancement device. If you take your thumb and you put it up, put the pad of your thumb up into the top of your mouth, into your. Your hard palate and start to suck on it, whether it's, you know, intense or not intense, you're going to notice that your lower jaw comes forward. And when your lower jaw comes forward, we are opening our airway, right? So we need to be looking at that. We need to look at what does the child's mouth look like when they're awake and when they are asleep? Do they mouth breathe when they are awake and do they mouth breathe when they are asleep? Is it only one scenario, but not the other? Are we mo. I mean, are we monitoring them all night to actually know that they don't mouth breathe at night if they are mouth breathing during the day? Have we ruled out allergies? Whether it's environmental or food based? You know, there's so many factors that we need to look into and that we need to rule out and figure out why a child might be mouth breathing. Okay. And so, you know, other things come into question too, like, well, if a child is mouth breathing, first of all, they have what we call an orofacial myofunctional disorder. This is typically treated between the ages of like, birth to four by like an SLP or OT who is trained in sensory, motor, feeding and myo and tetheral tissues and, and all, you know, and the like. Like in my course Feed the Peds, for example, we do teach on all of these topics and we are focused on the birth to five population. But there's discussions out there about, well, what causes this? Is it, you know, it could be prolonged use of a foreign object. It could be like a pacifier or a bottle that they walk around with it hanging out of their mouth. Right? Or maybe they use sippy cups. You know, there's a lot of debate around these topics. I'm not going to say yes or no that they cause an orofacial myofunctional disorder. But if a child is at risk of. And start. If they're struggling to nasal breathe and they're at risk of developing, you know, further symptoms, then these, these tools, if you will, right? Utensils, whatever you want to call them, bottles, pacifier, sippy cups, they're not going to help. If we're not using something that's supporting proper oral motor development and function. Could there be genetics at play? Yep, there could be. Could they have tongue tie issues? Could there be a tethered oral tissues? Right. Tongue lips buckle? Yeah, possible. What about oral habits? Well, I don't know, chicken or egg. What came first? Were they sucking their thumb and that led to a low tongue posture, an open mouth posture, a collapse of the palate, or were they born with that? Did they, you know, was it like that in utero? Is it possible that these things made the problem worse? Maybe. But I think what we need to look at is less of did I cause this problem, what caused this problem? And more of who is sitting in front of us? What is the presentation of the infant or the toddler or the preschooler? This child sitting in front of us, how do they present and what is the impact on their function? You will hear me talk about this a lot because oftentimes in pediatric cases we're going to see mouth open, the lips are apart, we're going to see that tongue low and forward. As I mentioned, we may even see some drooling or picky eating or a forward swallow posture. They thrust their tongue forward when they swallow, it may come up against their lips or teeth or through their lips. What we have to start asking about is how can I help this child? How can we right the path that they're on? How can we get them back to optimal health so that they are functioning in a way that supports their continued development, in a way that gives them the best lease on life? How do we get them to a point where they are on track with their functional skills? Right? Whether that's oral motor, feeding speech, fine motor, gross motor. I mean, there is a full body impact when we're talking about some of these things. So what I want to encourage, and this is not going to be a super long episode today because I do go into this, like I go deep into tepidural tissues and orofacial myofunction disorders and how we assess for these things, specifically with infants and toddlers and preschool population. What I want to focus on is that we need to be assessing for this as part of our feeding assessments. We need to be looking at more than just like, how do they chew and swallow their food, what foods they eat, you know, oral motor skills, right? We need to be looking at dental occlusion or where their jaws sit, is there, is there a lower jaw, they're mandible to retreated, can they close their lips? Is something preventing that from happening. Do they have a hypersensitive gag? Right. All these different things that might start to key us into something else might be going on here. And we need to dive into this a little bit better. Right. And when I mentioned before, you know, oral rest posture. Correct, Oral rest posture is tongue up, lips together, teeth slightly apart. Right. And nasal breathing. Breathe through your nose. And I think what we need to focus on is it's not as simple as just closing the lips and pushing the tongue up to the top. Now, we might do some of this in our therapeutic process in a very strategic way, essentially, but it's much more complex than I think we realize, especially when working with the birth to five population or that, you know, by age for some. Some children are ready for traditional myofunctional therapy assessments and treatment programs. But for a child who is not, we really need to take that more of that sensory motor feeding approach where we may be doing some more passive type of