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Hot Topic Blog - Oral/Pharyngeal Sensory-Motor, Orofacial Myofunctional, & Airway Information


Interview with Diane Bahr (DB) by Lisa Bowen (LB), Breathing Educator, Breathing Retraining Center, San Rafael, CA, USA

December 2016


LB: I once heard it said that anatomically we’re not born being able to mouth breath, but that channel to the airway develops after 6 months or so. Is any part of that true?

DB: Babies are supposed to be obligate nose breathers at birth. Although, if you look on YouTube, you will see newborns with obvious structural issues who are mouth breathing and snoring. This is extremely problematic and requires the immediate attention of a pediatric otolaryngologist in my opinion.

If you look at the work of Oetter, Richer, and Frick (1995), you can see the details of suck-swallow-breathe synchrony beginning at birth in their book entitled MORE: Integrating the Mouth with Sensory and Postural Functions. We are meant to nose breathe our entire lives.

LB: Does it matter if a baby mouth or nose breathes?

DB: Yes, mouth breathing is extremely unhealthy. I have two recent articles on my website discussing the reasons.

Dr. Scott A. Simonetti, a dentist in New York, discusses why nasal breathing is important for good health:

-The nasal passages are our first line of defense against illness as they prepare inhaled air for the lungs

-Nitric Oxide (produced in the paranasal sinuses) keeps the sinuses sterile, kills invaders in inhaled air, as well as improves oxygen utilization and exchange in the lungs

-Nasal breathing removes dust, mildew, mold, animal dander, smoke, and so on from inhaled air via cilia containing a layer of mucous which traps debris and pathogens

-Children who mouth breath bypass this system which often results in enlarged tonsils, snoring, fatigue, and illness

Dr. David McIntosh, an otolaryngologist in Australia, discusses in detail how heart problems in children are related to mouth breathing:

-Nose breathing leads air to the bottom of the lungs where oxygen is absorbed into the bloodstream

-Mouth breathing leads to more shallow breathing near the top of the lungs

-Blood vessels can detect less oxygen in the lungs leading to vasoconstriction which raises blood pressure making the heart work harder

-Therefore, mouth breathing leads to low oxygen levels which are not good for the body or the brain

LB: Under what circumstances would a baby (newborn – 1 month) start mouth breathing especially since we’re “obligate nose breathers?”

DB: A newborn to one-month old baby will mouth breath if something is obstructing nose breathing. For example, if a baby is born prematurely or at-risk, he or she may have had many tubes in the nose and mouth. If the roof of the baby’s mouth becomes high and narrow (for any reason), this changes the amount of room in the nasal areas, making them small and nasal breathing difficult.

Bottle feeding and pacifier use are also likely culprits in creating high-narrow palates because of narrow nipple shape, as well as the actions and forces involved in the use of these items which is completely different from breast feeding. In breast feeding, the mother’s breast is drawn deeply into the mouth to help maintain the palate shape. Additionally, the tongue resting in the roof of a closed mouth at rest is the other primary factor in maintaining an appropriately spread palate shape. People of all ages should be doing this.

LB: Why would a baby be mouth breathing, and how would you work with a baby with an open mouth posture at various ages and stages?

DB: I have worked with many of these babies and young children for years. The initial referral usually comes from a lactation consultant when a baby is not breast feeding well. I begin by teaching the parents and lactation consultants three fundamental practices found in my parent-professional book Nobody Ever Told Me (or my Mother) That! Everything from Bottles and Breathing to Healthy Speech Development. These are:

-Systematically applied oral massage for awareness and suck training

-Systematically applied jaw work to appropriately strengthen and grade jaw movements as well as assist with appropriate tongue retraction needed for the normal oral phase swallow

-Appropriate feeding methods. I prefer breast feeding, but there are bottle feeding methods (e.g., paced bottle feeding) in addition to the mouth work that can help to keep a palate spread

If I am working with a baby of 3 to 4-months, I add systematic mouthing of appropriate mouth toys along with jaw work to move the child toward good oral discrimination needed for eating, drinking, and speaking. As children are ready for feeding (around 6 months of age), I teach parents appropriate spoon, open-cup, straw, and finger feeding practices for the best mouth development possible based on the only longitudinal study available on the feeding patterns of typically developing children by my mentor Suzanne Evans Morris (1978, rev. 2003).


