It is so important children breathe efficiently to help them achieve their genetic potential.
If you think this is far-fetched or this is a new concept please read this joint blog by Dr Louise Oliver and Charlotte Marsh. Dr Louise Oliver is a GP, Functional Breathing Practitioner & Therapeutic Life Coach and Charlotte Marsh is Pilates teacher, breath coach with a special interest in children’s health & a children’s book author.
The moment a baby is born, we focus on their first breath and cry. Huge physiological changes occur as they switch from using the placenta to lungs for oxygen and carbon dioxide exchange. Breathing is generally automatic however it isn't automatically efficient. Parents or caregivers are infrequently educated on how their little bundle should breathe. Yet, the act of healthy respiration is precisely what will keep them alive.
Lung development starts in the womb and continues until young adulthood (1) From birth, babies instinctively breathe using their nose but as they grow, many switch to mouth breathing. In one study (2) the percentage of children with suspected mouth breathing increased from less than 20% at the age of 3 years to 40% at the age of 12 years.
The most important advice we can offer care givers is to observe whether a child is using their nose or mouth to breathe. Mouth breathing is generally caused by either an obstruction to the airway or habit. If an individual can breathe exclusively through their nose for 3 minutes it suggests habit rather than obstruction. (3) Habits can be changed, whereas the child should see a health professional if an obstruction is suspected. The nose is an organ that communicates with the rest of the body and has 30 unique design features to help the body function efficiently. It sounds so basic but so many children are not taking advantage of this.
The nose warms and moistens the incoming air as well as filtering out viruses, bacteria, pollen and pollution from entering the body. Mouth breathing does not take advantage of the natural filter of the nose in addition to bringing in cold, dry air into the lungs which can trigger cough and wheeze. How many individuals with chronic cough, hay fever, asthma etc have considered the impact of mouth breathing on their symptoms?
Persistent mouth breathing alters the posture and muscles of the face and tongue which may cause misaligned teeth, a long face, retracted small jaw, narrow V shaped hard palate, pouting lower lip, short upper lip and poorly developed nostrils. These changes may reduce the space at the back of the throat leading to a smaller airway making it more difficult to breathe whilst sleeping (4).
George Catlin in his book 'Shut your mouth and save your life' published in 1870 described how he observed in some cultures, elders carefully and deliberately closing a baby’s lips with their fingers after feeding and how this appeared to promote health compared to mouth breathing (5). To this day, nursery workers & teachers in some countries gently close a child’s mouth to encourage nasal breathing. Consider adding to the bedtime routine the habit of gently blowing the nose in preparation for nasal breathing whilst sleeping.
The nose is connected to the area of the brain involved in memory (hippocampus) and nasal breathing appears crucial for learning. One study used brain scans to investigate the impact of nasal versus mouth (oral) breathing:
'We can conclude that various brain regions related to working memory and normal breathing are adequately induced in nasal breathing conditions, but not in oral breathing conditions. This result is similar to that of a previous study in which oral breathing decreased the power of brain waves related to working memory function' (6)
To help improve memory and learning teachers and parents could consider encouraging nasal breathing.
In 2023, about 1 in 5 children and young people aged 8 to 25 years had a probable mental disorder (7) A recent meta-analysis (8) shows that slow breathing significantly improves self-reported stress, anxiety, and depression to the same extent as standard therapies, such as CBT and mindfulness. How many children and caregivers are aware that adopting a slow, nasal breathing pattern activates the vagus nerve which controls the relaxation (parasympathetic) response.
There is also a significant link between breathing, sleep and neurocognitive disorders. One common cause is sleep disruption due to inefficient breathing (sleep disordered breathing - SDB). Good sleep is essential for growth, concentration and learning.
The Avon Longitudinal Study of Parents and Children (9) found 'a history of SDB (mouth breathing, snoring, breath holding or stopping breathing whilst asleep) through 5 years of age was associated with ∼40% increased odds of special educational needs at 8 years, among >11 000 children'.
In a study of this type association does not automatically mean this is the cause however the link may be related to the reduced ability of the glymphatic (brain's waste removal) system to remove waste products when SDB is present. Click to read a blog on the glymphatic system In addition if a child's airway becomes narrowed or blocked whilst sleeping the body generates adrenaline in a fight, flight response to reawaken the child to allow efficient breathing. The child instead of being relaxed whilst sleeping is being over stimulated by their natural stimulant adrenaline to maintain breathing whilst sleeping. Over years this can have consequences on their behaviour, physical health, and intellectual development.
'SDB symptoms can include problems such as hyperactivity, shorter attention spans, unexplained anger or depression, and poor school performance all traditional hallmarks of ADD (attention deficit disorder) or attention deficit hyperactivity disorder (ADHD). Children suffering from SDB may also exhibit other easily overlooked symptoms, including snoring, bed wetting, slouched posture, poor appetite, messy eating habits, headaches, and frequent open mouth breathing' (10)
Therefore it is important to consider in specific neurodiverse conditions such as ADD/ ADHD could the breathing pattern of the individual be exacerbating the underlying condition.
Adults often ask 'why didn't anyone explain this to me sooner' so Charlotte has created a book, mainly aimed at children aged 3-8 years called ‘Susie Sloth and her Secret Superpower’ where Susie Sloth takes the children on a journey learning playful Pilates, five breathing exercises, discovering Susie's superpower and her secret code NEAT:
N is for Nose:
Your nose is perfect for breathing. It cleans and warms the air and sends it straight to where it’s needed. Little hairs filter out dust, bugs and germs. Your nose tells your brain about the air around you.
