Mouth breathing, tongue thrust, thumb sucking or a mouth that hangs open? Anna van Piggelen assesses how your child’s tongue, lips and jaw work, explains what she finds in plain English, and tells you honestly what should happen next.
A specialist in head, neck, and TMJ issues, integrating traditional osteopathy with Orofacial Myofunctional Therapy.
A whole-body practitioner combining manual therapy with Pilates techniques and ultrasound to enhance mobility and manage degenerative pain.
A versatile practitioner for all ages, offering both structural treatment and specialised Cranial Osteopathy for babies and adults.
Anna is a Registered Osteopath and Orofacial Myofunctional Therapist. Her interest is personal as well as professional: she underwent palate expansion and myofunctional therapy herself after problems linked to longstanding childhood oral habits, so she knows what a structured programme asks of you.
Breathes through their mouth, or sleeps with it open
Rests with their lips apart, or struggles to keep them together
Rests the tongue low, or pushes it forwards when swallowing
Uses lots of lip or face movement to swallow
Sucks their thumb or fingers, or still uses a dummy
Has restricted tongue movement or a tongue-tie referral
Snores regularly
Is in braces, has had relapse, or was referred by a dentist, orthodontist or ENT
None of these proves your child needs therapy. They are reasons to look more closely, and you do not need to diagnose your child before you book. Our approach is personalised: Anna listens to your concerns first, then assesses your child.
A blocked nose during a cold is normal. It becomes a concern when mouth breathing is your child’s usual pattern, at the TV, reading, playing or asleep. Mouth breathing is a breathing pattern, not a diagnosis, and the real question is what is behind it: congestion, allergies, enlarged tonsils or adenoids, structural factors, or a habit that outlived its cause. Research links mouth breathing in children with differences in dentofacial development, though not every mouth-breathing child develops the same changes.
Exercises cannot remove an obstruction, and therapy should never make a child keep their mouth shut when they cannot breathe comfortably through their nose. Anna will recommend your GP or an ENT specialist if there is persistent nasal blockage, regular snoring, pauses in breathing, suspected enlarged tonsils or adenoids, or ear and hearing concerns. Therapy is not a substitute for investigating sleep-disordered breathing.
A blocked nose during a cold is normal. It becomes a concern when mouth breathing is your child’s usual pattern, at the TV, reading, playing or asleep. Mouth breathing is a breathing pattern, not a diagnosis, and the real question is what is behind it: congestion, allergies, enlarged tonsils or adenoids, structural factors, or a habit that outlived its cause. Research links mouth breathing in children with differences in dentofacial development, though not every mouth-breathing child develops the same changes.
Exercises cannot remove an obstruction, and therapy should never make a child keep their mouth shut when they cannot breathe comfortably through their nose. Anna will recommend your GP or an ENT specialist if there is persistent nasal blockage, regular snoring, pauses in breathing, suspected enlarged tonsils or adenoids, or ear and hearing concerns. Therapy is not a substitute for investigating sleep-disordered breathing.
Oral habits are a normal part of early childhood. They matter more as a child gets older, or when a dentist or orthodontist is concerned about teeth, bite or oral function. A habit repeated for hours a day or all night becomes deeply established, so simply telling a child to stop rarely works. They need to be ready and involved.
Anna helps your child notice when the habit happens, understand why they are working on it, find triggers, use replacement behaviours and set achievable goals. You are involved, so what you do at home supports their progress. Your dentist assesses the teeth and bite.
Your orthodontist manages tooth and jaw alignment and may refer your child for tongue thrust, open-mouth posture, sucking habits or difficulty with lip closure. Anna assesses the functional pattern while the orthodontist stays responsible for diagnosis and treatment. A systematic review of orofacial muscle training in children found it promising in places but the quality of evidence questionable, so we never promise it will prevent orthodontic problems or guarantee stability. Exercises can be fitted around braces or aligners.
How the frenulum looks does not tell us how the tongue works, so Anna assesses movement. Some children are advised to do exercises before or after a release, because a procedure adds movement but does not teach a child to use it. Not every tongue-tie needs release. Anna does not perform tongue-tie surgery and will refer you to a qualified professional if function looks restricted.
The first visit is about understanding your child, not a long list of exercises. Anna asks about breathing, sleep and snoring, tongue posture, swallowing, habits, dental and orthodontic history, feeding history and speech. She watches where the tongue rests, how it moves, how the lips close and how your child swallows, so she can understand their pattern, not make them feel they are doing something wrong. Your observations matter, because parents notice patterns that clinic visits miss.
Anna then explains in plain language what she found, what is normal variation, whether therapy is appropriate, what the first goals are and whether anyone else should be involved. Not every child needs a full programme.
A movement done well once in clinic has not become a habit yet, which is why regular practice at home is an important part of therapy.
There is no fixed length. It depends on age, the pattern, how established the habit is, how consistently exercises are done, and whether orthodontic or other treatment is happening.
