Most of us breathe and do not actually think about how we are doing it. This is a good thing! Because children are still developing their facial features, chronic mouth breathing in kids can lead to more permanent consequences.
When you find yourself aware of your breathing, there is typically a reason. Sometimes mouth breathing is done temporarily, but if it is done for a long period of time, a host of health concerns may happen.
Mouth breathing is simply a process where we open our mouths to breathe air into our lungs and bypass using our noses. Nasal congestion or blockage is typically the underlying reason.
My previous post explores the many purposes of the nose; therefore, not using your nose has some significant consequences.
A few of the main functions of the nose are to warm, clean, and humidify the air you breathe. A healthy normal person will produce about two quarts of fluid (mucus) every day. Mucus is vital to our health and helps keep the respiratory tract clean and moist.
Tiny microscopic hairs (cilia) line the surfaces of the nasal cavity and move back and forth to help brush away particles. Eventually, the mucus and particles are moved to the back of the throat where it is unconsciously swallowed. This process occurs all day, every day.
There are many ways to think about the reasons people mouth breathe. As physicians, we are typically trained to think about any problem in terms of the problem type.
These are the main 5 categories we think about when we are looking for a diagnosis:
- Congenital: You are born with it
- Traumatic: It happens because of an injury
- Iatrogenic (EYE-at-TRO-jen-ICK): It happened during medical treatment
- Inflammatory: Well, it is due to inflammation, duh!
- Neoplastic: It is related to a tumor
However because I am a surgeon, I tend to separate causes into structural reasons as opposed to functional reasons.
For the most part, a structural problem is a persistent physical one that requires some mechanical or surgical intervention. Functional problems represent a large category that may resolve on their own, respond to environmental changes or medications.
Structural Causes of Chronic Mouth breathing in Kids
Enlarged turbinates
Turbinates were discussed in detail in my previous post when I highlighted the fabulous functions of the nose. Essentially, they are bony structures on the inside of the nose that are covered in spongy tissue. These structures swell to help with nasal functions but are supposed to automatically shrink back down.
This cause of nasal obstruction is actually the only problem that I put in both structural and functional categories. If it is treated early, it may resolve but sometimes surgery is needed to reduce this chronic blockage.
Deviated nasal septum
The right and left sides of the nose are separated by a wall made of bone and cartilage called the nasal septum.
This septum can lean more to one side, causing a blockage on that side. It is often described as a crooked nose, but it may occur without any visible signs by looking at the outside of the nose. This deformity can be present at birth or a result of trauma to the nose later in life.
Foreign body in the nose
Kids do the darndest things, don’t they? One of their favorite things to do is to place unusual things in their ears, noses, and throats. So, obviously, Pediatric ENT surgeons need to regularly retrieve these things!
Usually, these are only in one nostril and is highly suspected when only one nostril has drainage. Usually, allergies, colds and sinus infections equally impact both sides of the nose. But there are always exceptions! I have taken care of more than my share of highly motivated kids who shoved objects in both nostrils. Overachievers.
Additionally, one of the hallmarks of this problem is a really bad odor. Just remember, basic infections do not smell this bad. If you find yourself waving your hand in front of your face when you get near your child’s nose, you might want to see your child’s physician to look for a foreign object!
Nasal polyps
Chronic sinus infections may lead to severe swelling and ultimately polyp formation. When these polyps remain untreated, they expand into the nose and can completely fill the nose.
Nasal polyp surgery is combined with sinus surgery but then the underlying reason for chronic infection must be treated.
Enlarged adenoid pad
Nearly everyone has heard of tonsils, so I describe the adenoid as a “nose tonsil”. They both are lymph node type tissues that swell in response to inflammation. As with all lymph nodes, it is normal to swell to fight infections but then they are supposed to shrink back down.
There is only ONE adenoid although most people say “the adenoids”. Yup, two tonsils but only ONE adenoid. Also, you can open your mouth and see the tonsils but you cannot directly see the adenoid.
The adenoid hides behind the uvula…that thing that dangles in the back of your throat. So we need to get a x-ray or place a telescope in your child’s nose if we need to see them directly.
Nasal hematoma
A hematoma is a collection of blood trapped between two tissues. These can occur in any location of the body when a blood vessel is broken and leaks into a small space.
When a nose injury happens, the blood vessels on the septum can break and trap blood. This problem not only can block the nose but it can also damage the underlying tissues in the septum.
Long term, these problems can lead to a permanent hole in the middle of the septum and loss of the support to the entire nose. Surgical intervention for this problem is an emergency procedure.
Choanal atresia
Choanal (KO-ane-L) atresia is the big problem that every physician checks for as soon as a baby is born! It is one of the reasons a catheter is passed through each nostril. First, the liquid needs to be suctioned out but second, it needs to be known that the hole in the back of the nose is open.
The problem occurs when the hole in the back of the nose is closed with bone or soft tissue.
If both sides are closed, THIS IS LIFE-THREATENING TO A NEWBORN! In this case, surgical repair is needed immediately to allow the infant to breathe normally. If only one side is closed, surgery is still needed but not on an emergency basis.
