5 Signs of Oromotor Dysfunction in Children

Children develop oral skills gradually, and it is common for feeding, speech, breathing and oral habits to change as they grow. However, when you notice a repeated pattern affecting your child’s breathing, sleep, feeding, comfort, speech or daily life, it can be worth exploring further.

Oromotor dysfunction, also known as an orofacial myofunctional disorder, describes differences in how the tongue, lips, jaw, cheeks and throat work together. These muscles are involved in breathing, resting posture, feeding, chewing, swallowing and speaking. One sign alone does not mean there is a problem; it is the whole picture that matters.

Open-mouth posture and mouth breathing

A child who is breathing comfortably through their nose will often rest with their lips gently together, jaw relaxed and tongue inside their mouth. Some children, however, spend much of the day with their lips apart and their mouth open.

What you might notice

• Lips apart while watching television, drawing, playing or concentrating

• The tongue sitting low in the mouth or visible between the lips

• Dry, cracked lips or dry mouth on waking

• Noisy breathing during quiet activity

• A head-forward or chin-up posture

• Frequent nasal congestion or difficulty breathing through the nose

Common habits or behaviours

• Mouth breathing during the day or overnight

• Lip licking or lip biting due to dry lips

• Sleeping with the mouth open

• Sleeping with the head tipped back or propped up on pillows

• Holding the tongue low and forward rather than inside the mouth

Mouth breathing is not always simply a habit. It may be associated with allergies, congestion, enlarged adenoids or tonsils, nasal obstruction or sleep-disordered breathing. A child should not be encouraged to keep their mouth closed if they cannot breathe comfortably through their nose.

Tongue posture, swallowing and speech clues

The tongue has an important role in eating, drinking, chewing, swallowing, speech and resting posture. Ideally, it should be able to move comfortably up, down and side to side. Some children develop patterns where the tongue rests low, pushes forwards against the teeth, or needs the lips, jaw or chin to compensate.

What you might notice

• The tongue visible between the teeth or lips at rest

• The tongue pushing forwards during swallowing

• Chin dimpling, lip pursing or facial strain when swallowing

• Difficulty lifting the tongue towards the roof of the mouth

• Food left in the cheeks, around the gums or behind the teeth

• A history of feeding concerns, suspected tongue restriction or tongue-tie release

• Front teeth that appear to flare, space or do not meet fully

Common habits or behaviours

• Tongue thrust during swallowing

• Tongue resting between or against the teeth

• Tongue sucking, chewing or biting

• Excessive use of the lips and chin to swallow

• Moving the whole jaw or head to compensate for limited tongue movement

• Pushing food forward rather than moving it side to side for chewing

Some children with these patterns may have unclear speech or a frontal lisp, particularly with sounds such as /s/ and /z/. However, speech differences have many causes, and a lisp alone does not confirm an oromotor issue. A speech pathologist is the best professional to assess speech development, while an appropriately trained myofunctional therapist can assess oral posture and functional habits.

Feeding, chewing and swallowing differences

Feeding is complex. It involves oral movement, breathing, posture, sensory preferences, comfort, appetite, developmental stage and family routines. Oromotor function may be one part of the picture, but it is important not to assume that all picky eating or feeding difficulty is caused by the mouth.

What you might notice

• Long, tiring or stressful meals

• Coughing, spluttering or gagging during meals

• Food frequently pocketed in the cheeks

• A preference for soft foods or easy-to-chew textures

• Avoidance of meat, vegetables, mixed textures or crunchy foods

• Chewing only on one side

• A simple up-and-down “munching” pattern rather than more coordinated chewing

• Frequent need for a drink to wash food down

• Difficulty progressing from smooth purees to textured family foods

Common habits or behaviours

• Overstuffing the mouth

• Holding food without chewing or swallowing

• Swallowing food before it has been fully chewed

• Spitting out chewy foods

• Removing food from the mouth with fingers

• Relying on a drink after most bites

• Needing distraction, chasing or a screen to stay at the table

A child may avoid certain foods because of oral-motor difficulty, but also because of sensory preferences, reflux, pain, anxiety, neurodevelopmental differences or a previous negative feeding experience. The aim is to understand the child’s experience, rather than forcing them to eat foods they find difficult.

Seek prompt assessment if your child repeatedly coughs, chokes, has colour changes, becomes breathless during meals, has a wet or gurgly voice after eating or drinking, gets recurrent chest infections, struggles with weight gain or seems distressed by feeding. These are feeding and swallowing safety concerns that need medical and paediatric feeding assessment.melbourneswallowingclinics.com+1

Oral habits, jaw tension and dental changes

Many children use sucking, chewing or biting to soothe themselves, concentrate, manage tiredness or meet sensory needs. These habits are common and should not be treated as a parenting failure. But when a habit is intense, ongoing or paired with mouth breathing and altered tongue posture, it may contribute to a longer-term pattern.

What you may notice

• Prolonged dummy or pacifier use

• Thumb, finger, blanket, hair or clothing sucking

• Nail biting, lip biting or cheek biting

• Chewing pencils, toys, sleeves or collars

• Teeth grinding, especially at night

• Jaw clicking, jaw fatigue or reluctance to open wide

• Complaints of sore teeth, headaches, facial tension or jaw discomfort

• Dental wear, crowding, prominent front teeth or an open bite identified by a dentist

Common habits or behaviours

• Thumb or finger sucking

• Tongue sucking or chewing

• Lip sucking, licking or biting

• Teeth clenching or grinding

• Chewing clothing, hair or objects

• Resting with the tongue against the teeth

• Repeated jaw shifting or clicking

Rather than simply taking away an oral habit, it can be helpful to ask what it is doing for the child. Are they tired, anxious, bored, concentrating, overwhelmed or seeking sensory input? A dentist or orthodontist can assess dental and bite changes, while a myofunctional therapist may help identify the underlying tongue, lip, swallowing or resting-posture patterns.

