Li Zhenzhen is convinced that allowing her young son to breathe through his mouth while he sleeps will damage his appearance. So she has decided to force the boy to stop — by sealing his lips with medical tape.

Every night since her son was five months old, Li has covered his mouth with tape before putting him to bed. The mother has been told repeatedly that what she’s doing is unnecessary and potentially dangerous, but she doesn’t care.

She believes that the tape will ensure her child grows into an attractive adult. And in her view, being handsome will provide him with life-long benefits.

“I’ve simply been doing what I can … to ensure he has a better future,” the mother tells Sixth Tone. “Isn’t that what every parent wants?”

In China, a growing number of parents are taking drastic measures to ensure their infant children conform to traditional beauty standards. In their eyes, a child’s future success will depend on their physical appearance just as much as their education — and so they need to intervene early.

It’s a trend driven by social media. On Chinese social platforms, influencers are promoting a range of products that they claim will correct perceived physical imperfections in young children: from braces for 3-year-olds’ teeth, to helmets designed to mold a baby’s skull to a desired shape, and leg binds that supposedly make children’s legs grow straight.

Posts about these products often reach massive audiences, and they have fueled the growth of an entire baby beauty industry. On Xiaohongshu, an Instagram-like platform, there are now dozens of vendors selling anti-mouth breathing tape for children.

But the trend has sparked alarm among Chinese medical professionals. Doctors say that some of these products can seriously damage children’s health, causing brain damage and other permanent conditions. So far, however, the warnings have done little to dent their popularity.

‘Beauty is power’

Chinese society has long placed an outsized focus on physical appearance: Many employers, for example, still specify requirements for candidates to be a certain gender, height, and level of beauty.

As elsewhere, social media has only intensified the country’s obsession with beauty. Cosmetic surgery is exploding in popularity. Influencers are promoting extreme weight loss challenges. Cases of eating disorders are spiking, especially among teenage girls.

This is leading many parents to pass on their body image anxiety to their children, believing that they’re setting them up for success in later life, scholars from East China Normal University’s School of Psychological and Cognitive Sciences tell Sixth Tone.

“When it comes to beauty, it’s common for people to refer to widely acknowledged aesthetic standards,” says Li Ling, an associate professor at the school, who isn’t related to Li Zhenzhen. “It’s an era when ‘looks matter.’ People believe beauty is power.”

For many parents, physical appearance has become another front in the Chinese rat race, Li says. It has long been common for Chinese families to sign up children for hours of extracurricular tuition from as young as 3 years old, for fear they’ll fall behind their peers. Now, the competition is extending into other areas, too.

“Parents want to give their kids a better future. They want to make sure they don’t lose at the starting line,” says Li. “Traditionally, we believed it referred to academic studies. But now, it’s more about giving a child comprehensive preparation (for adult life).”

Adenoid face

In mother Li Zhenzhen’s view, being physically attractive is like having a safety net: It will give her son more security when he grows up.

“In the worst case scenario, if he doesn’t have any strong abilities, he will still be able to make a living with his good looks,” she says.

So when Li noticed that her 5-month-old son breathed through his mouth slightly while sleeping, she was immediately concerned. She’d read online that mouth-breathing can lead children to develop an unsightly “adenoid face.”

Adenoid face — also known as adenoid facies — is a real condition: When children suffer from blocked nasal passages and are forced to breathe through their mouths for long periods, it can affect the development of their jaws. Common signs of adenoid face include an elongated face, prominent incisors, a short upper lip, and elevated nostrils.

On Xiaohongshu, a lifestyle platform with a massive user base among young parents, influencers have spread fear about adenoid face. Many have suggested that any child who breathes through their mouth could develop the condition, and promote mouth tape as a way to prevent this.

These posts have had a huge impact. On Xiaohongshu’s shopping channel, there are around 200 mouth tape products specifically designed for children on sale. More than 100,000 packs of children’s mouth tape are sold on Chinese e-commerce platform Taobao every month, according to the platform’s sales data.

Li has become a passionate mouth tape advocate. After noticing her son’s mouth-breathing, she purchased some tape online straightaway. Within days, sealing his mouth shut had become part of her daily routine.

“He suffered from a skin rash at the beginning,” she recalls. “I changed brands many times, and eventually found a product that he didn’t develop an allergy to.”

But doctors warn that mouth tape cannot prevent adenoid face; on the contrary, using it can be highly dangerous.

Chronic mouth-breathing — the kind that causes adenoid face — is caused by enlarged adenoids, which are glands that sit above the roof of the mouth and the tonsils. When the adenoids become enlarged — which can happen due to an infection, allergy, or genetics — they block off a child’s nasal passages, forcing them to breathe through their mouths to get enough oxygen.

Enlarged adenoids can be treated with medication, which reduces the inflammation, or surgery in severe cases. Mouth tape does nothing but deprive the child of vital oxygen, which can cause lifelong harm.

“Sealing their mouths is not the solution to the blocked nasal passages,” says Qian Wei, an ear, nose, and throat specialist at United Family Healthcare in Shanghai. “The application of mouth tape without medical instruction might cause oxygen deprivation and brain damage.”

In June, a 5-year-old boy in east China’s Jiangsu province reportedly almost suffocated while wearing mouth tape. The story became a trending topic on Weibo, China’s Twitter-like microblogging platform, at the time, sparking much discussion of parents’ growing anxiety over their children’s appearance.

