Strategies for Teaching Nose-Blowing
These strategies were contributed by occupational therapists from the ot-peds, school-sis, and SI listservs. Thanks to all the therapists who contributed to these ideas.
*It is best to practice the act of blowing their nose BEFORE your child is sick. Once congestion sets in, it can be very frustrating for children as they attempt to blow their nose with very little “success.” After practicing when feeling well, your child should be able to more effectively blow their nose when their next cold occurs.
To Work on the Action of Blowing:
Have your child work on blowing through their mouth in various ways and label the action.
Ping pong volleyball: have you and your child blow a ping pong ball back and forth across a table from each other
Blow through a straw to make a ball move across a table
Blow a cotton ball around a simple maze (with or without a straw)
Blow a crumpled ball of paper (small) off their hand or your hand
Blow colored water drops off a piece of hard paper
Have your child practice blowing through their nose. Label this action. How does it feel different?
Hold a small feather on your hand beneath your child’s nose. The smallest puff of air will move the feather. You can use and model the following: “take a big breath, close your mouth (or “put your lips together”), make the air come out your nose.” If your child understands this, move your hand further away so your child needs to use more sustained breath through their nose to move the feather.
Practice humming. This is an activity that requires the mouth to be closed and air to go through the nose. Louder humming requires better sustained air.
You can use various nose-toys (such as: Big Nose Blowing Dragon Glasses, Nose Whistle, Nose Flute).
Visualize using the breath from your nose to blow out a candle on a cake.
Now hold a tissue in front of your child’s face (but not touching their face). Have your child try to make the tissue move: first by blowing through their mouth, then by blowing through their nose. How does it change when you use big blows or little blows?
When your child is blowing through their mouth or nose, you can provide verbal cues such as “blow out through your nose, blow hard” or “blow out through your mouth, blow soft.”
If appropriate for your child, call the movement of the tissue a “tissue boogie” and discuss how the air from their nose makes the tissue dance.
After they successfully move a tissue by blowing through their nose, have your child hold the tissue in place against their nose and try blowing. You can provide the same verbal cues to “blow out, blow hard, blow through your nose, etc.”
Increase Body Awareness First, Then Awareness of Blowing Through the Mouth and Nose:
Identify where the nose is with eyes open; with eyes closed
Demonstrate how the air comes out – look, see, and feel the air as you blow
Mist up a handheld mirror by blowing air out of the nose
Practice with one nostril plugged, then the other
Practice a big blow and little blow through the mouth, then the nose
Blow a tissue up into the air (can also use a light balloon)
Blow a ping pong ball across water. Use different strength blows to increase awareness
Use picture cues with your instructions if your child is a visual learner
Try “blowing raspberries” against your child’s skin so they can feel the vibration and air flow. Or use exaggerated, breathy vocalizations with your mouth close to your child’s skin (their hand is best) can help increase awareness of air flow.
Other Considerations:
Fine Motor Skills Required
When blowing one’s own nose, there are fine motor components that are necessary: one’s own nose, there are fine motor components that are necessary:
Eye-hand coordination
Bringing the hands to midline
Vision-obstructed motor control
Pincer grasp
Pinch grip strength
Sensory Considerations
For a child, the process of blowing his or her own nose can be quite distressing. Children with olfactory sensitivities may breathe primarily through their mouth, making the act of nose blowing difficult. A sensitivity to scents can cause an overreaction to the tissue that needs to be held near the nose. To accommodate for these sensitivities, try using unscented tissues. Attempting the nose-breathing activities listed below can help.
Cognitive and Oral Motor Skills Considerations
For young children, the process of completing each step of nose blowing can be a difficult process. Children need to maintain lip closure while breathing through their nose, one nostril at a time. This multi-process task can be difficult for older children who demonstrate difficulty with cognition. Nose blowing is also a task that requires many executive skills, such as initiation, planning, attention, impulse control, working memory, cognitive flexibility, and sequencing. To address these problem areas, try using a social story for the steps of nose blowing. A social story can also help children identify the appropriate time for attempting to blow their nose.
Katie Hugh Sam, MOT, OTR/L
Katie Hugh Sam is an occupational therapist at Havern School. She earned her Bachelor’s degree in Psychology from the University of Wisconsin – LaCrosse and went on to complete her Master of Occupational Therapy at Colorado State University. Katie says, “From a young age, I always wanted to work with children. I’ve been drawn to the idea of helping others gain skills they need (‘habilitation’) rather than relearn skills they’ve lost due to injury (‘rehabilitation’).”
Prior to coming to Havern in 2017, Katie worked at the Joshua School with students on the autism spectrum. She says, “While I loved my students dearly, I wanted to work with a wider range of diagnoses. Learning about Havern School, I was especially intrigued by the sense of community, individualization of student needs, and depth of care that was evident from my first day on campus.”