Pyriform aperture narrowing
Unlike the above life-threatening situation, pyriform (PEER-eh-FORM) aperture narrowing means that the boney opening in the nose is narrow. Air is able to pass through the nose but not very well.
Mucus build up and minor swelling can easily lead to similar extreme difficulty with breathing if it is present on both sides of the nose.
Facial bone abnormal development
Some children are born with different bone structures around the nose and midface area. This can lead to a blocked nasal passageway.
Dental and jaw alignment problems
Although this does not lead to nasal congestion, because of abnormal bone alignment, the mouth may not be able to properly close. Consequently, the same issues arise with chronic mouth breathing in kids.
Excessively large tongue
Although not a common finding, there are medical problems where children develop tongues that are abnormally large and do not properly fit into the mouth.
Tumors
Rarely, nasal obstruction can occur because of benign or malignant tumors, or cysts. These usually occur on one side and most often are not noted until well after birth.
Photo credit UpChuck_Norris on Visualhunt.com
Functional Causes of Chronic Mouth breathing in Kids
For the most part, functional causes of mouth breathing in kids is related to temporary swelling in the lining of the nose. Rhinitis (RYE-nigh-TIS) is the official term physicians use to describe this inflammation process in the nose.
Colds and flu
Everyone has had a cold, but hopefully, most of us will never get the flu. Get that flu shot, yo!
Typical viral infections are self-limited problems. If the symptoms become severe or the problem lasts too long, a complication may have occurred. Although we tend to want our kids to get better quickly, there really is an expected timeline for how long cold symptoms last.
Allergic Rhinitis
An allergic reaction is a very specific reaction that occurs in response to a foreign substance. The results cause the release of substances into the blood which then cause the allergy symptoms. Of course, classic allergens include pollen, dust, mold, and foods. But the list is actually endless!
Allergy reactions can impact the entire body but the hallmark symptom is a stuffy or a runny nose. Many people who think they have allergies but may have another medical problem. It is important to understand how to know if you actually do have allergies. Also, my might want to check out my post about the best nasal allergy treatments.
Non-Allergic Rhinitis
The exact same symptoms that allergies can cause often occur with a different immune reaction. Therefore, it is NOT all allergy. Looks the same but not the same.
Because the immune reaction is different, many times typical allergy medication is not as effective. Common causes of non-allergic rhinitis include smoke, pollution, perfume, and paint fumes. One of the best ways to remove substances from the nose is to perform frequent salt water nasal rinses.
Sinus infections
When nasal swelling becomes severe, it can block the drainage site of the sinuses. Ongoing sinus infections will continue to cause swelling which is not responsive to rhinitis treatments.
Many people only think about acute sinus infections with classic symptoms of a yellow-green runny nose, headache, and fever. However, ENT surgeons often see patients with chronic sinus infections with long-term nasal swelling which causes chronic mouth breathing in kids.
Enlarged turbinates
As mentioned above, turbinate swelling is a major cause of mouth breathing in kids. If treated early, the swelling is reversible. Over time, when chronic swelling occurs, it may become a problem that does indeed need surgical intervention.
Every time an Ear Nose and Throat physician evaluates a child for a stuffy nose, we mentally go through a checklist of these causes. Based on the history (which we really need parents to help us understand), the patient age and severity of symptoms, we often begin our evaluation. Be sure to check out my post where I discuss the importance of dentists and physicians to work together for long term management of chronic mouth breathing kids.
Often the causes are easily treated at home using your particular brand of Momma Medicine. if you are unable to improve the problem at home, I recommend an evaluation by your child’s primary care physician. I feel urgent care and walk-in centers are meant for acute problems that need treatment NOW, not for the chronic problems that will need more evaluation and assessment of treatments.
As always, much love for supporting my work. I will be adding many more posts to highlight parenting and healthcare tips, so be sure to consider subscribing to my podcast or to my blog to avoid missing a post!
6 comments
Such an important topic! Thanks for sharing this information in a thorough yet easy to read way!
I am hopeful that this can be a great resource for families who have questions about possible causes. Great to get the information out that it is not just a habit.
Thank you for this overview of the causes of mouth breathing. One of our cherubs snores for quite a while and raised some concern about redundant tissue in his airway. He appears to have grown out of it.
Yes, most of the time it is self-limited and when kids get bigger, it improves or completely goes away. That’s great news that the things I listed are not present!
Hello! I am a chronic mouth breather, and so is my son now. I have all of the side effects of a mouth breather and now my son is starting. We went to a ENT and he looked at him and didn’t see anything. My mother is also a chronic mouthed breather. What would you do in my situation to figure this out? We just went to an ENT & he says there is nothing that is enlarged. Please help! Could it just be the way we were made or is there something we are not seeing?
AL
As my post says, there are many different reasons. Each person has a different reason. I would focus on your child since there are different concerns with adults. ENT surgeons often focus on physical problems like enlarged adenoids (seen with telescopes or xrays) but you might look into seeing an allergist, and dentist. There are also specialists (oral facial myology) who work on training muscles around the face, but they need other medical problems evaluated and treated. You might check out my post about the consequences of mouth breathing (https://www.drmommasays.com/healthcare/nose/truth-about-health-consequences-of-mouth-breathing/) and check out a linked website by Dr. Meredith White. Good luck.