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Myofunctional Disorder Assessment
(Child)

Does your child have any of the following nighttime behaviors or issues?

  • Child has trouble falling asleep or staying asleep

  • Child tends to breathe through their mouth during sleep

  • Snore or heavy loud breathing

  • Pause breathing, gasp, choke, or struggle to breathe when sleeping

  • Restless or agitated sleep

  • Excessive sweating or bed wetting

  • Grinding teeth

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Does your child have any of the following daytime behaviors or issues?

  • Difficulty waking or wakes with a headache

  • Groggy/Tired or "out of it"

  • Hyperactive

  • Tends to breathe through their mouth

  • Easily distracted, fidget/ squirm when seated

  • Diagnosed with ADD/ADHD

Does your child have a history of any of the following?

  • Pacifier

  • Thumb or Finger Sucker

  • Lip Biting

  • Difficulty breathing through nose

  • Allergies

  • Sinus Infections

  • Tonsilitis

  • Ear Infections

  • Slow rate of growth

If you answer 'Yes' to any of the following questions, you are likely to have some myofunctional concerns.

 

If you answer 'Yes' to multiple questions, myofunctional therapy would be recommended.

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