By Beatriz Orallo
International Professor of Pediatric Respiratory Physiotherapy.
An Approach from Pediatric Physiotherapy
The nose is much more than an aesthetic appendage: it is a multifunctional organ deeply involved in a child’s respiratory, immune, vocal, digestive, postural, and neurological health. In pediatric physiotherapy, understanding and assessing its impact can profoundly change the way we approach child development.
Why does nasal breathing matter from an early age?
Although babies are born with nasal-nasal breathing, many children adopt chronic mouth breathing. This alteration is not just a habit but a sign of dysfunctions that can affect the child across multiple domains.
The vital functions of the nose
🧐 Respiratory: the intelligent filter
- It filters, humidifies, warms, but also dehumidifies and cools the air.
- It provides necessary nasal resistance for alveolar filling and activation of pulmonary surfactant.
- It participates in the “nasal cycle”: a physiological process of alternation between nostrils.
⛨️ Defensive/immunological: the respiratory system’s sentinel
It contains specialized lymphoid tissue (NALT), the first immune barrier of the respiratory tract.
🎤 Phonatory: the forgotten resonance chamber
- A congested nose alters vocal tone and expression, affecting child communication.
🌿 Olfactory: the forgotten sense
- It warns of danger (gases), activates taste, and initiates digestion.
- It contributes to memory, social relationships, and even sexual function via cranial nerve 0.
- Hyposmia can be an early sign of neurological disorders.
Mouth breathing: real consequences, not just aesthetic
🤦🏻 Cognitive and behavioral impact
- Lower brain oxygenation = fatigue, irritability, lack of concentration.
- Misdiagnosed cases of hyperactivity are linked to oral breathing.
🏋️ Physical consequences
- Hyperkyphosis, forward head posture, orofacial dysfunctions.
- Alterations in eye movement and tear production.
- High-arched palate, elongated viscerocranium, lips without proper seal.
🍽️ Feeding difficulties
- Mouth breathing interrupts chewing, causing dysfunctions.
The Triangle Model: Structure, Function, and Environment
To re-educate nasal breathing, we propose a triangular approach:
- Structure: assess for anatomical obstructions or malformations.
- Function: observe the quality of filtration, humidification, and the nasal cycle.
- Environment: empower families and educate in daily habits (sleep, nutrition, activity).
Pediatric Respiratory Physiotherapy: Beyond the Lungs
It’s essential for physiotherapists to understand that “the baby is not a small lung, but a global system”. Nasal breathing impacts postural, cognitive, and emotional development.
Ignoring the nose as the entry point of air means overlooking a powerful therapeutic tool.
That’s why pediatric physiotherapy must integrate pediatric manual therapy focused on the craniofacial sphere. This is a key part of TMPI Respi training.
Conclusion
The nose is an ally, not an accessory. Understanding its role transforms the vision of respiratory physiotherapy.
As Aristotle said: “Air is your food and your medicine.” If we care for the entryway from infancy, we don’t just improve breathing—we enhance the child’s overall development.
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