EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY VOL. 22/2-2021 163 Introduction Airway issues may be present at birth and are often observed in premature infants as difficulty with sucking, swallowing and breathing reflexes. A study from Stanford [Huang and Guilleminault, 2013] found that all preemies born before 34 weeks were mouth breathers, often the first sign of sleep disordered breathing (SDB). Therefore this section will focus on airway, breathing and sleep; awareness, implications, diagnosis and implications. When the infant cannot obligate nose breathing during sucking and swallowing, breastfeeding is difficult or impossible. And yet, breastfeeding helps develop the airway and shrink tonsils and adenoids which are the main cause of airway restrictions in babies and children. Lactation consultants and occupational therapists who intervene to improve sucking, swallowing and breathing often have more of an emphasis on feeding than breathing. Latching on can be impeded by a tongue tie or tight lingual frenum referred to tethered oral tissues or TOTs. This is easily solved as early as the first few days of life. Airway, breathing and sleep disorders in infants often begin with mouth breathing. Mouth breathing has been reported to M. Gelb 1 , J. Montrose 2 , L. Paglia 3 , S. Saccomanno 4 , V. Quinzi 4 , G. Marzo 4 1 Clinical Professor NYU College of Dentistry, Division of Basic Sciences, Department of Oral Medicine and Pathology, The Gelb Center NYC, USA 2 The Gelb Center NYC, USA 3 Department of Paediatric Dentistry, Istituto Stomatologico Italiano (ISI), Milan, Italy 4 Department of Health Life and Environmental Sciences, University of L’Aquila, Italy E-mail: sabinasaccomanno@hotmail.it DOI: 10.23804/ejpd.2021.22.02.15 Abstract EJPD 2021 CLINICAL FOCUS Myofunctional therapy Part 2: Prevention of dentofacial disorders KEYWORDS Airway Centric, Breathing, Prevention, Development, Sleep, Occlusion. occur in 55–56.8% of infants in 2 studies [Felcar et al., 2010; Abreu et al., 2008a]. This is profound as mouth breathing on a continuous basis may lead to snoring and obstructive sleep apnoea (OSA). Mouth breathing is the first sign of SDB. Bonuck [2012] studied the effect of snoring, mouth breathing and OSA on neurobehavioural development. SDB at 6 months and 18 months significantly increased hyperactivity, emotional problems, conduct disorder and difficulties in peer-to-peer relationship at ages 4 and 7. There was a 20–60% increase of neurobehavioural problems at age 4 and 40–100% at age 7. Habitual snoring is reported in 3–12% of children with reports of snoring in 21–68% overall. Bonuck found that 10–21% of parents reported on their children’s snoring. Guilleminault and his team at Stanford [Guilleminault and Huang, 2018] have identified other craniofacial features which have been confirmed by Boyd [2019] as Craniofacial Respiratory Complex (CFRC). Infants who are premature or exhibit SDB often have high narrow palates, tongue tie, retrognathic mandibles and maxillae. According to Lieberman, Our faces have been shrinking, compared to early Homo sapiens and Neanderthal [Shaw, 2013], particularly in the last 200 years. Our midfaces are retruded predisposing for a closed airway. Stupak [2018] and Guilleminault [2018] challenged earlier theories proposing that negative pressure changes in the airway precede or are causative of turbinate hypertrophy and enlarged adenoids. The narrowed airway and negative pressure lead to alterations in facial development and increased temporomandibular disorders (TMD) and SDB. 6–12 Months The epiglottis descends between 6 and 18 months of age. Other mammals have a lock between palate and epiglottis protecting the airway and facilitating breastfeeding. Only in humans does the epiglottis descend. This descent, combined with a flexible pharynx and larynx, facilitates our ability to make a variety of sounds improving speech and enhancing communication. This descent also leaves a vulnerable 1–2 inches behind the tongue and soft palate where the airway is prone to collapse. Snoring and sleep apnoea may begin at this age particularly when the infants or toddlers are sleeping on their back. Muscle tone Narrowed airways are often present in retrognathic children with high narrow palates. All children should also be evaluated AirwayCentric approach to prevention of dentofacial disorders The correct development of functions is important for the prevention of dentofacial disorders from the first days of life. The first and foremost function, to which all others are adapting, is nasal breathing. The AirwayCentric® method focuses on nasal breathing during early development and throughout childhood to promote: Neurobehavioural development and the brain, development of the craniofacial and respiratory complex, correct dental occlusion, proper and restful sleep and to improve performance and life overall. By working at the same time on orofacial functions and structures, many dentofacial disorders can be prevented.