Understanding Your Child’s Craniofacial Growth and Development is Key to Lifelong Well-being

So what do you need to know about facial growth and development and identifying potential problems affecting your child’s health, comfort, and appearance? 

Issues with facial growth and development, like misalignments of the teeth or jaws, can lead to eating, speaking, sleep and behavior issues in everyday life. 

Over time, these issues can cause significant damage to overall health if not properly addressed that can affect sleep and behavior. Detrimental environmental effects can impact the growth of the craniofacial-respiratory complex. Starting with how and what you feed your baby

A better understanding of the structures of mouth and jaws allows us to predict problems that may be resolved early on with successful interventions, which may include treatments such as Myo Munchee, ™ orthodontic expanders and orofacial exercises.

Underlying causes of malocclusion are the dramatic and progressive changes of the masticatory system. Less chewing has created facial muscles that are weak, anatomical structures that are poorly developed along with a compromised airway.

The philosophy of treatment is an integrated health approach, to educate patients about the intricacies of misalignment. Understanding of the overall health of our body, the creation of beautiful natural, healthy faces will be the frame of a functional muscles and a viable airway.

Malocclusion could potentially be a manifestation of sleep disordered breathing, craniofacial dystrophy or alterations of the environment that will have a negative impact on the growth and development of the craniofacial-respiratory complex.


  • Definition and Importance:
    • Craniofacial growth and development refer to the growth and changes in the structures of the head and face over time. Understanding this process is crucial as it impacts not just the physical appearance, but also influences critical functions such as breathing, chewing, speech, and even sleep and behavior..

Early Detection of Abnormalities:

  • Early stages of life are pivotal. Detecting and addressing any abnormalities in craniofacial development during infancy or early childhood can lead to more effective treatments. It helps in preventing complications that might affect a child’s health, speech, and self-esteem as they grow.
  • The nose accounts for over 50% of the total upper airway resistance. Many abnormalities in the nose and pharynx can cause or worsen snoring and sleep apnea. 

These include deviation septum, nasal polyps, turbinate hypertrophy, rhinitis, adenoid hypertrophy, nasopharyngitis, and nasopharyngeal tumors that can narrow the airways in the nasopharyngeal region.

  • Certain craniofacial features are associated with Breathing or obstructed breathing facial dimensions between individuals with OSA and individuals without OSA showing decreased interdental widths and higher arched palates among individuals with OSA.

Studies suggest that individuals with OSA have an overall lengthening, narrowing, and posterior rotation of their lower face compared with those without OSA. The literature is limited, however, in identifying factors influential to craniofacial development that predispose humans to OSA. 

Craniofacial development is influenced by both evolutionary/hereditary and environmental factors. Evolutionary anthropologists have compared humans to our primate ancestors and suggest that aspects of our unique evolution may predispose us to OSA.

Breathing and Sleep:

  • The structure of the face and skull directly affects breathing patterns. 

Abnormal craniofacial development can lead to conditions like sleep apnea, which not only disrupts sleep but can also impact overall health and cognitive development.

  • The nasal airway starts at the nostrils and extends to the nasopharynx. 

Although we often refer to the airway as a tube or pipe, it is actually made up of many structures that cause variations in airflow. 

Nasal obstruction and congestion are different; obstruction can be due to the nasal airway’s anatomical properties or reversible due to mucosal swelling and engorgement from infections and allergies. In upper airway infections, nasal congestion can lead to difficulty sleeping. 

  • Nasal breathing during sleep is essential to stimulate adequate ventilation, activate reflexes that help maintain the tonicity of the muscles that stabilize the upper airway, and to avoid mouth breathing. 

Addressing mouth breathing during sleep is essential, considering that, at birth, the child spends nearly 80% of the time asleep, and even at the age of  6 years they continue to have a prolonged sleeping time where they can spend up to 25% of their day sleeping. 