Sleep, regulation and daytime behaviour

A child’s breathing, sleep, oral posture and regulation are closely connected. Sometimes the most noticeable signs are not feeding-related at all. A child may snore, wake tired, be restless at night or struggle with attention and emotional regulation during the day.

What you may notice

• Loud snoring or noisy breathing during sleep

• Gasping, snorting, choking sounds or breathing pauses

• Restless, sweaty sleep or frequent waking

• Sleeping with the neck extended or in unusual positions

• Mouth breathing overnight

• Teeth grinding during sleep

• Morning headaches, dry mouth or bad breath

• Bedwetting in a child who has otherwise been dry overnight

Common habits or behaviours

• Sleeping with the mouth open

• Needing to sleep propped up

• Frequent night waking or movement between sleep positions

• Using a dummy, thumb sucking or tongue sucking to settle

• Daytime chewing, biting or oral-seeking behaviours when tired

• Irritability, emotional outbursts or seeming “wired but tired”

• Difficulty concentrating, sitting still or coping with everyday demands

Frequent snoring is not something to ignore. The Royal Children’s Hospital notes that loud snoring, breathing pauses, difficulty breathing, gasping, restless or sweaty sleep, unusual sleeping positions, mouth breathing overnight and morning tiredness can be signs of obstructive sleep apnoea in children. Persistent snoring or noisy breathing on three or more nights a week, outside of a cold, also warrants discussion with a GP.

What does a myofunctional therapist do?

An orofacial myologist or myofunctional therapist works with the function of the lips, tongue, jaw, cheeks and associated breathing and swallowing patterns. Therapy is usually individualised and may use age-appropriate activities to build awareness, movement, coordination and more efficient habits.

A practitioner may assess:

• Lip seal and oral resting posture

• Tongue mobility and coordination

• Chewing and swallowing patterns

• Oral habits such as thumb sucking, tongue thrust or clenching

• Jaw movement and facial tension

• Whether referral to a dentist, orthodontist, speech pathologist, ENT, GP or feeding specialist is needed

Myofunctional therapy is best viewed as one part of a collaborative plan. The evidence for its use in children is still developing: reviews suggest it may be a promising adjunct in selected airway, orthodontic and functional contexts, but the quality of studies varies, and it should not be presented as a stand-alone cure for sleep apnoea, speech issues, malocclusion or airway obstruction.pubmed.ncbi.nlm.nih+2

How cranial osteopathy may help

For some children, open-mouth breathing, disrupted sleep, feeding challenges or jaw tension can occur alongside a pattern of heightened nervous-system alertness. When breathing or feeding feels effortful, the body may compensate with tension through the jaw, face, neck, chest and upper body. This can contribute to difficulty settling, restless sleep, irritability, oral-seeking behaviours such as chewing or sucking, and increased muscle tension.

Cranial osteopathy may offer gentle, supportive care that considers the child as a whole. Assessment may include comfort and movement through the head, neck, jaw, floor of the mouth, hyoid region, rib cage and diaphragm, as well as posture, breathing patterns, feeding history and regulation.

The aim may be to support:

• Ease and comfort through the jaw, face, neck and upper body

• Reduced protective tension around the floor of the mouth, hyoid and jaw

• More comfortable head and neck movement for feeding, sleep and play

• Relaxed rib and diaphragm movement to support breathing mechanics

• A greater sense of calm, body awareness and capacity to settle

• A more comfortable foundation for feeding, speech or myofunctional therapy

Cranial osteopathy may support whole-body comfort, movement, breathing mechanics and nervous-system regulation as part of collaborative care alongside an appropriate health team.

When to seek further support

Arrange assessment if your child has:

• Repeated coughing, choking, breathlessness or colour changes with food or drink

• Poor weight gain, dehydration, recurrent chest infections or persistent feeding distress

• Difficulty progressing through textures or a very limited range of foods

• Snoring, gasping, breathing pauses, restless sleep or persistent mouth breathing

• Ongoing jaw pain, headaches, jaw locking or significant teeth grinding

• Speech concerns, persistent dribbling, food pocketing or difficulty chewing

• Dental or bite changes, or an oral habit that is difficult to stop

The goal is not to label every child with an open mouth, a dummy habit or a fussy eating phase. It is to notice when a pattern is persistent, effortful or affecting your child’s comfort, sleep, feeding, development or quality of life. A thoughtful assessment can help identify what is driving the pattern and which supports will be most helpful.

Mouth tape is not advised for children and should never be used as a home strategy to stop mouth breathing, snoring or open-mouth posture. Mouth breathing may be a child’s way of maintaining airflow when the nose is congested or restricted, or when there are underlying airway or sleep concerns. Taping the mouth closed does not address the cause and may make breathing less safe. If your child persistently mouth-breathes, snores, sleeps restlessly, gasps or has breathing pauses, seek assessment from an appropriate health professional rather than trying mouth tape.

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This article is general information only and is not a substitute for personalised medical or allied health advice. Please speak with your GP, MCH nurse or healthcare provider about your baby’s specific situation.

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