The Developing Airway: How Breathing Patterns Shape Growth Over Time

Why early breathing patterns matter for airway structure, facial growth, and long-term function.

Growth is not only guided by genetics. It is shaped continuously by function.

In childhood, breathing patterns provide one of the most consistent functional forces acting on the developing airway and face. From infancy through adolescence, the way air moves through the nose, mouth, and upper airway influences how tissues adapt, remodel, and mature.

A growing body of research suggests that nasal and oral breathing are associated with different developmental trajectories. While breathing patterns may shift temporarily in response to illness or obstruction, persistent patterns appear to play a meaningful role in shaping airway dimensions and craniofacial growth over time.

How the Airway Develops During Growth

The pediatric airway is not a static structure. It undergoes rapid changes in size, shape, and resistance throughout childhood and adolescence.

Aerodynamic studies measuring nasal airflow in healthy children and young adults show that nasal airflow rates increase steadily with age, while nasal resistance decreases through childhood and adolescence, stabilizing in early adulthood. These changes reflect both physical growth and functional adaptation of the nasal passages.

Three-dimensional imaging studies of infants and young children further demonstrate that the upper airway grows not only in length but also in width and shape. Early in life, airway expansion is especially rapid in the vertical and transverse dimensions, with the airway lumen gradually becoming more elliptical. These developmental changes are influenced by genetic factors, as well as epigenetic inputs such as breathing function and airflow patterns.

Together, these findings highlight that nasal breathing is not simply a preferred route for airflow — it is part of the physiological environment that supports healthy airway maturation.

Nasal Breathing as a Stabilizing Influence

Nasal breathing provides resistance, filtration, and directional airflow that contribute to stable pressure gradients within the upper airway.

As children grow, consistent nasal airflow appears to support balanced airway expansion and coordination between nasal structures, the palate, and surrounding soft tissues. This functional stability may help maintain airway patency while allowing facial growth to proceed in a more harmonious pattern.

Importantly, these processes unfold gradually. The airway adapts over the years, responding to repeated daily patterns rather than isolated events. This helps explain why long-standing breathing habits, rather than short-term disruptions, are most relevant to developmental outcomes.

When Mouth Breathing Alters the Growth Pathway

When nasal airflow is reduced — due to obstruction, chronic congestion, or habitual patterns — breathing may shift toward the mouth. Research consistently shows that mouth breathing is associated with changes in oral posture and airway mechanics.

Studies in young children demonstrate that mouth breathing often coincides with a lowered tongue posture. This change reduces palatal support and can contribute to maxillary constriction, posterior crossbite, and increased risk of open bite. Over time, altered oral posture has been linked to increased vertical facial growth and a tendency toward mandibular retrusion.

Quantitative studies employing airflow measurements and advanced imaging techniques have further linked oronasal breathing patterns to notable dentofacial changes observed in late childhood and adolescence. These changes do not imply inevitability, but they do suggest that the breathing route acts as a meaningful modifier of growth direction.

Mechanical Forces and Early Morphogenesis

The influence of breathing on development begins earlier than commonly assumed.

Experimental studies in fetal lung tissue show that mechanical forces, including pressure changes associated with breathing movements, directly influence branching morphogenesis. Reduced mechanical stretch has been shown to downregulate key growth factors involved in airway branching, highlighting the role of physical forces in shaping respiratory structures from the earliest stages of development.

Postnatal research continues this theme. Reviews of pediatric airway modeling emphasize that airflow dynamics, resistance, and pressure variability contribute to the shaping of nasal and laryngeal structures during growth. In this sense, breathing acts not only as a physiological process but also as a mechanical signal guiding form.

Growth as a Cumulative Process

Airway and facial development reflect cumulative exposure rather than single causes. Genetics, posture, muscle tone, breathing route, and environmental factors all interact over time.

Breathing patterns may therefore be best understood as part of a broader developmental system — one that is adaptable, especially in early life. When functional patterns support balanced growth, structures tend to develop within a healthy range. When patterns are persistently altered, structural adaptations may follow.

This perspective helps explain why early recognition of sustained mouth breathing or airway obstruction is often emphasized in pediatric care, even when symptoms appear subtle.

A Developmental Perspective

Breathing patterns do not determine outcomes on their own. Rather, they influence the conditions under which growth occurs.

Understanding the developing airway through this lens allows families and clinicians to focus on awareness rather than urgency — recognizing patterns, observing changes over time, and supporting development when needed.

As research continues to evolve, one principle remains clear: how children breathe, day after day, forms part of the environment in which their airway and face grow.

Selected References for Further Reading

Enlow, D.H. and Hans, M.G. (1996) Essentials of facial growth. Philadelphia: W.B. Saunders. Available at: https://pubmed.ncbi.nlm.nih.gov/9121319/(Accessed: 16 December 2025).

Ghoneima, A., Kula, K., Stewart, K., et al. (2022) ‘Growth changes of the upper airway in children from infancy to early childhood: a 3D computed tomography study’, PLOS ONE, 17(4), e0264981. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264981(Accessed: 16 December 2025).

Lin, L., Zhao, T., Qin, D., Hua, F. and He, H. (2022) ‘The impact of mouth breathing on dentofacial development: a concise review’, Frontiers in Public Health, 10, Article 9498581. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9498581/(Accessed: 16 December 2025).

Harvold, E.P., Tomer, B.S., Vargervik, K. and Chierici, G. (1981) ‘Primate experiments on oral respiration’, American Journal of Orthodontics, 79(4), pp. 359–372. Available at: https://pubmed.ncbi.nlm.nih.gov/2248231/(Accessed: 16 December 2025).

Souza, J.A., Lima, M.G. and Rizzatto, S.M. (2015) ‘Influence of breathing mode on craniofacial growth’, Brazilian Journal of Otorhinolaryngology, 81(2), pp. 173–181. Available at: https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition--497-articulo-breathing-mode-influence-in-craniofacial-S1808869415313045(Accessed: 16 December 2025).