Seeing your child sleep with their mouth open can be unsettling—especially if it seems to happen every night. The good news is that mouth breathing is common during colds. The important question is persistence: when mouth breathing becomes your child’s default, it often signals ongoing nasal obstruction and can affect sleep, behavior, and overall well-being.
In a pediatric ENT practice in Frisco, Texas, we see this every day—especially during North Texas allergy seasons. Chronic mouth breathing is not a diagnosis by itself. It’s a symptom, and it’s usually fixable once we identify why your child can’t comfortably breathe through their nose.
Is mouth breathing in kids normal?
Short-term mouth breathing can be normal during:
- A viral cold (especially the first 7–14 days)
- A flare of seasonal allergies
- Temporary nasal irritation or congestion
Chronic mouth breathing—day and night, most days of the week—often means your child’s nose is blocked enough that the body has adapted to breathing through the mouth.
Common causes of chronic mouth breathing in young children
The most common ENT drivers include:
1) Enlarged adenoids (adenoid hypertrophy)
Adenoids are lymphoid tissue behind the nose. When they enlarge, they can block airflow through the nasopharynx and contribute to nasal obstruction, snoring, and sleep-disordered breathing.
2) Allergic or chronic rhinitis
Allergic inflammation can swell the nasal lining and turbinates, creating persistent congestion. Chronic rhinitis and obstruction are strongly linked with mouth breathing.
3) Tonsil enlargement (often with adenoids)
Tonsils don’t block the nose, but enlarged tonsils narrow the throat and can worsen snoring and obstructive sleep-disordered breathing.
4) Less common (but important) causes
- Chronic sinusitis in select cases
- Deviated septum or structural narrowing (less common as a primary cause in very young kids)
- Nasal foreign body (often one-sided congestion/foul drainage)
- Congenital narrowing (rare)
Symptoms that commonly accompany chronic mouth breathing
Parents often notice mouth breathing along with one or more of the following:
Sleep-related symptoms (high priority)
- Snoring most nights
- Restless sleep, frequent waking, sweating at night
- Pauses in breathing, gasping, or labored breathing during sleep
- Unusual sleep positions (neck extended, propped up)
These patterns raise concern for sleep-disordered breathing and possibly obstructive sleep apnea.
Daytime symptoms
- Morning dry mouth, bad breath
- Nasal-sounding speech (“stuffy” voice)
- Chronic cough or postnasal drip
- Daytime sleepiness or behavioral “wired but tired” patterns (irritability, hyperactivity, inattention)
Ear and hearing symptoms
Because the adenoids sit near the Eustachian tube opening, some children develop:
- Recurrent ear infections
- Persistent middle ear fluid
- Hearing fluctuations or speech delay concerns
When should parents consider an ENT evaluation?
Here’s a practical threshold: If mouth breathing is happening most days for several weeks, especially outside a clear cold, it’s reasonable to seek evaluation.
More specifically, consider a pediatric ENT visit if your child has chronic mouth breathing plus any of the following:
- Regular snoring, restless sleep, or witnessed breathing pauses
- Daytime fatigue, attention/behavior changes, or morning headaches
- Recurrent ear infections, persistent ear fluid, or hearing/speech concerns
- Persistent nasal congestion despite appropriate allergy care
- Growth concerns or poor weight gain
- Any situation where you feel sleep quality is declining
Medical guidelines emphasize that children should be screened for snoring, and those with snoring plus symptoms/signs of obstructive sleep apnea should be evaluated—often with polysomnography (a sleep study) when available.
What an ENT evaluation looks like (what parents can expect)
A good ENT visit is both medical and practical—we’re trying to connect symptoms to anatomy and sleep quality.
1) Focused history
We’ll ask about:
- Snoring frequency and severity
- Mouth breathing patterns (day, night, or both)
- Witnessed pauses, gasping, or labored breathing
- Bedwetting, morning fatigue, behavioral changes
- Allergy triggers, seasons, pet exposure, and prior medication trials
2) Physical exam
- Nasal exam for swelling, drainage, turbinate enlargement
- Throat exam for tonsil size and airway space
- Ear exam for fluid/infection effects
3) Looking at adenoids when needed
Depending on age and symptoms, we may recommend:
- A gentle nasal endoscopy (camera exam) to assess adenoids and nasal anatomy, or
- Alternative methods in younger kids when appropriate
4) Deciding whether a sleep study is needed
A sleep study (polysomnography) can be especially helpful when:
- Symptoms suggest significant obstruction
- The story and exam don’t match (big symptoms, small tonsils—or vice versa)
- A child is very young or has certain risk factors
ENT guidelines recommend polysomnography before tonsil surgery in children under 2 years or with specific comorbidities, and also when the need for surgery is uncertain or symptoms and exam don’t align.
The AAP also recommends polysomnography for children/adolescents with snoring and symptoms/signs of OSAS when available.
Treatment options: stepwise and individualized
Treatment depends on the cause and the impact on sleep and daily function.
A) Medical management (often first, when appropriate)
For many children—especially when allergies/rhinitis are prominent—ENTs may recommend:
- Saline to reduce mucus burden
- Intranasal corticosteroid sprays (with correct technique and consistency)
- Allergy management strategies and, in selected cases, allergy evaluation
Evidence reviews have found intranasal steroids can improve nasal obstruction symptoms in children and may reduce adenoid-related symptoms in some cases.
B) Surgical considerations (when obstruction and sleep impact are significant)
If adenoids and/or tonsils are driving obstruction—especially with significant snoring, disrupted sleep, or obstructive sleep apnea—surgery may be the most effective path.
- Adenotonsillectomy is recommended as first-line treatment for children with obstructive sleep apnea and adenotonsillar hypertrophy.
- ENT guidelines recommend tonsillectomy for children with OSA documented by overnight polysomnography.
Children who are very young or have severe OSA may need closer post-operative monitoring, guided by severity and age considerations in ENT guidelines.
C) Follow-up matters
Guidelines emphasize reassessment after treatment—especially when symptoms persist or when a child is higher risk.
Why evaluation is worth it (the parent takeaway)
Chronic mouth breathing can be more than a “quirk.” In many children it signals nasal obstruction that can disrupt sleep and contribute to downstream problems. Adenoid-related obstruction has also been associated with sleep-disordered breathing and potential impacts on craniofacial development when prolonged.
A pediatric ENT evaluation can:
- Identify why your child is mouth breathing
- Determine whether sleep is being affected
- Offer a stepwise plan—medical therapy when appropriate and surgery when clearly beneficial
- Help protect sleep quality, hearing, and day-to-day function
Quick FAQ (designed for fast answers)
How long is “too long” for mouth breathing after a cold?
If mouth breathing persists for several weeks beyond an acute illness—or becomes the everyday default—it’s reasonable to evaluate for chronic nasal obstruction.
Is snoring in kids normal?
Occasional snoring with a cold can happen. Frequent snoring should be discussed with your child’s clinician; guidelines recommend screening children for snoring and evaluating when symptoms suggest obstructive sleep apnea.
Will my child always need surgery?
No. Many children improve with targeted medical therapy (especially allergy/rhinitis management). Surgery is considered when anatomy and symptoms strongly suggest obstructive sleep-disordered breathing or when medical therapy isn’t enough.
Learn more about removing the adenoids at the Cleveland Clinic.
Learn more about snoring by clicking here.