Studies monitoring nasal and mouth breathing during sleep have shown that normal individuals spend 96% of their sleep time breathing through their nose. 

  • Nitric oxide helps keep upper airways open by transmitting signals between the nose, pharyngeal muscles, and lungs. Nitric oxide is produced in the nose in significant quantities. It has been clinically proven to be a potent pulmonary vasodilator that improves oxygenation and ventilation. 

Nitric oxide also plays a role in maintaining muscle tone, and regulating sleep. 

  • Sleep apnea is a silent disease that causes numerous health problems, from hypertension to anxiety. 50% of cases are due to issues arising from the nose, ENT consultation should be the standard of care when apnea or airway resistance is suspected.  If you routinely feel you can’t breathe properly through your nose, especially at night when sleeping, you should consider having a doctor look at your nose; your health depends on it.


  • Dental Health:
    • The alignment of the jaws and teeth are a critical part of craniofacial development. Understanding and monitoring this can prevent or minimize dental issues, leading to better oral health and reducing the need for extensive orthodontic treatments later in life.


    • The evolution of our craniofacial structure has been encoded into our genetics and inherited from generation to generation, but craniofacial development is also influenced by environmental factors. Scientific journals have brought to light the role of environmental factors in human facial development, including diet, breastfeeding, and nasal obstruction/mouth breathing

Speech and Hearing:

    • Facial and cranial structures play a significant role in a child’s ability to speak and hear. Abnormalities can lead to speech delays or hearing problems, affecting communication skills and academic performance.


    • The evolution of the human upper airway is also unique because our larynx descends during infancy, separating the epiglottis from contacting the soft palate. This separation is thought to allow humans to create more complex speech patterns.
  • Psychological Impact:
    • We cannot overlook the psychological aspect. Children with noticeable craniofacial abnormalities may experience social challenges or bullying, which can impact their self-esteem and mental health. Early intervention can be key in supporting their emotional and social development.


  • Role of Nutrition and Environment:
    • Nutrition and environmental factors significantly influence craniofacial growth. A balanced diet rich in essential nutrients and a healthy lifestyle free from harmful habits like prolonged pacifier use or thumb sucking are vital.


  • Having a strategy to identify the different environmental factors influencing craniofacial development will allow us to make better choices to prevent issues from happening in the first place. 

Assessing: development, morphology, shape, size, growth, anthropology, evolution, consistency, structure, width, depth, arch, malocclusion, obstructive sleep apnea, airway, OSA, breastfeeding, and bite. 

Screening: diet, secular change, breastfeeding, nasal obstruction/ mouth breathing, and masticatory muscle function. 

Diet: The transition of the human diet from a hard to a soft consistency has been reported as a possible driving force for these craniofacial changes

Breastfeeding and NNSH There were 28 studies in this review comparing changes in craniofacial development related to breastfeeding and Non-nutrivie sucking habits. Ten studies evaluated breastfeeding vs bottle-feeding, 8 studies evaluated NNSH, and 10 studies looked at both breastfeeding and NNSH. Exclusive breastfeeding was defined as obtaining nutrition solely from suckling of the breast while bottle feeding included feeding of both pumped breast milk and infant formula. NNSH included digit sucking and pacifier use.

Four studies showed there was not sufficient evidence to confirm an association between breastfeeding and malocclusion, but they did find exclusive breastfeeding to be associated with a decrease of overall incidence of malocclusion.

Non nutritive sucking habits were associated with a variety of malocclusions, including, overjet, posterior crossbite, and anterior open bite. Non nutritive sucking was also found to influence craniofacial dimensions, with several studies observing decreased maxillary arch width and increased maxillary arch depth.

Nasal obstruction and mouth breathing:

Children with mouth breathing or nasal obstruction attributed to allergic rhinitis showed higher palatal arches, decreased volume, narrower maxillary widths, decreased maxillary length, greater anterior facial height. 

