Understanding Breathing Challenges in Children with Autism and How to Support Them

Understanding Breathing Challenges in Children with Autism and How to Support

Breathing is something most people do without thinking. Many autistic children do not intuitively develop an understanding of how breathing functions within their body. For many children with autism, breathing can be a source of difficulty and discomfort. Clinically, this may present as mouth breathing, breath-holding patterns, difficulty generating airflow or reduced awareness of nasal breathing. These differences are often associated with variations in sensory processing, interoceptive awareness and oral motor coordination. Differences in sensory processing, nervous system regulation and body awareness can make it hard for these children to breathe in and out smoothly. This can show up as mouth breathing, breath-holding or trouble breathing through the nose. Understanding these challenges is key to helping children with autism feel more comfortable and supported in their breathing.

Because of this, verbal prompts such as “take a deep breath” are frequently ineffective. These cues assume an existing internal awareness that may not yet be developed.

Before breathing can be used for regulation, children must first experience and differentiate airflow in a concrete, sensory-based way.

A structured yet play-based progression supports this development.

Why Breathing Can Be Difficult for Children with Autism

Children with autism often experience sensory processing differences. This means their brains may interpret sensations like airflow or the feeling of breath differently from other children. Several factors contribute to breathing challenges:

• Sensory Processing Challenges: Some children may be overly sensitive or under-responsive to sensations related to breathing. They might not notice the feeling of air moving through their nose or mouth.

• Nervous System Dysregulation: The autonomic nervous system controls breathing automatically. In children with autism, this system may not regulate breathing smoothly, leading to irregular patterns.

• Oral Motor Differences: Muscle tone and control in the mouth and face can affect how a child breathes. Weakness or coordination issues may cause mouth breathing or difficulty controlling breath.

• Reduced Interoception: Interoception is the ability to sense internal body signals, like hunger, thirst or breathing. Children with autism may have trouble recognizing when and how to breathe deeply or exhale fully.

  
  

These factors can combine to make simple instructions like “take a deep breath” confusing or unhelpful. Without a clear sense of what breathing feels like, children may struggle to follow such directions.

Signs That a Child May Have Breathing Difficulties

Recognizing breathing challenges early can help caregivers and therapists provide the right support. Some common signs include:

• Frequent mouth breathing instead of nose breathing

• Holding their breath during activities or when upset

• Difficulty exhaling fully or seeming to “forget” to breathe out

• Appearing anxious or restless without clear cause

• Complaints of feeling out of breath or chest tightness (if verbal)

• Struggling with tasks that require breath control, like speaking or blowing bubbles

  
  

If these signs are present, it’s helpful to observe the child’s breathing patterns during calm moments and during activities that require focus or self-regulation.

How to Help Children Understand Breathing

Before children can practice breathing exercises, they need to develop awareness of their breath. This means helping them notice the difference between breathing in and breathing out. Here are some practical ways to support this:

Step 1: Establishing Exhalation Awareness

Teaching breathing awareness through structured, sensory-based play.

Starting With Breathing Out (Exhaling)

Breathing out is often easier for many children to understand and physically practice before learning controlled breathing in through the nose. Exhalation is typically more accessible, as it produces observable and tangible effects in the environment.

Play-based activities can help children learn how to move air out of their mouth in a fun and meaningful way.

Activities should provide clear visual, tactile or auditory feedback linked to airflow:

Breathing skills can be taught through simple, playful experiences.

Some breathing out activities may include:

• blowing bubbles

• blowing dandelions

• pretending to blow out birthday candles

• blowing feathers

• pinwheels

• whistles

• straws in water

• blowing cotton balls across a table

Breathe air out exercise.

If a child has difficulty blowing air out, it can help to begin with simple body-awareness activities first.

For example:

• blowing kisses

• puckering the lips (lip rounding) to direct airflow forward

• puffing the cheeks and applying gentle external pressure to release air with sound

• placing a hand near the mouth to feel warm air

• practicing short gentle puffs of air

• watching tissues or lightweight objects move with airflow

These activities help children begin noticing that air can move out of their body and affect the environment around them.

Breathing out activities can also support:

• oral motor development

• body awareness

• attention and focus

• nervous system regulation

• emotional calming

• sensory exploration

• airflow control

• external awareness of breath

Step 2: Developing Awareness of Inhalation

Breathe In

Inhalation is inherently less observable and often less understood. It requires a shift from external feedback to internal sensory awareness. Once children begin understanding breathing out, they can gradually learn the concept of breathing in through the nose.

