Authors Note:
Breathing pattern (nasal vs mouth breathing) and soother use are separate topics that have been researched extensively individually, but a potential connection between breathing mode and soother use remains largely unexplored.
This article will discuss the somewhat minimal, available evidence, alongside observations, opinions and theories about possible links. Where a connection is plausible but has not been proven, this will be clearly acknowledged.
Introduction
Nasal breathing is the primary breathing route under normal conditions, and as such healthy newborns and young infants preferentially breathe through the nose at rest. The nose warms, humidifies and filters inhaled air before it reaches the lungs [1]. Mouth breathing is a secondary breathing route, which generally occurs during crying or when nasal airflow is restricted.
Breathing mode may be particularly important during childhood, as it may influence the jaws, dental arches and surrounding muscles as they are developing.
Persistent mouth breathing has been associated with developmental changes such as a narrow palate, posterior crossbite, increased facial height and some Class II jaw patterns. Though, this remains an association and not an established cause. It is not definitively known whether mouth breathing contributes to or develops alongside these features [2].
Nasal breathing is a widely discussed topic and has gained popularity on social media platforms. The importance of nasal breathing is not a new phenomenon. It has long been recognised in many cultures. In the nineteenth century, artist and traveller George Catlin described mothers in some Indigenous North American communities gently closing their babies’ lips together after feeding and during sleep as a way of encouraging nasal breathing to protect health [3].
It is, however, important to point out that there is no evidence that manually closing a baby’s mouth establishes nasal breathing or prevents illness. A baby’s mouth should never be forcibly held closed.
Soothers, also known as soothers or dummies, satisfy an infant’s natural sucking reflex. They can provide comfort, help babies settle and reduce distress. Soother use at the start of sleep is also associated with a lower risk of sudden infant death syndrome (SIDS), although the mechanism for this remains unclear [4].
Open mouth or mouth breathing?
Temporary mouth breathing is common, for example, when babies cry, feed or have a cold.
Habitual mouth breathing is a persistent breathing pattern, where the mouth is the predominant route for airflow during quiet wakefulness or sleep. It may occur when nasal air flow is reduced by:
- Respiratory infections
- Allergies or ongoing rhinitis
- Enlarged adenoids and/or tonsils
- Nasal narrowing or obstruction
- Sleep-disordered breathing
When the nasal airway is restricted, the mouth provides an important alternative route for breathing.
A persistent open mouth can indicate difficulty nasal breathing and is something that warrants investigation.
Open-mouth posture and mouth breathing are closely associated, but they are not always mutually exclusive.
A child can rest with their lips apart but still be breathing nasally.
That being said, in one study, children with open lips at rest were approximately 4x more likely to be diagnosed as mouth breathers [5]. Similarly, mouth breathing has been linked with incompetent lips (lack of a lip seal at rest) [6]. These studies demonstrate an association, but not a causal relationship.
An open mouth, or incompetent lips make oral airflow possible at rest. It is therefore reasonable to suggest that a persistent open-mouth posture could help maintain an already established mouth breathing pattern.
Is soother use compatible with physiological nasal breathing?
During soother use, a baby’s lips usually rest around the teat. If the nasal airway is clear, it is reasonable to assume nasal breathing is likely occurring.
A reasonable suggestion could be that soother use could encourage nasal breathing patterns.
However, a soother does not always guarantee an airtight seal. Air can still pass around the teat, and a baby may pause sucking or part their lips.
One of the very few studies to examine soother use and breathing directly involved 20 healthy newborn babies.
Researchers temporarily obstructed their noses and compared oral airflow with and without a soother.
Unexpectedly, the soother helped the babies maintain more effective oral airflow during the temporary obstruction. This showed that a baby can still breathe through the mouth around a soother if nasal breathing becomes difficult [7].
At present, there is no evidence that appropriate soother use causes habitual mouth breathing.
A study of 198 children aged three to five who had used soothers, found no relationship between breathing patterns during sleep, and no influence of the age at which soother use began or how long it continued [8].
