Mouth Breathing in Toddlers Why It Matters

So listen, I'm not saying do this one exercise or try these, like, few things and that's going to fix everything. No, no, no. I'm saying, like, these are some things that you can do to address some of what you're seeing. Right? Because function can change and early intervention matters. Hi and welcome back to the Untethered podcast. This is your host, Halle Balkan, and I want to dive into one of my favorite topics today. If you've ever had a parent say, my toddler always has their mouth open and you felt that little internal ooh, this episode is for you. Because not breathing, my friends, in toddlers isn't just an aesthetic habit. It's a functional signal, really, in anybody at any age. But let's we're going to focus on toddlers a bit, okay? And this can ripple into feeding development, chewing, swallowing coordination, sleep quality, and craniofacial growth. So today I'm going to give you myo assessment basics for the under five proud number one. Number two, what to look for with lip seal, tongue posture in toddlers and nasal breathing. Three, how this ties directly to feeding struggles. Four, age appropriate assessment techniques you can do without turning your session into a wrestling match. And five, my favorite part, the 30 second assessment you can do in basically any setting. So let's dive in.

Welcome to the Untethered podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner 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 myofascial functional therapy, airway, tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest. Posture, Tongue up, lips closed, teeth apart.

Breathe through your nose.

Let's get started.

All right. Why does mouth breathing even matter? Like, why do we care? It is tied to dentofacial development and malocclusion risk. Okay. There is a strong body of evidence showing associations between mouth breathing and patterns like increased vertical growth tendencies on like think long face, right? People call it long face syndrome, but like basically those longer, more narrow faces, altered jaw position and malocclusion patterns. Okay. A 2021 systemic review and meta analysis in BMC oral health by Zhao Zhang, Wang Li Lu and Hugh et al found that mouth breathing children showed measurable differences in craniofacial parameters compared to nasal breathe Earth. All right. More recently, another article by Festilla et al published a 2025 review in Children on oral breathing effects on malocclusion and mandibular posture reinforcing this. Isn't this like woo woo conversation. It's a growth and function conversation. And then there was a concise 2022 review in Frontiers in Public Health that summarized how mouth breathing, which is often driven by airway obstruction like adenotonsillar hypertrophy. Right. Enlarged tonsils, adenoids, is linked with abnormal dental maxillofacial development and emphasizes the importance of early screening. Yay, early screening. So here's the thing, right? Mouth breathing shows up in broader developmental outcomes like not just the mouth, Right. So one of the biggest, like zoom out studies, a large population based cohort paper looked at sleep disorder breathing symptom trajectories from six months to seven years, and they included mouth breathing as a key symptom. Okay. And they found associations with later behavioral outcomes at ages 4 and 7. This is in the Journal of Pediatrics. Now that's not a feeding paper, Right? But it's a loud reminder that breathing patterns early in life matter and mouth breathing is often part of a bigger physiologic picture. Okay. Feeding, my friends, is a breathing sport. Let's just look at it that way. Feeding requires coordinated neuromuscular function across systems. Okay. In the ASHA practice Portal that highlights feeding as a complex skill that requires tight coordination of multiple nerves and muscles. Which it is. And okay. Infant feeding development research emphasizes this central importance of coordinating swallow breathe for safe and efficient intake. Okay. That's in the American Journal of Clinical Nutrition. So if a toddler's default is open mouth posture, the low tongue resting position, poor lip seal development, you know these three things right up about posture, low tongue resting position, poor lip seal development. You're often looking at a kid who's working harder just to use to exist. And then we ask them to, hey, manage these food textures and chew and make a nice bolus and transition. But yeah, cool, cool, cool. Yeah, totally fair to ask them for all those things when they're already just struggling to breathe. Okay. And just exist day in, day out. So how do we, how do we assess this? Okay, I'm going to give you some myo assessment basics for the under 5 prod. And this is like we go deep into this inside of feed the peds, my course, feed the pee. But what I want to focus on for you. Okay. Is we're looking at the similar structures, but the way in which you do it is different. So I just want to kind of put that disclaimer out there. It's not truly like myo or mini myo. There's no such thing. It's pediatric feeding therapy through a myo lens. And basically applying that to our pediatric feeding, because it really is the ultimate. Like, it's just one additional goal that we add into our feeding program, and it's complimented by the work we're already doing in feeding. Okay, so here's your shift. With toddlers, you don't test, you observe. Your goal is to get a snapshot of oral rest, posture, and functional foundations. All right, number one, look at the lips. Are they together? Are they resting apart at rest? Right. When not eating or speaking? Just like when playing. Breathing. Not eating or speaking. That was number one. Number two, tongue resting position. Is it up on the palate or is it low and forward? Number three, breathing. Is it nasal breathing? Are we breathing through our mouth orally or is it a mix? The combination of the two. Number four, jaw and posture. Is our jaw stable? Is our head forward? Do we have an open bite position? Posture? Like, what does. What does it look like? Right. Number five, drool. Is there persistent drooling past the typical window? And when I say typical window, I mean like very short periods of time where maybe the baby's crawling around, they drool a little bit because their mouth opens or they're teething. So there's maybe a little extra saliva being produced right now. But it's not like every month for their entire infancy and toddlerhood. Because persistent drooling past that typical window can be a function plus airway, plus tone clue. Right? Context matters here. And then number six, chewing. Nessy open mouth chewing, fatiguing preference for multiples or softer foods over harder to chew foods. These are all the things you're going to look at when you're kind of getting a snapshot of their oral rest, posture, and functional foundations. Okay? And so ashes orofacial myofunctional disorders resource. It's a little helpful, right? And it's a helpful reference for kind of framing how OMDs can interfere with growth and function and why multidisciplinary management matters. Okay, so definitely take a peek at that. But the toddler friendly rule, you can get like 80% of what you need before you ever look inside their mouth. I still want you to look inside their mouth, but you can get 80% of what you need before you ever look inside their mouth. That is my little toddler friendly rule. All right, so here's the 32nd assessment that you can do the statue and the sniff. 30 seconds. Number one, statue. Tell them to freeze like a statue. Watch them for five to 10 seconds while they are standing still. Look for are their lips parted or sealed, Is their jaw hanging, Is their tongue visible or forward? Is their head forward, you know, posture wise or is it, are the ears nicely over their shoulders? That's the statue. Now the sniff test is very play based. Smell the flowers, right? Two to do two to three quick sniffs. Ask them to do it, like model it for them and ask them to do the same thing. Let's smell the flowers. Okay, What I want you to look and listen for, can they sniff with their lips closed or is their mouth hanging open? Hear a nasal noise, like do you hear signs of congestion? Right. Is it or is it, you know, like that was really bad. Especially those of you who listen. They sound like a pig, not like a congested child, but anyways. Do they immediately open the mouth to breathe? And then optional, you can look at, do like a quick nasal airflow check. If you're trained and comfortable, you can do like a visual airflow cue. So it's like watching like condensation on a small mirror. So I have one right here, but basically you can basically just have them breathe out and see if the circles on the mirror are the same size. Right. We do that in like a full blown eval, but do that only if you're trained and comfortable. Okay. Because that again will just support what you're already seeing. But I want to say your clinical observation is often enough to know like this is not stable nasal breathing at rest. So there we go. Right. Okay, so why this predicts future feeding struggles. I was gonna say something else about sleep, but we're gonna focus on feeding because oral rest posture is the default setting. Right. If the default is open mouth and low tongue. And then you know what's gonna happen with chewing and swallowing? Well, they're gonna be compensatory, less tongue to palate, stability for bolus control, open mouth, chewing patterns, fatiguing, messy eating, texture resistance. Not always sensory, sometimes it's mechanics and endurance. Friends. And yes, the question parents ask like, well, where should the tongue rest in the mouth? In general, we should be educating them that the tongue should be resting up on the palate. The tip of the tongue