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Your Child’s Journey To Healthy, Nasal Breathing

Mother and daughter smiling

Any inability to breathe through the nose will cause developmental changes to the face and jaws.  The body will compensate, potentially causing negative effects on facial and jaw development. It is important to eliminate mouth breathing completely and retrain nasal breathing in your child.  Here are the steps to follow for healthy, nasal breathing.

Step 1:  Determine if your child is able to breathe clearly through their nose or not using a simple at home assessment

If your child can’t breathe through their nose, then the problem is likely caused by chronic swelling of adenoids and/or tonsils.  If your child CAN breathe through their nose, but does not keep their lips sealed 90% of the time, they have an open mouth habit which can be corrected quite easily with some exercises…. Yep. Tongue and lip yoga is a thing!

Quick 2 minutewater hold test:

Ok, so grab a timer and have your child hold water in their mouth for 2 minutes without swallowing it. If they can  hold the water in their mouth for 2 minutes without a struggle to breathe, then their mouth breathing is a habit.

If your child had to swallow the water before the 2 minutes or is uncomfortable holding water in their mouth for 2 minutes with their lips closed, that is an indication of a reaction to something causing their nose to be congested and you need to further investigate the cause.

Step 2: The 3 Ds: Dairy, Dust, Dander

You may think your child does not suffer from “allergies”, however, if your child cannot breathe clearly through their nose, it is possible an allergy or food intolerance are contributing.  Something as common as eczema can be an indicator of food allergy or intolerance. Dairy, Dust and Dander are the three most common allergens that cause allergy symptoms in children, including nasal congestion in children.

There are two methods to evaluate your child for allergies.

1) You can do an elimination process and observe if your child becomes less congested and able to breathe through their nose again. I recommend immediately trying the elimination process first.

2) If you do not see improvement in nasal breathing through the elimination process, allergy testing with a specialist provides a faster, more definitive answer.

The Elimination Process:

Because dairy is the most common cause of chronic airway allergies, 1st eliminate 100% dairy products from your child’s diet for 30 days, yes…that includes all milk, ice cream, yogurt and cheese 🙁  However, there are a lot of good dairy substitutes in the grocery store, including almond, coconut and oat milk which are fortified with calcium.

To assist in reducing inflammation of the sinuses during this elimination period,  I suggest beginning a bedtime nasal sinus rinse with NeilMed Sinus Rinse bottle or Netti Pot followed by Xlear nasal spray or Flonase.

Flonase sensimist

Show this video to your child, it will help them feel more confident seeing another child being able to do the sinus rinse successfully!

If no improvement in 30 days of eliminating dairy and using a sinus wash + nasal spray at bedtime, I next recommend eliminating gluten and dairy 100% for the next 30 days.  Continue bedtime sinus rinses and Xlear nasal spray or Flonase.

Keep your house free of pollen dust allergens and pet dander.

There is an app you can install on your phone that tells you the pollen “Allergy Alert” in your specific geographic location.

Keep the house sealed up during allergy season.  Do NOT leave windows open at night for “fresh air”.  This only allows pollen dust to enter your child’s sleeping space.

When allergens are high, have your child take their shoes and clothes off in the laundry room and shower before going into their bedroom.

Install allergen filters in your A/C or purchase a free standing HEPA air filter for your child’s bedroom and keep the door shut all the time, if possible.

Do not allow the pet in your child’s bedroom or to sleep with your child.  If you suspect your child is allergic to your pet, I’d recommend a consultation with an allergist for some healthy suggestions on your child living harmoniously with their pet.

If you are seeing positive results with the elimination process, try the 2 minute water test again.  If your child is able to hold the water in their mouth for 2 minutes your child is able to breathe through their nose and I would have your child begin lip taping using 3M Micropore tape to stimulate a nasal breathing habit.  First try this during a quiet time while reading a book or watching TV for 30 minutes. If your child is comfortable with that, then try at bedtime before they go to bed.

CharlieWhen first starting out, place the tape vertically like this.  Once your child is comfortable sleeping like this for a few weeks, then begin taping the lips horizontally to completely seal the lips during sleep.  This is good for parents too as there are many benefits of nasal breathing!

Rules for Lip Taping:

  • Lip taping is not suitable for children <3 years of age.
  • The child must be capable of removing the tape themselves.
  • Lip taping should not be used if the child is sick or have a cold.
  • If the child has an upset stomach, or is nauseous with a chance of vomiting, lip taping should be avoided.
  • Lastly, lip taping should not be used in combination with any sedative or narcotic medications.