intervention versus active and having them as the. A more like a more active participant. Right. Or it might be more of a combination, depending on the case. But mouth breathing over time, that's what I really want to just highlight. As we start to wrap this up a little bit, we see a much bigger issue grow out of it if it's not addressed. We see malocclusion, we see gingivitis, we see chapped lips, we see the area around the lips become chapped. There may be bad breath, dry mouth, There is a higher decay rate, inflamed, enlarged turbinates in the nose, narrow nasal passages or sinus cavity. Like I mentioned before, we'll see frequent colds, sore throats, upper respiratory infections. We see a lot more of that in our mouth. Breathers, enlarged tonsils I mentioned, and possibly adenoids. We see the face change shape over time. We see a longer face grow and they call this long face syndrome. So you'll see changes in physical appearance. Right. And that high vaulted and or narrow palate and the malocclusion I mentioned before, this is going to play a big role in this as well. We might see sleep disorder, breathing UARS or osa, you know, obstructive sleep apnea or just sleep apnea, which is never normal. UARS is upper airway resistance syndrome. As we mentioned before, there's a lower oxygen intake. Now, different studies say anywhere from 10 to 20%, others say 30% to 40%. It really depends on the study you're looking at. But the bottom line is we all agree with there's a lower oxygen Intake that leads to reduced energy and behavior and attention disorders. This can also lead to decreased appetite. It can dull our smell and taste. I mean, there's a whole host of issues that grow out of mouth breathing. And so while we may think a baby, it looks cute on a baby, and they're a little baby, everything's fine, they're healthy, everything looks good over time and fairly quickly over just a couple of years. We're seeing this now in 3 year olds where they have this chronic mouth breather profile of a flattened nose, a short upper lip. They have a receding chin and a forward head, neck or shoulder kind of posture. They're kind of sitting a little bit more forward or even hunched. That, that's not what we want to see. Okay, so we need to be looking into mouth breathing because these are what we consider airway issues. And we don't want to hear audible breathing when awake. Right. Or when asleep. And so again, I go into a lot deeper into this and I talk about like things that we need to look for and consider in our little ones and how we assess it and then how we potentially treat it. But no child should be mouth breathing. And so share this. And let alone snoring. So share this. If you have a child that you're concerned about and you just want to help, kind of see, start to impart some information, let's start with mouth breathing. Let's start with what we can see very easily on the lips. Sleep is extremely important for development across the lifespan, but especially in the first seven years of life. Let's look into why a child is, why their mouth is open, right, why their tongue may be down. And finding a provider is going to be really key. Finding a provider who can help you navigate this and assess the child to figure out, okay, hey, here's our, here's our game plan, here's our treatment plan. Here's what we need to do. That is arguably probably one of the hardest things these days. But it's, it's becoming more and more possible. If you go to pediatricfeedingtherapist.com, you will see the graduates from the Feed the Peds course who have the training to help you. We have over 1400 graduates since March of 2020 that have gone through the course. And so we're about to open doors. As mentioned, next week, September 19, 2022, it'll be course number nine, the ninth time we've taught it. But we just had a whole new cohort graduate just a few weeks ago. So more and more people are adding their names. If for some reason you can't find a provider in your area, DM me on Instagram alliebulken and I would be happy to ask my network of graduates if anybody's in your area who's maybe not yet on the directory, but if you're a therapist and you want to learn more, go to feedthepedes.com backslash training for the free five day training and again, the doors to the course will be open the 19th through the 23rd of September 2022@feedthepedes.com so I hope this isn't this information is helpful. I really wanted to just kind of hone in on it for a moment because mouth breathing is a big problem, but we can intervene. It should not be ignored. Unfortunately there are providers out there who ignore it. We are very well aware of many of the causes behind mouth breathing which allows us to address it and get your child on the right track, along with giving them the best lease on life and improving functions. So again, I hope this information is helpful and reach out to me if you can't find somebody in your area on pediatricfeedingtherapist.com and I'd be happy to help you source that person closest to your area. All right, everybody has a great day. This is Hallie Balkan signing off. Thanks for listening to this podcast.

If you want to hear more of these Myo Tots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts or pledge a small amount on patreon.com forward/the untethered podcast. If you found value, others you know.

In this space will too.

So be sure to share this episode on your social media platforms and join us over on Facebook on my Facebook page @HALLIEBLCAN BIZ on Instagram at Alibulcan, and you can head over to theuntedpodcast.com to grab a copy of the Show Notes, where you can also subscribe to be kept up to date on the latest podcast episodes.