Sleep struggles in babies and toddlers are often chalked up to normal development. Or sleep regressions. Or temperament. But in some cases, the root cause isn’t about sleep at all—it’s about how well a child can breathe while sleeping.

Airway dysfunction is one of the most overlooked causes of disrupted sleep in kids. It can affect everything from oxygen levels to brain development, and even the shape of a child’s face. And yet, many parents—and even doctors—don’t know what to look for.

What is an Airway Issue?

An airway issue means your child is having trouble getting enough air through their nose and throat – especially during sleep. This can be caused by things like a tongue-tie, enlarged tonsils or adenoids, a high narrow palate, chronic nasal congestion, or underdeveloped facial bones. These issues often show up in the way a child breathes, sleeps, eats, and behaves.

Airway issues matter because oxygen is the foundation for healthy sleep. When kids don’t get enough oxygen at night, their bodies stay in a stressed, restless state. They may wake often, toss and turn, sweat during sleep, or seem tired and cranky during the day—even if they technically got “enough” hours of sleep.

Common Signs of Airway Dysfunction in Babies & Children

Not all snoring is a red flag. Sometimes, occasional soft snoring can be normal, especially if your kiddo is congested from a cold or allergies. If snoring is rare, quiet, and your child sleeps well otherwise, it could be nothing to worry about.

However, persistent, loud, or frequent snoring—especially paired with mouth breathing or restless sleep—is always worth further investigation.

Common signs of airway dysfunction:

• persistent, loud or frequent snoring
• Mouth breathing (especially during sleep)
• Restless sleep or frequent wakeups
• Head tilted back or chin up when sleeping
• Sleeping with their bottom sticking up in the air
• Teeth grinding
• Drooling past infancy
• Bedwetting beyond the toddler years
• Dark circles under the eyes
• Trouble waking in the morning
• Hyperactivity, mood swings, or difficulty focusing (often misdiagnosed as ADHD)
• Delayed speech or feeding difficulties
• Chronic runny nose, congestion, or ear infections

Why Nasal Breathing Matters

Nasal breathing is absolutely essential for our health. The nose isn’t just a passageway—it humidifies, filters, warms and cleans the air we breathe. It even helps release nitric oxide, which improves oxygen absorption.

Mouth breathing misses all of those benefits. Over time, it can:

• Lead to lower oxygen levels
• Contribute to inflammation and enlarged tonsils
• Dry out the mouth (increasing risk of cavities and bad breath)
• Narrow the jaw and palate, worsening airway issues
• Keep the body in a fight-or-flight state during sleep

It’s not just about sleep. Chronic mouth breathing can also impact your child’s facial development, immune function, and ability to focus during the day.

Why you’ve never heard of this before

Most pediatricians don’t receive extensive training in airway health, facial development, or oral function, and as a result, snoring is often dismissed as “normal” for kids. To make matters worse, symptoms like hyperactivity or poor sleep are often treated in isolation—without looking at the root cause.

The good news is that this is changing. As time passes, more and more awareness is growing around airway health. In recent years, pediatric ENTs, airway-focused dentists, and myofunctional therapists have begun working together and speaking up, changing the way we look at breathing and sleep.

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ADHD or Airway?

The symptoms of sleep-disordered breathing and ADHD can look nearly identical:

• Hyperactivity or constant movement
• Trouble focusing or completing tasks
• Mood swings and irritability
• Difficulty following instructions
• Impulsivity
• Poor emotional regulation
• Restlessness, especially at school or during quiet time
• Inattentiveness or “zoning out”
• Frequent daydreaming
• Trouble sitting still or fidgeting
• Learning delays or trouble processing information
• Poor memory or forgetfulness
• Difficulty waking in the morning or seeming “tired but wired”
• Behavioral issues, especially in the late afternoon or evening
• Trouble with transitions or adapting to change

The root cause, however, is very different.

A tired brain behaves differently. When a child is chronically tired from disrupted sleep and poor oxygenation, their brain may appear “wired” rather than fatigued. This can lead to a misdiagnosis of ADHD when in fact, the child is simply exhausted and struggling to breathe well at night.