E is for Easy:
The main muscle we use to breathe is called the diaphragm. It needs to move easily so that your lungs can gently fill out.
A is for Air:
Air is amazing, but not too much! From the air we breathe, we use some of the oxygen and need just the right amount of another gas called carbon dioxide. To get the right amounts, we need to breathe very gently. Fast breathing upsets the balance and your body can feel unsettled.
T is for Time:
Your brain notices how quickly or how slowly you breathe. Timing your breathing can change your thoughts and feelings. If you’re playing football, or running really fast, & your breathing is faster than normal, your brain thinks “okay, we’re exercising so that makes sense.” However, if you’re breathing fast because you’re worrying about a test, or if someone just said something cruel, then your brain gets a bit confused & goes searching to understand the reason for the fast breathing.
Why are we deviating away from how we have been biologically programmed to breathe? In recent times the human facial structure has changed which has resulted in less room in the airway especially during sleep. It is believed this is due to chewing softer processed foods, using our mouths to breathe (instead of our nose) and a reduction in breastfeeding (we are not making any judgements about breast feeding as we know how hard it is to breastfeed). If you would like to understand this in greater detail watch this video by Sandra Kahn and Paul Ehrlich (pioneering orthodontist and world-renowned evolutionist, respectively) who present the biological, dietary, and cultural changes that have driven us toward this major health challenge.
This is a video created by the mother of a child with behavioural problems who discovered Connor’s difficulties were worsened by struggling to breathe whilst sleeping and some of his symptoms improved when he was helped to breathe efficiently.
Everyone should be aware that mouth breathing, snoring, breath holding or stopping breathing whilst sleeping is not innocent in adults or children. If you are a professional and notice children are persistently using their mouth to breathe consider sharing this blog with their caregiver.
Buteyko Clinic International has free online children's exercises that can be used from 4 years upwards - click to access.
Additionally, the exercises from Susie Sloth are a fun and screen free way to introduce these crucial principles to children.
May we suggest starting with these 3 top tips:
1. When children brush their teeth, have them gently blow their nose, morning and night, to help clear their airway. Nerves within the nose inform our brain about the outside environment and nasal breathing delivers higher amounts of nitric oxide to open the airways and the blood vessels in the lungs.
2. If you notice your child is mouth breathing, gently use your fingers under their chin to encourage them to close their mouth and revert to using their nose or if they are old enough encourage them to close their mouth themselves.
3. You can encourage children to gently breathe in, breathe out, pinch their nose and nod their head up and down whilst they count to 3, 4, 5 (whichever is comfortable) and then release the pinch, breathe gently in and out through the nose again and repeat this another two times. The nose will naturally open up a little making nasal breathing easier.
Educating our youngest generation that their breathing is their own superpower is crucial. Susie Sloth school workshops are proving very popular with children and teachers alike - click for more information. We hope we have inspired you to find out more about breathing and to help the children around you learn these valuable tools to benefit their health for the rest of their lives.
Dr Louise Oliver & Charlotte Marsh (website, Instagram, Susie Sloth Instagram)
References
(1) Schittny JC. Development of the lung. Cell Tissue Res. 2017 Mar;367(3):427-444. doi: 10.1007/s00441-016-2545-0. Epub 2017 Jan 31. PMID: 28144783; PMCID: PMC5320013.
(2) Nogami Y, Saitoh I, Inada E, Murakami D, Iwase Y, Kubota N, Nakamura Y, Kimi M, Hayasaki H, Yamasaki Y, Kaihara Y. Prevalence of an incompetent lip seal during growth periods throughout Japan: a large-scale, survey-based, cross-sectional study. Environ Health Prev Med. 2021 Jan 21;26(1):11. doi: 10.1186/s12199-021-00933-5. PMID: 33478389; PMCID: PMC7819306.
(3) Zaghi, S., Peterson, C., Shamtoob, S., Fung, B., Kwok-keung Ng, D., Jagomagi, T., . . . Morrissey, L. (2020). Assessment of nasal breathing using lip taping: a simple and effective screening tool. International Journal of Otorhinolaryngology, 6(1), 2472-2405.
(4) Zhao Z, Zheng L, Huang X, Li C, Liu J, Hu Y. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis. BMC Oral Health. 2021 Mar 10;21(1):108. doi: 10.1186/s12903-021-01458-7. PMID: 33691678; PMCID: PMC7944632.
(5) Shut your mouth and save your life by George Catlin, published in 1870.
(6) Jung JY, Kang CK. Investigation on the Effect of Oral Breathing on Cognitive Activity Using Functional Brain Imaging. Healthcare (Basel). 2021 May 29;9(6):645. doi: 10.3390/healthcare9060645. PMID: 34072444; PMCID: PMC8228257.
(7) Newlove-Delgado T, Marcheselli F, Williams T, Mandalia D, Dennes M, McManus S, Savic M, Treloar W, Croft K, Ford T. (2023) Mental Health of Children and Young People in England, 2023. NHS England, Leeds.
(8) Fincham, G.W., Strauss, C., Montero-Marin, J. et al. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Sci Rep 13, 432 (2023). https://doi.org/10.1038/s41598-022-27247-y
(9) Bonuck K, Rao T, Xu L. Pediatric sleep disorders and special educational need at 8 years: a population-based cohort study. Pediatrics. 2012 Oct;130(4):634-42. doi: 10.1542/peds.2012-0392. Epub 2012 Sep 3. PMID: 22945405; PMCID: PMC3457621.
(10) Catalano PJ, Walker J. ADD & ADHD in Children: The Answer is Right in Their Nose. Am J Otolaryngol Head Neck Surg. 2018; 1(5): 1025
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