Are Infants Really Obligatory Nasal Breathers?

@article{Bergeson2001AreIR,
  title={Are Infants Really Obligatory Nasal Breathers?},
  author={Paul S. Bergeson and Jonathan C. L. Shaw},
  journal={Clinical Pediatrics},
  year={2001},
  volume={40},
  pages={567 - 569}
}
on its meaning, and suggest future areas of research. The nose is the preferred primary route of breathing in the infant because of its ability to humidify, warm, decontaminate, and regulate the air coming into the lungs. The upturned nose, so characteristic of the newborn, and the relatively large tongue allow the child to breathe and suck simultaneously while breastfeeding. Nasal breathing during feeding ensures swallowing without aspiration. The posterior portion of the tongue presses upward… 

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References

SHOWING 1-10 OF 26 REFERENCES

Infants are not obligatory nasal breathers.

It is concluded that infants are not obligatory nasal breathers, because they can breathe through the mouth by detaching the soft palate from the tongue, thus opening the oropharyngeal isthmus.

The pharyngeal effect of partial nasal obstruction.

It is suggested that partial nasal obstruction in a sleeping obligatory nasal-b breathing infant could result in a sucking back of the tongue over the larynx in this "cafe coronary" type of situation and prevention of this obstructive type of apnea would depend on the recognition of infants showing inspiratory and expiratory changes in pharyngeal airway size.

The effect of nasal occlusion on the initiation of oral breathing in preterm infants

It is suggested that preterm infants usually establish oral breathing in response to nasal airway occlusion, and this switch to oral breathing is preceded by a decrease in O2 saturation and in respiratory frequency; and arousal does not always precede the switch to Oral breathing as is traditionally accepted.

Iatrogenic acute nasal obstruction in an obligate nose breather.

Recently an infant came to the emergency department with acute nasal obstruction from the use of hypertonic saline nose drops, which may become catastrophic in an obligate nose breather.

The nasal resistance of newborn infants.

Neonatal respiratory distress from rhinitis medicamentosa

A neonate started on topical phenylephrine at birth was having multiple daily episodes of apnea and cyanosis and an evaluation documented edematous, obstructing nasal turbinates, as well as polycythemia, cardiomegaly, and prominence of the pulmonary vasculature.

The site and function of the nasal valve

This resistive segment of the airway was investigated using a “head‐out” body plethysmograph in subjects with anatomically normal noses and, as might be expected, caval resistance changed proportionately with the degree of mucosal congestion; but, more surprisingly, vestibular resistance changed similarly.

Nasal occlusion during sleep in normal and near-miss for sudden death syndrome infants.

Infants are not obligatory nasal breathers, and the nasal obstruction hypothesis should be discarded in the etiology of SIDS.

Clinical observations on response to nasal occlusion in infancy.

The suggestion is made that apnoea occurs as a response to nasal obstruction, which appears to be characteristic of early postneonatal life, is more likely to occur during REM sleep, and may progress to sudden unexpected death.