title: Orientation and position of head posture, scapula and thoracic spine in mouth-breathing children.
abstract: OBJECTIVE
  Mouth-breathing is a common clinical condition among school-age children and some studies have correlated this condition with quality of life and postural alterations. Therefore, the objective of this study was to investigate the orientation and position of the scapula, thoracic spine and head posture among mouth-breathing (MB) children and nasal-breathing (NB) children.
  
  
  METHODS
  Twenty-one male MB children and 21 male NB children between 8 and 12 years of age participated in the study. Data were obtained through a stereophotogrammetry system that uses passive markers over anatomical landmarks to capture the position of the segments. Internal rotation, upward rotation, anterior tilt, scapular elevation and abduction were measured bilaterally as well as thoracic kyphosis, forward head position and shoulder protrusion.
  
  
  RESULTS
  The MB children showed increased scapular superior position in relation to the NB group. No statistically significant differences were found between groups regarding the angular and linear measurements of the scapula. To verify reliability, three measurements were taken for each variable in the study. The intraclass correlation coefficient (ICC) showed results above 0.8 for all the variables except for the internal rotation angle (I-Rot), below 0.5, probably due to uncertainty in the palpation of the inferior angle of the scapula. Ninety-five percent of the NB children and 58% among the MB children had been breastfed, this difference was statistically significant. There were statistically significant differences between groups regarding the domains of the Autoquestionnaire Qualité de Vie Enfant Imagé (AUQEI) scale and body mass index, which was higher among the NB children.
  
  
  CONCLUSIONS
  MB children increased scapular superior position in comparison to NB children due probably to the position of forward head, leading to an alteration in the positioning of the mandible. The absence of significantly difference in posture pattern between groups in the present study could attributed to height-weight development in this age, as the posture of children changes in order to adapt to new body proportions, regardless of health status. The results observed in this study demonstrate the importance of using reliable measurements in the postural assessment of MB and NB children helping physical therapists to focus their strategies during rehabilitation in more specific conditions.
authors.affiliation: Biological Science and Health Institute, Pontifícia Universidade Católica de Minas Gerais, Minas Gerais, Brazil. pdayrell@gmail.com
authors.forename: Patrícia Dayrell
authors.initials: PD
authors.lastname: Neiva
authors.forename: Renata Noce
authors.initials: RN
authors.lastname: Kirkwood
authors.forename: Ricardo
authors.initials: R
authors.lastname: Godinho
mesh_terms: D002648:Child; D006257:Head / Q000502:physiology*; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D009058:Mouth Breathing / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D010780:Photogrammetry; D011187:Posture; D012399:Rotation; D012540:Scapula / Q000502:physiology*; D013904:Thoracic Vertebrae / Q000502:physiology*