This is a huge problem, as ADHD is typically treated with stimulants. If the issue is airway-related, medication doesn’t solve the underlying problem – it just masks the symptoms. Children are being medicated with powerful, brain-altering stimulants while they’re not getting the airway support they need!

Recent research suggest that  up to 50% of children diagnosed with ADHD may actually be experiencing symptoms of sleep-disordered breathing—meaning the problem isn’t behavioral. It’s biological. These kids were misdiagnosed and treated with medication when what they truly needed was better breathing and sleep.

This is why recognizing the signs of airway dysfunction is so important. Your child’s energy, behavior, and development all hinge on how well they breathe and sleep.

If your child has been diagnosed with ADHD, or if you’ve been wondering whether they might be, it’s worth ruling out sleep-disordered breathing.

Childhood Sleep Apnea

Sleep apnea isn’t just an adult problem. In kids, it often shows up as obstructive sleep apnea (OSA)—where the airway collapses during sleep and breathing stops for a short time, over and over again through the night. Signs can include loud snoring, gasping, sweating, and bedwetting.

Snoring doesn’t always = sleep apnea, though. Some children may snore temporarily due to congestion or illness. Chronic snoring, especially if it’s loud or paired with pauses in breathing, is a red flag for sleep apnea.

Here’s something many people don’t realize: a child can seem like an awesome sleeper – and still have sleep apnea. They might fall asleep quickly, stay in bed all night, and not call out for you once. But what’s happening inside their sleep is a different story. Their brain may be arousing over and over again to restart their breathing, fragmenting their sleep and preventing deep rest. These micro-arousals don’t show up as full wake-ups—but they can leave your child exhausted, irritable, and struggling to focus during the day.

Left untreated, OSA can affect everything from growth to cognitive function to heart health. If you suspect it, talk to your pediatrician about a referral to a pediatric sleep physician.

Baby-Led Weaning can strengthen your baby’s airway

We often hear that baby-led weaning (BLW) helps with independence and picky eating. But it also supports oral and airway development in powerful ways. When babies feed themselves soft solids instead of being spoon-fed purées for months, they learn to chew, manipulate textures, and use their full facial muscles.

This builds strength in the jaw, tongue, and cheeks—laying the foundation for:

• Better tongue posture
• Proper swallowing
• Wider palates
• Stronger airway support
• Lip seal and nasal breathing

Unfortunately, modern soft diets and overuse of purées may contribute to underdeveloped jaws and narrower airways. BLW isn’t a trendy parenting move—it’s a return to what humans have always done: letting babies use their mouths the way nature intended.

What you can do about your baby’s airway health

• Start by observing. Watch your child sleep. Are they breathing through their nose? Snoring? Tossing and turning?
• See the right professionals. Pediatric dentists trained in airway health, myofunctional therapists, ENTs, and bodyworkers (like craniosacral therapists) can offer assessments and support.
• Consider a myofunctional therapy evaluation. This is like physical therapy for the mouth and face. It helps retrain the muscles used for breathing, chewing, swallowing, and speaking—often in collaboration with other treatments.
• Address any oral restrictions. Tongue-ties and lip-ties can restrict proper tongue movement, impacting both feeding and airway development. A release combined with bodywork and therapy may be recommended.
• Evaluate tonsils and adenoids. If they’re enlarged, they may need to be addressed by an ENT—especially if they’re blocking the airway.
• Support nasal hygiene. Saline spray, humidifiers, and addressing allergies can help your child breathe clearly through their nose.

Remember: a little snoring or stuffy nose now and then can be totally normal—especially during a cold. But if your child is snoring loudly most nights, breathing through their mouth, tossing and turning, or showing signs of behavior challenges, it’s worth looking into. These can be signs that something’s going on with their airway. Getting the right support—like an evaluation by an airway-focused provider or trying something like myofunctional therapy—can make a big difference in your child’s sleep and overall well-being.

You don’t have to become an airway expert overnight – I know this topic can feel overwhelming! The process can take time, and treatments may involve several steps. That’s okay. One step at a time.

We’re only just scratching the surface of how airway health shapes childhood. There’s still a lot we don’t know—but if something feels off with your child’s sleep, breathing, or behavior, it’s worth paying attention. Sometimes the missing piece is right under your nose—literally.