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Do breastfed children have a lower chance of developing mouth breathing? A systematic review and meta-analysis

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Abstract

Objective

Determine the association between breastfeeding and the development of mouth breathing in children.

Materials and methods

Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding.

Results

The overall prevalence of mouth breathing was 44% (95% CI: 38–49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41–0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31–1.18).

Conclusions

Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern. Clinical relevance: The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding.

Trial registration

PROSPERO registry: CRD42017062172

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References

  1. Basheer B, Hegde KS, Bhat SS, Umar D, Baroudi K (2014) Influence of mouth breathing on the dentofacial growth of children: a cephalometric study. J Int Oral Health 6(6):50–55

    PubMed  PubMed Central  Google Scholar 

  2. Garde JB, Suryavanshi RK, Jawale BA, Deshmukh V, Dadhe DP, Suryavanshi MK (2014) An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 years old children. J Int Oral Health 6(1):39–43

    PubMed  PubMed Central  Google Scholar 

  3. Sharma S, Bansal A, Asopa K (2015) Prevalence of oral habits among eleven to thirteen years old children in Jaipur. Int J Clin Pediatr Dent 8(3):208–210

    PubMed  PubMed Central  Google Scholar 

  4. Lopes TSP, Moura LFAD, Lima MCMP (2014) Association between breastfeeding and breathing pattern in children: a sectional study. J Pediatr 90(4):396–402

    Google Scholar 

  5. Felcar JM, Bueno IR, Massan ACS et al (2010) Prevalence of mouth breathing in children from an elementary school. Ciência Saúde Col 15(2):427–435

    Google Scholar 

  6. Campanha SM, Fontes MJ, Camargos PA, Freire LM (2010) The impact of speech therapy on asthma and allergic rhinitis control in mouth breathing children and adolescents. J Pediatr 86(3):202–208

    Google Scholar 

  7. Chambi-Rocha A, Cabrera-Domínguez ME, Domínguez-Reyes A (2018) Breathing mode influence on craniofacial development and head posture. J Pediatr 94(2):123–130

    Google Scholar 

  8. Pacheco MCT, Fiorott BS, Finck NS, Araújo MTM (2015) Craniofacial changes and symptoms of sleep-disordered breathing in healthy children. Dental Press J Orthod 20(3):80–87

    PubMed  PubMed Central  Google Scholar 

  9. Jiménez EL, Barrios R, Calvo JC, de la Rosa MT, Campillo JS, Bayona JC, Bravo M (2017) Association of oral breathing with dental malocclusions and general health in children. Minerva Pediatr 69(3):188–193

    PubMed  Google Scholar 

  10. Saitoh I, Inadab E, Kaiharacet Y et al (2018) An exploratory study of the factors related to mouth breathing syndrome in primary school children. Arch Oral Biol 92(1):57–61

    PubMed  Google Scholar 

  11. Ballikaya E, Guciz DB, Onay O, Uzamis TM (2018) Oral health status of children with mouth breathing due to adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 113(1):11–15. https://doi.org/10.1016/j.ijporl.2018.07.018

    Article  PubMed  Google Scholar 

  12. Popoaski C, Marcelino TF, Sakae TM et al (2012) Avaliação da qualidade de vida em pacientes respiradores orais. Arq Int Otorrinolaringol 16(1):74–81

    Google Scholar 

  13. Nagaiwa M, Gunjigake K, Yamaguchi K (2016) The effect of mouth breathing on chewing efficiency. Angle Orthod 86(2):227–234

    PubMed  Google Scholar 

  14. Hitos SF, Arakaki R, Solé D, Weckx LLM (2013) Oral breathing and speech disorders in children. J Pediatr 89(4):361–365

    Google Scholar 

  15. Mota LJ, Bachiega JC, Guedes CC et al (2011) Association between halitosis and mouth breathing in children. Clinics 66(6):939–942

    Google Scholar 

  16. Mizutani S, Ekuni D, Tomofuji T, Azuma T, Kataoka K, Yamane M, Iwasaki Y, Morita M (2015) Relationship between xerostomia and gingival condition in young adults. J Periodontal Res 50(1):74–79

    PubMed  Google Scholar 

  17. Al-Awadi RN, Al-Casey M (2013) Oral health status, salivary physical properties and salivary mutans streptococci among a group of mouth breathing patients in comparison to nose breathing. J Baghdad Coll Dent 25(1):152–159

    Google Scholar 

  18. Demir UL, Cetinkaya B, Karaca S, Sigirli D (2013) The impacts of adenotonsillar hypertrophy on periodontal health in children: a prospective controlled pilot study. Am J Otolaryngol 34(1):501–504

    PubMed  Google Scholar 

  19. Ribeiro GCA, Santos ID, Santos ACN et al (2016) Influence of the breathing pattern on the learning process: a systematic review of literature. Braz J Otorhinolaryngol 82(4):466–478

    PubMed  Google Scholar 

  20. Leal MB, Gomes MC, Granville-Garcia AF et al (2016) Impact of breathing patterns on the quality of life of 9- to 10-year-old school children. Am J Rhinol Allergy 30(5):147–152

    PubMed  Google Scholar 

  21. Franco LP, Souki BQ, Cheib PL, Abrão M, Pereira TBJ, Becker HMG, Pinto JA (2015) Are distinct etiologies of upper airway obstruction in mouth-breathing children associated with different cephalometric patterns? Int J Pediatr Otorhinolaryngol 79(2):223–228

    PubMed  Google Scholar 

  22. Imbaud TCS, Mallozi MC, Domingos VBTV, Solé D (2016) Frequency of rhinitis and orofacial disorders in patients with dental malocclusion. Rev Paul Pediatr 34(2):184–188

    PubMed  PubMed Central  Google Scholar 

  23. Harari D, Redlich M, Miri S, Hamud T, Gross M (2010) The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients. Laryngoscope 120(10):2089–2093

    PubMed  Google Scholar 

  24. Menezes VA, Cavalcanti LL, Albuquerque TC et al (2011) Mouth breathing within a multidisciplinary approach: perception of orthodontists in the city of Recife, Brazil. Dental Press J Orthod 16(6):84–92

    Google Scholar 

  25. Peres KG, Peres MA, Thomson WM, Broadbent J, Hallal PC, Menezes AB (2015) Deciduous-dentition malocclusion predicts orthodontic treatment needs later: findings from a population-based birth cohort study. Am J Orthod Dentofac Orthop 147(4):492–498

    Google Scholar 

  26. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 387(10017):475–490

    PubMed  Google Scholar 

  27. Costa SP, Van der Schans CP, Boelema SR et al (2010) Sucking patterns in full-term infants between birth and 10 weeks of age. Infant Behav Dev 33(1):61–67

    PubMed  Google Scholar 

  28. Limeira AB, Aguiar CM, Bezerra NSLB, Câmara AC (2013) Association between breastfeeding and the development of breathing patterns in children. Eur J Pediatr 172(4):519–524

    PubMed  Google Scholar 

  29. Park EH, Kim JG, Yang YM et al (2018) Association between breastfeeding and childhood breathing patterns: a systematic review and meta-analysis. Breastfeed Med 13(4):1–8

    Google Scholar 

  30. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341

    PubMed  Google Scholar 

  31. Stroup FD (2000) Meta-analysis of observational studies in epidemiology. JBFA 283(15):2008–2012

    Google Scholar 

  32. Joanna Briggs Institute. Joanna Briggs institute reviewers’ manual: 2014 edition. Adelaide: Joanna Briggs Institute; 2014: 197

  33. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188. https://doi.org/10.1016/0197-2456(86)90046-2

    Article  PubMed  Google Scholar 

  34. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557

    Article  PubMed  PubMed Central  Google Scholar 

  35. Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane collaboration. Available from: http://handbook.cochrane.org

  36. Borenstein M, Higgins JPT, Hedges LV, Rothstein HR (2017) Basics of meta-analysis: I2 is not an absolute measure of heterogeneity. Res Synth Methods 8(1):5–18. https://doi.org/10.1002/jrsm.1230

    Article  PubMed  Google Scholar 

  37. Schünemann HJ, Tugwell P, Reeves BC, Akl EA, Santesso N, Spencer FA, Shea B, Wells G, Helfand M (2013) Non-randomized studies as a source of complementary, sequential or replacement evidence for randomized controlled trials in systematic reviews on the effects of interventions. Res Synth Methods 4:49–62. https://doi.org/10.1002/jrsm.1078

    Article  PubMed  Google Scholar 

  38. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, GRADE Working Group (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926. https://doi.org/10.1136/bmj.39489.470347.AD

    Article  PubMed  PubMed Central  Google Scholar 

  39. Guyatt G, Eikelboom JW, Akl EA, Crowther M, Gutterman D, Kahn SR, Schunemann H, Hirsh J (2013) A guide to GRADE guidelines for the readers of JTH. J Thromb Haemost 11:1603–1608. https://doi.org/10.1111/jth.12320

    Article  PubMed  Google Scholar 

  40. Trawitzki LVV, Anselmo-Lima WT, Melchior MO, Grechi TH, Valera FCP (2005) Breast-feeding and deleterious oral habits in mouth and nose breathers. Rev Bras Otorrinolaringol 71(6):747–751

    Google Scholar 

  41. Neto ETS, Barbosa RW, Oliveira AE, Zandonade E (2009) Fatores associados ao surgimento da respiração bucal nos primeiros meses do desenvolvimento infantil. Rev Bras Cresc Des Hum 19(2):237–248

    Google Scholar 

  42. Ieto V, Rehder MIC, Bianchini EMG (2011) Possíveis associações entre o padrão respiratório predominante e o histórico alimentar infantil. Distúrb Comun 23(3):285–295

    Google Scholar 

  43. Andrada e Silva MA, Natalini V, Ramires RR, Ferreira LP (2007) Análise comparativa da mastigação de crianças respiradoras nasais e orais com dentição decídua. Rev CEFAC 9(2):190–198

    Google Scholar 

  44. Neu AP, Silva BFT, Mezzomo CL et al (2013) Relação entre o tempo e o tipo de amamentação e as funções do sistema estomatognático. Rev CEFAC 15(2):420–426

    Google Scholar 

  45. Ferreira AA, Barbosa CCN, Barbosa OLC, Brum SC (2016) Hábitos parafuncionais infantis decorrentes do desmame precoce e seu impacto na cavidade bucal. Ortodontia SPO 49(2):135–139

    Google Scholar 

  46. Moyers RE (1991) Ortodontia. Guanabara, Rio de Janeiro

    Google Scholar 

  47. Felício CM, Folha GA, Ferreira CLP, Medeiros APM (2010) Expanded protocol of orofacial myofunctional evaluation with scores: validity and reliability. Int J Ped Otorhinolaryngol 74(11):1230–1239

    Google Scholar 

  48. Abreu RR, Rocha RL, Lamounier JA, Guerra AF (2008) Prevalence of mouth breathing among children. J Pediatr 84(5):467–470

    Google Scholar 

  49. Victora CG, Horta BL, Loret de Mola C et al (2015) Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Glob Health 3(4):e199–e205

    PubMed  PubMed Central  Google Scholar 

  50. Horta BL, de Sousa BA, de Mola CL (2018) Breastfeeding and neurodevelopmental outcomes. Curr Opin Clin Nutr Metab Care 21(3):174–178

    PubMed  Google Scholar 

  51. Silveira LM, Prade LS, Ruedell BF et al (2013) Influence of breastfeeding on children’s oral skills. Rev Saúde Pública 47(1):37–43

    PubMed  Google Scholar 

  52. Sakalidis VS, Williams TM, Garbin CP (2013) Ultrasound imaging of infant sucking dynamics during the establishment of lactation. J Hum Lact 29(2):205–213

    PubMed  Google Scholar 

  53. Sakalidis VS, Geddes DT (2016) Suck-swallow-breathe dynamics in breastfed infants. J Hum Lact 32(2):201–211

    PubMed  Google Scholar 

  54. Geddes DT, Sakalidis VS, Hepworth AR (2012) Tongue movement and intra-oral vacuum of term infants during breastfeeding and feeding from an experimental teat that released milk under vacuum only. Early Hum Dev 88(6):443–449

    PubMed  Google Scholar 

  55. Elad D, Kozlovsky P, Blum O (2014) Biomechanics of milk extraction during breast- feeding. Proc Natl Acad Sci U S A 111(14):5230–5235

    PubMed  PubMed Central  Google Scholar 

  56. Moral A, Bolibar I, Seguranyes G et al (2010) Mechanics of sucking: comparison between bottle feeding and breastfeeding. BMC Pediatr 10(6):1–8

    Google Scholar 

  57. Moimaz AS, Garbin AJ, Lima BF et al (2014) Longitudinal study of habits leading to malocclusion development in childhood. BMC Oral Health 14(1):2–6

    Google Scholar 

  58. Hermont AP, Martins CC, Zina LG, Auad S, Paiva S, Pordeus I (2015) Breastfeeding, bottle feeding practices and malocclusion in the primary dentition: a systematic review of cohort studies. Int J Environ Res Public Health 12(3):3133–3151

    PubMed  PubMed Central  Google Scholar 

  59. Melink S, Vagner MV, Hocevar-Boltezar I, Ovsenik M (2010) Posterior crossbite in the deciduous dentition period, its relation with sucking habits, irregular orofacial functions, and otolaryngological findings. Amer J Orthod Dent Orthop 138(1):32–40

    Google Scholar 

  60. Fialho MPN, Pinzan-Vercelino CRM, Nogueira RP, Gurgel JA (2014) Relationship between facial morphology, anterior open bite and non-nutritive sucking habits during the primary dentition stage. Dental Press J Orthod 19(3):108–113

    PubMed Central  Google Scholar 

  61. Paiva GB (1999) Identificando o MB. Rev APCD 53(4):265–274

    Google Scholar 

  62. Muñoz CL, Orta PB (2014) Comparison of cephalometric patterns in mouth breathing and nose breathing children. Int J Pediatr Otorhinolaryngol 78(7):1167–1172

    Google Scholar 

  63. Milanesi JM, Berwig LC, Marquezan M et al (2018) Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment. Codas 30(4):1–9

    Google Scholar 

  64. Vidigal BCL, Mordente CM, Cheib PL et al (2018) Are computed tomography 3D measurements of the upper airways in mouth-breathing children in agreement with the ENT clinical diagnosis of obstruction? Braz J Otorhinolaryngol 633(1):1–9

    Google Scholar 

  65. Agostinho HA, Furtado IÃ, Silva FS, Ustrell Torrent J (2015) Cephalometric evaluation of children with allergic rhinitis and mouth breathing. Acta Med Port 28(3):316–321. https://doi.org/10.20344/amp.5556

    Article  PubMed  Google Scholar 

  66. Hill AB (1965) The environment and disease: association or causation? Proc R Soc Med 58:295–300

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Authors and Affiliations

  1. Master’s Course in Mother and Child Health, Universidade Franciscana, UFN, Santa Maria, Rio Grande do Sul, Brazil

    Cristiane Medianeira Savian

  2. Dentistry Course and Postgraduate Program in Health Sciences, Universidade Federal de Santa Maria, UFSM, Santa Maria, Rio Grande do Sul, Brazil

    Gabriela Bohrer Bolsson, Graziela Botton, Raquel Pippi Antoniazzi, Rachel de Oliveira Rocha & Fabrício Batistin Zanatta

  3. Dentistry Course and Postgraduate Program in Mother and Child Health, Universidade Franciscana, UFN, 1175 Silva Jardim Street, Santa Maria, RS, 97010-491, Brazil

    Bianca Zimmermann Santos

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  1. Cristiane Medianeira Savian
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Savian, C.M., Bolsson, G.B., Botton, G. et al. Do breastfed children have a lower chance of developing mouth breathing? A systematic review and meta-analysis. Clin Oral Invest 25, 1641–1654 (2021). https://doi.org/10.1007/s00784-021-03791-1

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