Children with nasal obstruction due to a deviated septum were also reported to have similar findings of increased anterior facial height, increased gonial angle, maxillary retrusion, mandibular retrusion, high arched palate, and narrower maxillary width.

Nasal obstruction and mouth breathing due to adenoid enlargement were associated with increased lower facial heights, steep mandibular plane angles, and more retrognathic mandibles. 

Mouth breathing was also associated with increased incidence of malocclusions, including anterior open bite, posterior crossbite, increased dental crowding, and increased dental overjet.

Muscles of mastication act as an external force against the craniofacial bones that allow for movement of the jaw for chewing. It is believed that this action and counteraction of the muscles and bones can lead to morphological changes in craniofacial development.

Secular change Various ethnicities around the world have experienced a change in craniofacial dimensions over time. The most common patterns reported are narrowing of the maxilla and mandible, lengthening and thinning of the mandibular body, and downward/posterior rotation of the mandible leading to a narrower and longer face. 

Malocclusion rates have also increased over time. These changes have occurred in relatively short time spans of a few hundred years, with some evidence suggesting significant changes even across a few generations. 

Environmental changes, such as changes in diet or urbanization, are suggested to have played influential roles in shaping our craniofacial morphology.

The best analogy for prevention and treating of the jaw that is not optimal for the kids ability to sleep well sooner when we are told just wait your child will outgrow it is compared to

If somebody says just wait til they are older and get all their permanent teeth.

Would be if The Doctor told my mom to wail to get me glasses for nearsightedness that won’t get better on its own, cannot self correct will get worse and can be associated with systemic neurological problems. 

I could not see the trees had tops. So I got glasses. I also could not breathe through my nose and sucked my thumb.

Well, malocclusion can follow the same pathway because of the impact of sub optimal mode of breathing mode of respiration. 

So really the best analogy is if you really want to help a kid get them glasses  so they  can see. If you want a kid to sleep and have good behavior make sure their jaw is optimal for their ability to breathe through the nose and sleep well. 

You know a child who’s diagnosed at  three or four with nearsightedness, they may have six different pairs of glasses. A child with baby teeth that touch, a crossbite, grinding  or snoring Guess what? It’s not rocket science that a kid will need expansion. We have a sleep breathing epidemic. 

Malocclusion, maxillary insufficiency, mandibular insufficiency, and the vertical dimension or skeletal open bites are the easiest thing to grasp is that the kid’s jaws are not wide enough for the teeth. That means there’s no room for the tongue. Il If we wait to treat seven or eight years old. That means there wasn’t room for this tongue when there was about two or three what are we waiting for?

Dr Boyd says by age two, okay, a child should be able to get close to  28 mm by the age of 4 and achieve 30 millimeters certainly by age five they should have certainly by age six, by six to seven, they should be 31 and so on.

Getting kids chewing hard foods and breathing through their nose and taping their lips if they have to. 

Look at tonsils and adenoids that you know you have to eliminate the problem with lymph tissue. Does the kid have an allergy? Is it an environmental allergy? Is it food allergy? Are they mouth breathing and airborne pathogens? 

It doesn’t mean your kid is going to need surgery. It does mean they may need to see an ENT, airway dentist or orthodontist, PT, Myofunctional Therapist, body worker, 

As early as what age can we start with interceptive orthodontics? 

When the kid has absolutely quantifiable malocclusion what does that mean if there are no spaces between baby teeth your child will need enough room for the tongue.

There are three dimensions. The transverse is  the easiest to fix. You can start a child as young as the age of 6 months by getting a kid to start eating raw carrots or introducing a bebe myo munchee. That’s a myofunctional appliance you can give them to support the tongue being up and breathing through the nose..

How much of a problem is an untreated tongue tie when starting orthodontics on adolescent or younger children? Not every child needs a release but every child does need to function properly.

You need  to build a house for the tongue to live in. You may need to start sooner rather than later.