Charlie 2At this point, if your child is able to sleep all night nasally breathing, you are well on your way to eliminating mouth breathing.  Continue lip taping… the matrix of the air flow will stimulate the lining of the nasal sinuses and help reduce any residual nasal congestion and shrink the adenoids and tonsils further, improving the upper airway size.

I recommend nightly nasal sinus wash, Xlear or Flonase nasal spray and lip taping as an ongoing part of the bedtime routine for all children who have made it to this step successfully!

I recommend nightly nasal sinus wash, Xlear or Flonase nasal spray and lip taping as an ongoing part of the bedtime routine for all children who have made it to this step successfully!

Surgically removed tonsilsStep 3: Tonsils and Adenoids.

Tonsils are in the back of the throat.  If you look in the back of your child’s mouth and they open wide and say “ahhh”, you should be able to see them.  Enlarged tonsils can cause your child to have a difficult time breathing because they take up airway space in the back of the throat.

Tonsils that are Grade 3 or 4 can block the back of the throat and make it difficult for your child to breathe. Evaluation by an ENT is indicated.

Dental X-ray 1

Adenoids are located way back behind the nose, above where the tonsils are located, but are unable to be seen without a special scope.  Swollen adenoids are almost always due to a chronic allergic reaction to dairy, gluten, pet dander or pollen dust.

Dental X-ray 2

If your child is unable to lip tape after completing Step 2, consider evaluation of tonsils and adenoids with ENT.  If enlarged, consider removal of swollen tonsils and adenoids.

IMPORTANT:  Optimal and healthy night time sleep breathing should be quiet, your child’s lips should be closed and breathing exclusively through their nose (no mouth breathing during sleep)  At any time during your elimination process you observe your child snoring or heavily breathing with their mouth open while sleeping, you need to have your child assessed for UARS (upper airway resistance syndrome) which is a condition that causes your child increased efforts to breathe while sleeping.

Snoring in children of any age is not normal and has serious health consequences that need to be addressed immediately.  In my office, I do a three step sleep screening process to evaluate a child for a possible sleep disordered breathing.

  1. Parent questionnaire- Here are a few questions I ask:
    1. Does your child snore or make noises while asleep?
    2. During sleep, does your child gasp for air or have pauses in their breathing?
    3. Does your child sleep with their lips sealed, or mouth open?
    4. Is your child a restless sleeper?  Move around a lot while sleeping?
    5. Does your child sleep in strange positions?
    6. Does your child wake up frequently during the night?
    7. If your child is potty trained, does your child wet the bed? Or get up several times a night to potty?
    8. Does your child wake up sweaty?
    9. Is your child’s neck ever extended back or head tilted back when sleeping?
    10. Does your child wake up extremely tired?
    11. Is your child excessively tired during the day?
    12. Is your child hyperactive during the day? Or have attention issues?
    13. Does your child grind his/her teeth at night?
    14. Does your child have Nightmares or Night terrors?
  1. Parents are asked to video record their child during sleep 3 times throughout the night and bring the videos to review with me in my office.

Charlie Image 03

  1. SnoreLab app recording every night for 1 week.  It’s very easy to download this app on your cell phone, activate the app once your child falls asleep and place your cell phone face down in your child’s nightstand.  The parent then brings their cell phone into the office during a consultation to review results.

Snorelab

Step 4: Lips and Tongue Yoga (aka. Myofunctional Therapy)

Have your child evaluated by a myofunctional therapist to assess your child’s resting lip posture, resting tongue position, swallow pattern.  If your child rest’s their tongue low in the floor of their mouth they will continue to mouth breathe and they need to be taught exercises to re-train their tongue to naturally rest high on the roof of the mouth.  Also, if your child has a tongue thrust, which most children who mouth breathe do, exercises will teach your child how to swallow properly while eating and drinking and eliminate harmful swallow patterns which can negatively affect jaw and facial development.

Goals of Lips and Tongue Yoga for your child:

  • Lip together (Nasal Breathing) 90% of the time during the day and during sleep
  • Train proper resting tongue position high in the roof of the mouth
  • Eliminate any tongue habits such as a tongue thrust
  • Eliminate any finger sucking, pacifier habits, sippy cup use, toddler food pouches.

Your myofunctional therapist will monitor progress of your child’s Yoga Therapy and if there are delays in therapy progress, will evaluate for a Tongue and/or Lip Tie and consider surgical release if mobility of the lip or tongue are restricted due to a tie.

Step 5: Functional orthopedic appliance therapy.

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