should be gently behind the upper front teeth, like not pushing on those teeth, just like 2 milliliters, 1 to 2 millimeters behind our lips should be closed. We should be breathing through our nose. Right. And that's at every age. Every age. Okay. So I'm going to give you a few age appropriate techniques. And this is really more to work on, more to work towards, like that closed mouth posture initially. Okay. So bubbles, you know, we can breathe through our nose. What this does smell, then blow. Right. It separates the nasal inhale and gives you a controlled oral exhale. So we can start to help them see the difference between using our nose and using our mouth for breathing. All right, Then you can use like a pinwheel or a party blower or something, you know, age, depending on the age. And see what they do with their lip seal, their breath control, their endurance. Do they, do they round the lips? Do they, you know, if they're trying to blow something, are they having a hard time blowing? Because they may be able to open their mouth and exhale. But can they control the lips? Can they control the breath? What is the endurance? Like how long can they breathe out for? Right. This starts to give us a lot of good insight into airway. Okay, Then the mouth closed. Mission game. Right? I do this like 3 seconds, then 5 seconds, then 10 seconds. But you can only do this to see like how long we can keep our mouth closed for while we're still breathing. You can only do this if the airway is clear. Clear. And it's appropriate. Okay, so you're not trying to like white knuckle breathe through obstruction here. Like, we're not trying to get kids to do something that's uncomfortable or not really possible based on their current anatomy and physiology. We really only want to do this if we're like, sure that their nasal airway is clear. Okay. And then chewing. So for chewing observation, give them something developmentally appropriate. Give them make sure it's solid. You can do a liquid as well, like a small Dixie cup of water, but at least do the solid and watch them. And I, I like to do this, I do this in screenings, any type of feeding or OT screening. In my private practice, we will do quick snack at the end for this purpose and we just give them a graham cracker, obviously get that approved by the parent. There's so many allergies and preferences and everything these days. If the school can provide it, if the parent can provide it, depending on what setting you're working in, if you can provide it and they just sign off that it's safe, that's fine. This also admittedly works better with regular Graham crackers, not gluten free graham crackers. So you're gonna have to get a little bit more creative if you've got like a kiddo with certain things going on. And that's a lot of kids these days, we have a lot of food restrictions out there. So give them the solid and watch them like open and close their mouth while they're chewing. Like what does it look like? Is the mouth closed the whole time? Is it opening at times? Like what's happening? Is the jaw shifting? Are they pocketing any food? Are they fatiguing quickly? Do we feel like they're swallowing solid foods that are not completely broken down? Right. And here's the thing, I want you to keep your referrals tight at this point. Okay. If there's chronic congestion, snoring, restless sleep, tonsils, adenoids, you know, you're suspecting that they may be enlarged entirely. Okay. If there's oral restrictions, dental facial concerns at play, that's an airway aware dentist, orthodontist. Okay. And then for any persistent feeding dysfunction, you're probably going to want a feeding specialist team, right? So and that might be you, or maybe it's not you, but it's someone you know. Right. So okay, here's the thing. I've got some different like research based types of nuggets that I can kind of share with you. So there I shared with you that mouth breathing is associated with measurable craniofacial and airway differences in and children's out at all. That was 2021 in BMC Oral Health. That's a systemic review meta analysis. So check that out, you can find it on Springer Link. There was a clinical review, mouth breathing. They found that mouth breathing is commonly linked to airway obstruction like the adeno tonsillar hypertrophy. And early screening is emphasized. Right. That was in Frontiers. I'm kind of just doing like a summary of some of the things I mentioned earlier on that's Frontiers in Public health. That was 2022. There was the review by Festilla et al in children 2025, that's on MDPI. And that basically showed that oral breathing is discussed in relation to malocclusion, mandibular posture impacts and pediatric orthodontic contact. Because this all comes from outside sources, but it all plays into the same and you know, conversation. And then for the intervention examples, right, the preschool age intervention examples, this is in Europe, pmc, you can look this up, but it's a study in the Archives of Oral Biology and you can find it On Europe PMC is what I should say online. This was Inada et al. And this was in 2023. But so this study basically looked lip facial training and reported improvements in lip closing strength and facial morphology in preschool children. So listen, I'm not saying do this one exercise or try these, like, few things and that's going to fix everything. No, no, no. I'm saying, like, these are some things that you can do to address some of what you're seeing, right? Because function can change and early intervention matters. All right? So if you're listening to this and you're thinking, okay, I can spot it, but I want a clean system for what to do next. That's assessment to kind of figuring out like the differential diagnosis, right? To some referrals to treatment planning. And that, my friends, this is something that we dive into in my programs. But we found that a lot of feeding therapists were like, I want additional training. And so this is why we created the certified Pediatric Feeding Therapist certification, the cpft. Inside of cpft, we go deep into pediatric feeding airway, Myoinformed foundations, medical complexities. And so, so, so, so much more so that you're not guessing. You clinical data, clinical experience, patient outcome data, all these things. So if you're ready to become the clinician who is able to say, I'm not just a pediatric feeding therapist, I'm a certified pediatric feeding therapist, I'm an advanced level pediatric feeding therapist. Because we have probably like 90 hours of intermediate to advanced coursework in there as well. And you want to be the one who's kind of connecting all the dots. The CPFT enrollment, my friends, is your next move. So definitely email us@supporteedthepedes.com if that's something that interests you. You. But the references, I had a bunch of references in here. Go check them out there. You know, I always hear people saying we don't have a lot of research to support X, Y and Z. We do have research out there with more coming. You just have to know where to look and how to connect the dots because it's not always going to be handed to you on a pretty platter in a way that makes complete sense based on said outcomes of said research article. There is like, you have to be able to understand it and interpret it and then apply it right clinically. So that's where we try to, we're trying to help bridge that gap for you. But anyways, for anybody who wants to advance their pediatric feeding skills, skills, and you want to be certified and you want to do all the amazing things that our past two years of graduates are out there doing. Definitely reach out to us. Like I said, supporteedthepeds.com tell us that you would like to apply for the cpft, the Certified Pediatric Feeding Therapist Certification. I would love to chat with you about it, so feel free to reach out to me on Instagram as well at Hellybulcken. That's all I've got for you guys today. As always, oral rest posture matters in everybody, but today we really focused in on toddlers and why it matters because early intervention is so important.

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