Find a good relationship with a myofunctional therapist, assess the risk. 

If a parent understands this or they’re just curious and they want to help their child, Let’s start preparing them at 6- 18 months with Myobrace and baby led weaning and bebe Myo Munchee

30 months of age is the ideal time to treat, not to correct irregularities of the teeth, not to straighten the teeth but to make more room for the tongue such that the child can breathe through the nose while they’re awake and asleep for lifelong health. Get them chewing.

Dr Boyd calls it phase one part a, He recommends seeing them in his practice when they have at least eight to ten  permanent teeth. He always starts on the upper and the lower will follow. There’s a suture on the roof of the mouth that expands easily when they are younger so you’re using their growth and development rather than waiting until they are 8 or 10 years old when 80% of the growth and development has already taken place.

Start out with a removable appliance

These Specific Human Malocclusion (poorly aligned teeth and jaws) phenotypes are a way more common finding among children raised in post  industrialized societies. 

Many children diagnosed with Sleep Disordered Breathing/Obstructive Sleep Apnea have also been diagnosed with ADD/ADHD; have certain malocclusion phenotypes known to be related  development.

 SDB/OSA and ADD/ADHD, etc are usually first detectable in very early childhood (primary dentition), and recent evidence suggests that they might even be detectable in utero (mid-gestaional ultrasound imaging).  

Changs in  dietary regimens associated with cultural industrialization during infancy/early childhood (i.e., nursing and weaning period) and beyond, seem to have played a role in the observed increased prevalence of skeletal-dental malocclusion  since the Industrial Revolution in Western Europe and North America from the late 18th- thru the mid/late-19th-Centuries.

And all of these changes have changed how we breathe.  Mouth breathing, tongue posture and/or shallow breathing leads to Sleep Disordered Breathing/Obstructive Sleep Apnea.

About Dr. Kevin Boyd:

Dr. Boyd is a Pediatric Dentist in Chicago. He is an attending instructor in the Pediatric Dentistry residency program at Lurie Children’s Hospital where he serves as a dental consultant to the Sleep Medicine service.  His clinical focus is centered on prevention of oral and systemic disease through promotion of healthy breathing and eating; his primary research interest is in the area of infant/early childhood feeding practices and how they impact palatal-facial development, naso-respiratory competence, and neuro-cognitive development. He is currently a visiting Scholar at U. Pennsylvania doing research in the areas of anthropology and orthodontics. He has also recently been appointed as an adjunct Assistant Professor in the Dept of Anthropology at the University of Arkansas where he is mentoring PhD candidate research.  www.dentistry4children.net 

Poor oral health can impact speech, eating, smiling, and other social areas of life which may cause significant social anxiety, depression, and isolation. People with depression are 20 to 30% more likely to have missing teeth, thereby exacerbating problems with self-esteem and self-image.


specific craniofacial changes related to environmental influences. Future, rigorous prospective studies will allow us to better understand the complex relationship between environmental influences on craniofacial development and OSA risk

Focus on etiological factors that might have a detrimental effect on masticatory effort, body posture, swallowing patterns, breathing, and temporomandibular joint disorders; as part of the understanding of the malocclusion 

  • Summarizing the Importance: Understanding and monitoring your child’s craniofacial growth and development is a critical component of their overall health. It’s not just about their appearance; it’s about their ability to breathe, sleep, eat, speak, and interact confidently with the world around them.
  • Call to Action: I encourage each of you to pay close attention to this aspect of your child’s growth. Consult with pediatricians and specialists regularly, and take proactive steps to ensure that any issues are addressed early and effectively.
  • Closing Remarks: Let’s give our children the best start in life by ensuring their craniofacial development supports their health, functionality, and well-being. Thank you for your attention and commitment to the health and happiness of our future generations.”



Guilleminault C, Partinen M, Praud JP, Quera-Salva MA, Powell N, Riley R. Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr. 1989;114:997-9.