Anna is brilliant – she really listens and then treats any issue so well I walk out feeling completely different. She thinks about things between visits so always moves things forward and has different sets of exercises to perfect after each visit, which I love. This speeds recovery and aids long term maintenance. Anna always goes the extra mile after each appointment, she’s a life saver. Needless to say she’s v popular but I’ve always managed to get to see her when I need to, she tries to giggle things to fit people in. Her lovely practise has such a calm air about it, lovely lighting feels so relaxing. Thank you Anna for fixing me!
pippa moodyI have seen Anna regularly for a few years and every time I leave the practice I feel relaxed, straighter and pain free. Typically carrying stress in my back, Anna not only treats the area of pain, but has a holistic approach, and gives advice on exercises, stretches, and breathing techniques to take away. She knows just what you need: a specific adjustment after massage to release tension, to a ‘maintenance session’ and five minute relax at the end. Anna has treated the whole family with various injuries and growing pains and I can not recommend her enough!
Rhoda BreakellI specifically booked in with Anna as she came highly recommended by a friend. I have been visiting physios, chiropractors and osteopaths for years with no real success. The problem I had wasn’t complex, but I also suffer with a rare syndrome which means fixing that simple problem made it slightly complex!! I was pleasantly surprised when Anna was aware of my syndrome and knew all about it! No one else I had been to knew anything about it! The treatment she gave me was so relevant and was in line with my syndrome, which meant I saw immediate results when I stuck to the exercises. I genuinely feel like Anna really listened to what I had to say when so many others hadn’t. She is so knowledgeable, approachable, helpful and thoughtful I wouldn’t go anywhere else and would 100% recommend visiting. On a side note, her studio is so spacious and clean, it always is a pleasure to attend.
Hollie BlueI had a fantastic treatment from Anna. She really got to the root of problem and gave me great advice to improve my form and help me to prevent further injury.
James MartinLove Anna, she is really good. Helped me out with mobility issues, muscle and tension release post training. Also now that I’m expecting my baby she’s been fantastic, helping with some discomfort I started having during my third trimestre… 100% recommended!
Maria Alejandra ReisAnna is a brilliant osteopath she has helped me with varioys limitations and helped improve my quality of life
Gabriel CiriloAfter years of visiting chiropractors, I have decided to try osteopath services. Anna is very skilled and knowledgeable as well as warm and friendly. Each session improved my condition and I always left feeling pain-free. I would highly recommend Anna’s services.
Ania ProchonFantastic service! Anna has worked her magic when I’ve been in real pain. She’s professional, honest and is always smiling – I couldn’t recommend more highly !
LorraineI have been seeing Anna for a few years now after struggling with migraines. She has not only helped me immensely but was the first person I’d seen to get to the root of the problem. Along with being a brilliant therapist, her advice and aftercare is invaluable. I can’t recommend the clinic highly enough
Gemma ShanleyChildren with these concerns often sit between several areas of healthcare. Anna works within her own training and refers you to a different practitioner where necessary.
There is no single right age. A child needs enough understanding and cooperation to follow instructions and practise consistently, and for some younger children a dental, ENT or medical check comes first.
You do not need to decide. Persistent mouth breathing, open-mouth posture, tongue thrust, difficulty with lip closure or persistent habits may justify assessment, especially if a dentist or orthodontist has raised concerns.
It can help with established habits where nasal breathing is comfortable and medically possible. It should never be used to force nasal breathing where there is obstruction or another medical issue.
Congestion, allergies, enlarged tonsils or adenoids, structural factors and habit can all be involved. If it is persistent, especially with snoring or breathing concerns, talk to a healthcare professional.
The tongue moves forwards, often towards or between the teeth, when swallowing, and may rest forwards. A full assessment looks at swallowing, tongue, lips and the wider pattern.
Persistent sucking affects how the lips, tongue and jaw are positioned and may be relevant to dental development, which is why dentists sometimes recommend stopping.
It may be right where an orthodontist has identified a functional issue, or before or after tongue-tie treatment. It does not replace orthodontic or tongue-tie care.
Regular home practice is needed and Anna will show you both what to do. There is no fixed length, and progress is reviewed as therapy continues.
Myofunctional therapy has been studied in relation to tongue posture, swallowing, mouth breathing, lip function, oral habits and orthodontics. Some findings are useful, but systematic reviews point to limits in the quantity and quality of evidence. That is why we do not present therapy as a treatment for every breathing, dental, sleep or developmental concern.
Book a children’s myofunctional assessment with Anna at Key Osteopaths. She will explain her findings clearly and say whether therapy, exercises or another professional is the right next step. The goal is not to label every difference as a problem. It is to understand your child’s function and give you a clear plan.
Key Osteopaths is in West Byfleet and regularly sees patients from Woking, Weybridge, Guildford, Pyrford, Cobham and across Surrey. Find us at Ground Floor, 3 Park Court, Pyrford Road, West Byfleet KT14 6SD, or call 01932 640322.