LB: If a parent doesn’t realize mouth breathing is harmful and then finds out when they have a toddler, preschooler, or elementary school-age child, what’s your advice to facilitate nasal breathing and how does it change as the age of a mouth-breathing child rises?

DB: I suggest parents work with therapists and/or other professionals who understand mouth development and the crucial nature of nose breathing. Mouth breathing can only lead to illness in my opinion, and the children we treat are usually sick children. Fortunately, more and more therapists, dental professionals, otolaryngologists, and others are becoming aware of the problems associated with mouth breathing. In addition to my parent-professional book which provides detailed information on good mouth development (via appropriate feeding and mouth development activities) and the importance of nasal breathing, I will be writing a birth to age 5 or 7 year mouth development program with an orofacial myofunctional therapist in the relatively near future.


LB: At what age would kids be treated like adults as far as the process to transition from mouth breathing to nasal breathing? Connected to jaw growth?

DB: I begin this treatment as soon as I meet the child at any age. I use one set of treatments for children birth to around age 7. I use adult-like treatments beginning around age 7 if the child has the underlying oral sensory-motor abilities. Many of the children I treat do not have the underlying oral sensory-motor abilities for traditional orofacial myofunctional treatment.

For young children and those who do not have the ability to do traditional orofacial myofunctional treatment, I use a combination of systematic jaw and other appropriate oral activities, as well as appropriate eating, drinking, and speech work. Most of the children I treat also have speech problems as well as mouth breathing.

Systematic jaw work is completely underrated and often done haphazardly. While the jaw is growing, jaw work usually needs to be done daily and consistently in my opinion. Jaw growth continues through adolescence and sometimes beyond. In addition to the jaw program I created for my own clients, both Sara Rosenfeld Johnson and Mary Shiavoni developed systematic jaw programs. If folks email me (, I am happy to share my jaw program with them.

LB: Off kids’ topic but…What’s your advice for adults who are heavy mouth breathers from your vantage point? Sometimes they get discouraged with the Buteyko Breathing Technique because that assumes there are no structural issues or that nasal breathing as the first step is a cinch and now let’s get on with reduced breathing (!). Seeing a myofunctional therapist would be optimal, but there is only one in San Francisco and Marin County and one in the East Bay to my knowledge. Would most speech-language pathologists be able to help? There are more of them because that’s a more mature profession. Is there a source of general exercises that can be effective or can move people forward (such as the GOPex exercise)?    

DB: Unfortunately, most speech-language pathologists in the USA are not trained in this type of work. For approximately 20 years there was a movement away from oral sensory-motor treatment in the field of speech-language pathology. It is only with recent research from all over the world that speech-language pathologists in the USA are coming back to this work.

I would look at the International Association of Orofacial Myology (IAOM) website for qualified people. I also think activities like GoPex are moving us in the right direction. I have spoken with the current president of the IAOM about how we can get more people trained in this work, and they are working on it. Additionally, many groups of professionals are coming together to work on these issues which is very hopeful for the future. And, by the way, I love the breathing work of Tess Graham, Roger Price, and others. I consistently do respiratory work as part of my practice.

Listen to the radio interview (October, 2016).


Morris, S. E. (1978, rev. 2003). A longitudinal study of feeding and pre-speech skills from birth to three years. Unpublished research study.

Oetter, P., Richter, E. W., & Frick, S. M. (1995). M.O.R.E.: Integrating the mouth with sensory and postural functions (2nd ed.). Hugo, MN: PDP Press.

Translated into Chinese by networker Deborah Mak: