Airway-First Parenting: Supporting Breathing, Feeding and Sleep from Day One

Most parents are taught to watch nappies, weight gain, and wake windows.

But almost no one tells you to watch your baby’s airway.

And yet airway health can quietly shape everything: how your baby feeds, how they sleeps, how their jaw grows, how they behave, and even their long-term health as they get older.

In this episode of Thriving Parenting, Jen sits down with Dr Shereen Lim, a pioneer in dental sleep medicine and author of Breathe Sleep Thrive, to talk about what happens before obstructive sleep apnoea ever enters the conversation, and why early intervention can change the entire trajectory for a child.

This is a blog version of that conversation, written to help you connect the dots and know what to look for.

What is airway-first parenting?

Airway-first parenting is a lens. It’s not a trend, and it’s not another thing to “get right”.

It’s simply this:

Breathing, feeding, jaw development, and sleep are all connected.
If one is off, the others often get harder.

Dr Shereen explains that obstructive sleep apnoea is often the “tip of the iceberg”. The earlier signs can show up in infancy and childhood, long before anyone is talking about sleep studies or CPAP.

What many families miss isn’t because they’re not paying attention. It’s because they were never taught what matters.

Obstructive sleep apnea doesn’t start in adulthood

One of the most important moments in the conversation was this reminder:

Adult sleep breathing issues often have developmental origins from birth and infancy.

In simple terms, airway dysfunction can begin early, then build slowly over time.

Dr Shereen shares how her interest in airway health started with her husband’s snoring and sleep apnoea, and what she learned through that journey was eye-opening:

• many breathing issues don’t suddenly appear out of nowhere

• they often develop as the airway and jaw develop

• and we can do better if we pay attention earlier

She also highlights a tough truth in modern healthcare:

We often manage “end-stage problems” and try to mask symptoms, instead of noticing the early warning signs and supporting the root cause.

Mouth breathing is not normal, even in babies

This is one of the clearest messages from Dr Shereen:

Mouth breathing is never normal.

It might be common, but it’s not neutral.

If your baby regularly sleeps with their mouth open, that’s not just a quirky habit. It may be a sign of resistance in airflow or poor oral function, and it can impact how the jaw grows and how sleep quality develops.

The goal isn’t to panic.

The goal is to notice early and ask better questions.

The first year matters more than most parents realise

Dr Shereen explains that the first year of life is a powerful window because jaw and facial structures grow rapidly.

A key stat she shared:

Around 60% of jaw structures are finished growing by age six.

That matters because the jaws form the outer borders of the airway.

Many parents think airway issues are only about what’s happening “inside” the airway, like:

• tonsils

• adenoids

• nasal congestion

But Dr Shereen reframes it:

• the upper jaw forms the floor of the nose

• the jaws house the tongue

• the jaws provide the structure that supports the upper airway

So if jaw development is restricted, airflow can be restricted too.

And this is why orthodontic issues can be a clue, not just a cosmetic thing.

Crooked teeth are not just genetic

If you’ve ever thought, “My baby will have a narrow palate or crooked teeth because I did”, this part might surprise you.

Dr Shereen explains crooked teeth are largely epigenetic, meaning influenced by environment and function, not just genes.

She points to anthropological studies showing crooked teeth became far more common with industrialisation, as human habits changed:

• less breastfeeding

• more bottle-feeding and pacifiers

• more cooked and processed foods

• less chewing demand

• more indoor living and pollution

• more mouth breathing

In other words: form follows function.

How your child uses their mouth matters for how their mouth grows.

The “suck phase” problem: why chewing matters from six months

Dr Shereen describes something she sees often: children getting “stuck in the suck phase”.

Babies are meant to transition from suckling to chewing as they grow.

From around six months, chewing becomes a major driver for:

• jaw strength

• muscle tone

• palate development

• airway support

But many children today rely heavily on:

• purées

• pouch foods

• soft options that require almost no chewing

That doesn’t make you a bad parent. Convenience is real.

But it does mean a lot of kids miss out on the muscle stimulation their jaws need.

Dr Shereen’s reminder is simple:

Offer regular opportunities for chewing.

Not force. Opportunities.

Chewing foods. Chewing toys. Building strength gradually.

If you didn’t breastfeed, here’s what you can do (no guilt)

This conversation is deeply important because it doesn’t shame parents.

Dr Shereen is clear:

Breastfeeding has mechanical benefits for oral development, but if breastfeeding didn’t happen or didn’t last, there are still plenty of opportunities to support jaw and airway development.

Some supportive steps mentioned:

• work with a lactation consultant (even for bottle-feeding support, pacing, and positioning)

• reduce congestion and support nasal breathing (saline sprays and clearing mucus when needed)

• introduce chewing from six months

• use tools like the Myo Munchie / Bebe Munchie to promote chewing and oral muscle function

• stay aware of extended pacifier use, because it can contribute to oral dysfunction over time

The message isn’t “you should have”.

The message is “here’s what you can do next”.

What to do if your baby mouth breathes or snores

If you notice mouth breathing or snoring in the first year, Dr Shereen suggests a few early steps.

1) Encourage closed-mouth breathing when possible

If baby is sleeping with their mouth hanging open, gently closing the jaw can help.

2) Check tongue posture

A huge goal is helping the tongue rest on the roof of the mouth.

Because when the tongue is up, mouth breathing becomes much harder.

3) Look for tongue tie or lip tie

Tongue tie can prevent the tongue from lifting.
Upper lip tie can affect lip seal and keep the mouth open.

4) Consider body work support

Dr Shereen mentions osteo and chiro can help in some cases, especially when tongue posture is influenced by tension or pressure from the birth process.

5) Seek ENT input if breathing is noisy or severe

Sometimes an ENT referral is appropriate, especially when there are signs of obstruction.

Tongue tie: why release isn’t a magic fix

This part of the episode is gold because it’s balanced.

Dr Shereen explains:

• the goal is tongue-to-palate seal

• the tongue is critical for airway function and keeping the airway open in sleep

• but releasing a tongue tie doesn’t automatically create function

She compares it to removing a cast.

Just because restriction is removed doesn’t mean strength and movement are instantly there.

Support matters:

• oral exercises

• lactation support

• body work

• later on, speech pathology or myofunctional therapy

Tongue tie decisions should be individualised, based on function, not fear.

Red flags parents can watch for (beyond snoring)

One of the most helpful parts of the episode was learning what to look for.

Feeding red flags in infancy:

• shallow latch

• coming on and off the breast often

• nipple pain

• poor milk transfer

• falling asleep quickly during feeds

• clicking or gulping

• taking in lots of air

• reflux-like symptoms that don’t improve with reflux meds

• constant upright holding, arching, crying, bloating

Dr Shereen shares that many “reflux” cases can actually be air intake issues from poor oral function.

Toddler red flags:

• gagging, chewing struggles, messy eating

• avoiding chewy foods (meat, tougher textures)

• pouching food in the cheeks

• picky eating that’s actually effort avoidance

• speech delays or lisping

• thumb sucking or compensatory habits

• teeth grinding

Teeth grinding is a big one

Many people are told kids grind their teeth and will “grow out of it”.

Dr Shereen flags teeth grinding as a strong red flag for sleep-breathing issues.

Children may not have the long apnoeas adults have, but they can have repeated arousals and stress responses that:

• fragment sleep

• reduce deep restorative sleep

• impact mood, regulation, and behaviour

Jen adds something she sees commonly too:

• restless sleep

• constant tossing and turning

• “bum up, face down” sleep posture

• mini fight-or-flight responses overnight

These can be protective strategies when breathing doesn’t feel easy.

What healthy sleep should look like

This line is worth saving:

A sleeping child should be silent, still, mouth closed, and peaceful.

Dr Shereen also mentions other sleep signs that can point to airway resistance:

• sweating

• bedwetting

• stomach sleeping

• waking for “no reason”

• struggling to fall asleep

• waking tired or grumpy

• daytime behavioural issues (attention, emotional regulation)

And she makes an important point:

Before labelling behaviour as “a problem”, we need to check if sleep is actually restorative.

Why ENT isn’t the whole answer

This is a big one.

Dr Shereen explains that enlarged adenoids and tonsils can be a symptom, not always the root cause.

They may be linked to:

• narrow palate

• increased resistance to nasal airflow

• increased effort to breathe (negative pressure)

• tissue irritation over time

Some kids improve after tonsils/adenoids removal but still:

• mouth breathe

• grind teeth

• have ongoing symptoms

That’s why she encourages parents to look at the whole airway system:

• inside the airway

• and the structural framework of the airway (jaw development and function)

Ultimately, the goal is:

Closed-mouth nasal breathing, 24/7.

Palate expansion: how early is possible?

Dr Shereen shares she has started palate expansion as young as 3.5, with her current intake typically from age four and up.

Her favourite age window is often around 5.5 to 6 where possible, before adult teeth erupt, because changes can be significant in both function and development.

She shares a personal story about her daughter:

• had ENT surgery

• still had teeth grinding and bedwetting

• improved rapidly after expansion

• had beautiful development as adult teeth came through

And she offers a powerful analogy:

If you wouldn’t delay glasses for a child because you don’t want to change prescriptions, why delay breathing support when sleep and learning are at stake?

What Dr Shereen wants every parent to remember

Her closing message is simple and strong:

Good nasal breathing and airway development are the foundation for thriving health and vitality, and the earlier we establish it, the better.

And it’s not one fix.

It’s often a multidisciplinary approach that looks at:

• function

• muscle tone

• tongue posture

• jaw development

• airway obstruction where relevant

If this topic has opened your eyes, you’re not alone.

Many parents feel relief when they finally have a framework that explains why sleep, feeding, and behaviour have felt hard.

It’s not about perfection.

It’s about noticing what matters and getting the right support.

If baby sleep feels overwhelming or confusing right now, Jen offers a free Sleep Clarity Session to help you get clear on what’s happening and what your next steps could be. The link is in the show notes.

Until next time, Thrivers, keep trusting yourself. You’ve got this.