What evidence indicates is that a soother is compatible with nasal breathing when the nose is clear. However, its presence alone is not proof of nasal breathing. A soother can also support mouth breathing during a temporary nasal obstruction. Soother use does not appear to influence nighttime breathing patterns in three- to five-year-olds who had used soothers.
The importance of soother design, frequency and duration
Orofacial development is influenced by multiple factors, including airway function, genetics, oral habits and muscle function. Frequent and prolonged soother use is one of several factors associated with certain developmental changes, including anterior open bite, posterior crossbite and narrowing of the palate [9].
These effects are not the same across all soothers, and design appears to influence how the teat interacts with the teeth, palate and tongue.
A significant anterior open bite separates the top and bottom front teeth and can make it harder for the lips to come together without muscular effort. This may contribute to an open-mouth posture during rest.
One possible indirect pathway is that, in some children, excessive or prolonged soother use is associated with the development of an open bite, which may contribute to reduced lip competence, making an open-mouth posture easier to maintain. This could theoretically increase the likelihood of mouth breathing.
However, the relationship may also work in the opposite direction: nasal obstruction may initiate mouth breathing, leading to a lower tongue posture and greater reliance on a soother for comfort.
Not all soothers interact with the developing oral structures in the same way. Increasing evidence suggests that teat shape and flexibility influence how forces are transmitted to the lips, tongue and dentition. It is widely accepted in the dental community that designs with a thin, flexible neck and teat is preferred over conventional cherry shaped soothers, as they facilitate a more natural oral posture.
The MAM Perfect soother, an example of a physiological design, was studied in a randomised controlled trial involving children with soother associated anterior open bite or increased overjet. After 12 months, children who switched from conventional soothers to the MAM Perfect showed reduced open-bite and overjet measurements than children who continued using conventional or other physiological soothers [12].
A 2024 review also concluded that physiological soother designs were associated with fewer anterior open bites and less increased overjet than conventional designs. The authors nevertheless emphasised that more high-quality trials are required [13].
Reducing the likelihood or severity of an open bite may reduce one possible contributor to lip incompetence and open mouth posture. Soother design may help to minimise interference with the developing teeth and lip seal.
This remains a reasonable hypothesis but is not yet a proven respiratory benefit.
Practical Guidance
Recommendations vary globally, and there is currently no universally agreed optimum age for soother withdrawal. The American Academy of Pediatric Dentistry recommends weaning soother use by 36 months [14], while the European Academy of Paediatric Dentistry advises discontinuing before the age of 4 years [15]. As the likelihood of bite changes increases with the frequency and duration of use, parents should be supported to wean their child as soon as practical.
Parents should be supported to:
- Choose an age-appropriate, well-fitting soother with a thin, flexible design.
- Use it for sleep and genuine comfort.
- Allow regular time without it for feeding, babbling and normal mouth movement.
- Clean and sterilise it according to the manufacturer’s instructions.
- Perform a pull test regularly to check for tears, cracks or other damage.
- Replace worn soothers regularly.
- Never dip it in honey, sugar or anything sweet.
A professional assessment should be considered if a child regularly mouth breathes, has persistent nasal congestion, snores, gasps or pauses during sleep, or continues to sleep with an open mouth after an illness has resolved.
Future Research
Future research could investigate and clarify any association between breathing pattern and soother use.
Conclusion
The current body of research does not establish a relationship between soother use and nasal or habitual mouth breathing.
It does, however, support the benefits of appropriate soother use in satisfying the natural non-nutritive sucking reflex, providing comfort, helping children settle and reducing the risk of SIDS.
For parents who choose to use a soother, a physiological design with a thin, flexible teat neck, such as MAM Perfect, may better support passive lip competence than thicker conventional designs and is associated with a lower risk of anterior open bite.
Although there is currently no known association between soother use and breathing route, persistent mouth breathing should still be investigated to identify any underlying restriction to nasal breathing.
This scientific article has been authored by an expert who received compensation from MAM.
Published in September 2026.