One way to help children understand breathing in is by creating playful sensory experiences that increase awareness of airflow through the nose. For this reason, inhalation should be introduced through meaningful sensory experiences rather than instruction.

Approaches may include:

• gently closing one nostril and practicing breathing through the open side

• comparing blocked airflow versus open airflow

• briefly holding both nostrils and then releasing to notice the feeling of air entering

• helping children notice where the air is moving

These activities are done gently and playfully to help children become more aware of how breathing feels inside their body. Meaningful sensory experiences can then help strengthen the concept of breathing in through the nose.

Some examples include:

• smelling favorite snacks or drinks

• engaging with distinct scents (e.g., food, drink, natural elements)

• smelling scented toys or sensory objects

• exploring outdoor smells like flowers, grass, trees or nature

• participating in brief, repeated “sniffing” experiences

The focus is on noticing the sensation of air entering, rather than modifying or controlling it.

At this stage, the child begins to differentiate:

• Internal vs. external airflow

• Intake vs. release of air

Use Visual and Tactile Cues

• Place a hand gently on the child’s chest or belly so they can feel it rise and fall.

• Use a small feather or tissue in front of their nose or mouth to show airflow.

• Blow bubbles together to make exhaling visible and fun.

  
  
  
  

  Visual supports can also help children better understand the concept of air moving in and out of the body. Balloons, for example, can demonstrate how air fills space when breathing in and releases when breathing out. Watching a balloon expand and shrink can help make breathing more concrete and visually understandable.

  
  

Step 3: Coordinating Inhalation and Exhalation

Once both components are independently experienced, they can be gradually linked.

This stage introduces simple, paired sequences without requiring timing precision or control:

• Inhalation followed by exhalation in a natural sequence

• Observing expansion and release (e.g., a balloon)

• Associating inhalation and exhalation with meaningful actions

Examples include:

• Smelling an object followed by blowing (e.g., cooling warm food)

• Inflating and releasing air from a balloon

The goal is not structured breathing patterns, but the emergence of a coordinated, cyclical awareness of breath.

Break Down Breathing Into Simple Steps

• Start by focusing only on breathing in. Say, “Let’s smell the flower,” and guide them to notice the air coming in.

• Next, focus on breathing out. Say, “Blow out the candle,” and help them feel the breath leaving their body.

• Use short, clear phrases instead of abstract instructions.

  
  

Incorporate Play and Movement

• Use games that involve blowing, like blowing ping pong balls across a table.

• Encourage activities that require breath control, such as blowing up balloons or playing wind instruments.

• Combine breathing with gentle movement, like raising arms when breathing in and lowering them when breathing out.

  
  

Breathing Exercises That Can Help

Once a child shows some awareness of breathing, simple exercises can support regulation and calmness. These exercises should be adapted to the child’s comfort and ability:

• Counting breaths: Encourage the child to breathe in for a count of three and out for a count of three. Use fingers or visual aids to help keep track.

• Square breathing: Guide the child to breathe in, hold, breathe out, and hold again, each for a count of four. This can help with focus and calming.

• Guided imagery: Use stories or images that involve breathing, like imagining blowing dandelion seeds or floating on a cloud.

  
  

It’s important to be patient and flexible. Some children may need repeated practice and gentle encouragement before these exercises feel meaningful.

When to Seek Professional Support

If breathing difficulties significantly affect a child’s daily life, professional help can make a difference. Speech therapists, occupational therapists and respiratory therapists have strategies to address oral motor skills and breathing regulation. Medical evaluation may be needed if there are concerns about underlying respiratory or neurological conditions.

Supporting Breathing in Everyday Life

Create an environment that supports healthy breathing habits:

• Encourage nose breathing by gently reminding the child and providing positive reinforcement.

• Maintain good air quality and humidity at home to make breathing easier.

• Promote regular physical activity that encourages natural breath control.

• Use calm, reassuring language when guiding breathing to reduce anxiety.

Moving Toward Regulation Through Play & Connection

As children become more comfortable with breathing in and breathing out, breathing activities can naturally become part of everyday play, outdoor exploration, emotional regulation and calming routines.

The goal is not perfection. The goal is helping children build awareness of their bodies in ways that feel safe, playful, sensory-friendly and meaningful to them.

Every child learns differently. Through patience, sensory exploration, connection and co-regulation, breathing skills can gradually become easier and more natural over time.

If you feel your child may benefit from additional support with sensory regulation, breathing awareness or life skills development, Lavardi Sanctuary offers supportive, individualized approaches designed around each child’s unique needs.

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