Science You Can Use: What does snoring have to do with breastfeeding?

A study just out in Pediatrics has many people trying to connect the dots between three seemingly unrelated issues:  snoring, behavioral problems, and breastfeeding.

This prospective study looked at 250 Cincinnati children aged 2 to 3.  The goal:  to determine whether persistent snoring in this age group is associated with behavioral and cognitive problems, and to identify factors predictive of snoring.  Persistent snoring was defined loud snoring (reported by parents) 2 or more times per week, at ages 2 and 3.

The findings?  Persistent snoring was associated with higher rates of hyperactivity, depression, and attention problems.

The strongest predictors of snoring? Lower socioeconomic status and not breastfeeding or breastfeeding for a short period of time.

In fact, none of the 250 children who had breastfed for one year or more were persistent snorers, while nearly 25% of those who were not breastfed or breastfed for a month or less became persistent snorers.

The authors concluded:  “We found that children who were fed breast milk, especially across longer periods, were at markedly lower risk for persistent snoring, even after controlling for potential confounding variables.”

The authors note that this finding is consistent with prior research:

Two epidemiologic studies that coded breastfeeding dichotomously reported similar findings, and a study of habitually snoring children found that longer duration of  breastfeeding between 2 and 5 months of age was associated with greater protection from obstructive sleep apnea.

So, why would that be?  The authors note:

Authors of the latter study speculated that the act of breastfeeding promoted the development of a healthy upper airway structure and that breast milk provided immunologic protection against infections that promote sleep disordered breathing.

This discussion reminded me of the late Dr. Brian Palmer, a dentist who devoted much attention to the question of breastfeeding and its relationship to normal development of the oral cavity and surrounding structures.  As part of his investigation Dr. Palmer studied the skulls of humans born before the widespread use of bottles and pacifiers.

In this fascinating discussion of obstructive sleep apnea (OSA) and breastfeeding, he noted:

An article published in 1997 by a sleep research team from Stanford describes a formula for predicting OSA.  It states that individuals with high palates, narrow dental arches, overjets (lower jaw retruded), and large necks who are overweight are at risk for OSA. The information is extremely significant when one realizes that evidence from skulls shows that before the invention of baby bottles and pacifiers, high palates, narrow dental arches, and overjets were rare.

A high palate can impact occlusion and breathing. It can also narrow the upper dental arch and cause a crossbite. Since the roof of the mouth is also the floor of the nose, any increase in the height of the palate decreases the volume size of the nasal chamber. This decreased size can then increase the air resistance through the nose. High palates also lead to a narrowing of the posterior nasal aperture or choanae (skull opening at the back of the nose). A smaller opening means a narrower opening into the soft tissue section of the airway.

How does the breast impact the normal development of these structures?  Dr. Palmer wrote:

While the soft breast adapts to the shape of the infant’s mouth, anything firm requires the mouth to do the adapting.  In addition, during breastfeeding, the tongue moves in a peristaltic motion underneath the breast.  This motion is critical for the proper development of swallowing, alignment of the teeth, and the shaping of the hard palate.

Dr. Palmer noted that there are other factors which might have influenced these changes.  But he concluded, “The best prevention (for OSA) is breastfeeding and keeping objects like pacifiers out of the mouth.”

The authors of this recent study might well agree.

Are your children snorers?  Has breastfeeding had a discernible impact on your children’s sleep breathing or orofacial development?  Has snoring had an impact on their behavior?

5 thoughts on “Science You Can Use: What does snoring have to do with breastfeeding?

  1. While I believe there is a strong correlation between these issues. I would question this study. My first question would be WHY the children were not breastfed or only breastfed for a short time. It may be that there was a latching problem or the mother was experiencing pain because the baby already had a problem getting their tongue or jaw into the proper position for breastfeeding. I find that many babies have fascial restrictions around the dural tube which prevents the head from being in the correct position which causes the tongue and jaw to not be able to get in the correct position. If that is not corrected, there is obstruction of the airway and the child will snore. If the child is uncomfortable and not getting good quality sleep, because they do not have the verbal skills to tell you what the problem is, they act out and that translates to behavioral problems. All babies should be examined by a pediatric fascial specialist, in addition to their pediatrician, right after birth. Fascial Integrative Therapy™ is a very gentle approach that can remove fascial restricitons and prevent these problems before they develop or correct them when they are recognized. We work with babies who are only hours old to make sure they do not have any imbalances in their bodies as well as with babies whose mothers report breastfeeding problems and many children who were undiagnosed early but now are exhibiting behavioral problems, sleep problems, inability to crawl, difficulty walking, or symptoms of autism among other issues. Fascial Integrative Therapy™ addresses all of these issues and we have an excellent success rate.


  2. Counter-example: my son was breastfed until he was 32 months old, and he snored so badly that his adenoids were removed when he was 7. I realize that large adenoids are a compounding factor here, but I don’t think it’s possible to generalize and say that breastfeeding will necessarily mean no snoring.


  3. I’d be curious, like the first commenter, to know why those snoring children were not breastfed. Like the first commenter, I’d guess that many of them were prematurely weaned because their mothers experienced a lot of pain — caused by tongue tie or other oral-facial restriction that often goes unrecognized and untreated. If this is true, it would demonstrate a different sort of causality than the study seems to suggest. Very interesting!


  4. As for the “what my baby did” comment, within populations there are always variations. A sample size of 1 doesn’t counter a sample size of 250. Breastfeeding is merely the normal way that infants are fed and therefore confers no benefits. Not breastfeeding increases risks — which does not mean that every baby that is NOT breastfed experiences those risks. My mother smoked cigarettes from the time she was 14, had a heart attack at age 52 and died of a stroke at 62. My father who was 7 years older than she was is still going strong despite smoking. There are INDIVIDUAL variations.

    The more important question here is whether or not this is a reverse causality issue. I can think of many anatomical reasons that could lead to snoring that also make breastfeeding more challenging. Nevertheless, babies who HAVE those conditions and also also formula fed are at greater risk of increased disease and if the formula is fed via a bottle may be at greater risk of oral development issues because the way in which babies suck from a bottle are different from the ways in which they suck. This doesn’t mean that ALL the babies who are formula fed will experience these risks. For example, not using a car seat puts babies at risk of injury and death in the event of a car crash. Yet many babies will not experience injuries and death if they are not in car seats when they are in a car.

    The research is quite interesting and really needs to be looked at from the which comes first angle. Snoring clearly is an important health indicator and should probably be explored as an potential indicator of “infant feeding problems” that could be addressed.


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