Yet mouth tape remains popular. Li says she had no idea the product could be dangerous until she posted about her experience using it on Xiaohongshu, and several commenters mentioned the health risks.

She took her son to the hospital for an examination soon after. Fortunately, the results showed that her son’s brain was developing normally. The doctor questioned Li’s use of the mouth tape, but the mother still insists she’s doing the right thing.

“I want to give him the best I can,” says Li. “There’s nothing wrong with parents striving for their children to have a good appearance.”

Even today, Li continues to use mouth tape on her son, and posts regularly about the product on Xiaohongshu. Though she regularly receives criticism from other users, many other parents support her enthusiastically. 

Under one recent post, the most upvoted comment among hundreds of responses is from a user praising Li for her persistence, and saying that her boy is sure to grow up into a handsome man. 

“Thanks for the blessing! To make sure he will continue growing up good-looking, I’ll keep using mouth tape,” Li replied.

The baby beauty business

For doctors like Qian, the level of faith that Chinese parents now place in social media is extremely worrying — but difficult to counter.

“Exchanges on online platforms are social behaviors, not medical consultations — it’s a dangerous trend that people turn to social media for serious medical advice,” says Qian. “Parents have been paying more attention to the adenoid issue. It has been partly fueled by discussions on social platforms.”

Li Ling, the professor, says that social media exerts a powerful influence on parents’ behavior in China. As elsewhere, the Chinese platforms spread anxiety among families, which the baby beauty industry has learned to manipulate and channel into sales.

“The flood of information and the market strategies that purposefully create anxiety to drive consumption have worked together to lead parents to think and move in the same direction,” says Li.

Today, the baby beauty business goes far beyond mouth tape. Dental products are increasingly being targeted at very young kids: some children as young as 3 years old are now wearing braces 24 hours a day.

Other parents are using swaddling products to tightly bind their children’s lower legs. Influencers claim this can prevent children from developing so-called “X-shaped legs,” where the legs are not fully straight.

Among the most popular new products are helmets that correct a baby’s skull shape as it grows. Vendors say that if a baby wears the helmet 23 hours a day for four months, it will develop the desired skull shape: round instead of flat, and with a prominent forehead.

In the United States, doctors sometimes prescribe helmet therapy if a baby’s skull is misshapen, but the product can only be used under medical supervision. In China, however, the helmets are sold freely online, with prices ranging from 2,000 yuan ($287) to 20,000 yuan.

And they have reached a wide audience. Last year, the helmets began trending on Weibo, generating an enthusiastic response from users. “I want to go back to my baby days and ask my parents not to give me a flat head,” read one of the top comments, with nearly 5,000 likes.

Xu, a mother from east China’s Zhejiang province, placed an order for a helmet for her 7-month-old baby in August, after hearing about the product online. It has been bothering her for months that her son’s skull isn’t fully symmetrical — an issue that she believes stems from the days he spent in an incubator after being born, when the nurses failed to correct his sleeping posture.

“It just didn’t look standard,” the mother tells Sixth Tone. “I had to take action to help. Otherwise, it will break my heart every time I see my son, if his head remains that asymmetrical.”

Now, Xu makes sure her son wears the helmet all day, and posts updates on Xiaohongshu to let other parents know how he’s doing. Her only regret, she says, is that she didn’t buy the helmet sooner.

“I regret it so much that I made up my mind so late,” she says. “I should have put him in a helmet when he was just 3 months old. It’s much easier to make the correction then.”

Alternative remedies

More worryingly, Chinese parents are increasingly treating social media as an alternative source of medical advice. In some cases, this is causing them to seriously damage their children’s health.

Mouth-breathing is a case in point. If a child fails to receive treatment for a severe case of enlarged adenoids, it can cause real harm: sleep disorders, intermittent hypoxia, poor neurological development, hearing loss, and even brain damage.

“When a child’s nasal airway is severely obstructed or their hearing is affected, surgery is a must,” Qian, the ENT specialist, says. “But if the symptoms do not impose any restrictions on the child’s everyday life, medication is enough.”

But some parents are becoming reluctant to allow their children to have surgery, preferring to try alternative treatments they’ve seen on social media. Mouth tape, lip muscle exercises, and herbal remedies are all widely shared as cures for enlarged adenoids on Xiaohongshu.

Yang Yan, another mother from Zhejiang province, first noticed that her daughter was breathing through her mouth when the child was 3 years old. When she took the girl to the hospital, the ENT specialists told her that her daughter needed surgery as soon as possible.

“They told us her enlarged adenoids had blocked over 90% of her nasal passage,” Yang recalls. “But my family were too conservative to agree with the surgery, and we were worrying too much about the health risks from the application of general anesthesia.”

Instead, the family decided to give Yang’s daughter massage and herbal therapies, which they’d heard could alleviate her condition. They continued with this approach for three years, even though the girl continued to breathe only through her mouth at night.

“We learned about those (the alternative treatments) from social media,” Yang says. “Of course, Xiaohongshu is where lots of discussions about that can be found.”

In late 2021, during a routine check-up, the doctors informed Yang that her daughter had partially lost her hearing due to the damage done by her enlarged adenoids. The girl has also developed a typical adenoid face, Yang says.

Yang decided to allow her daughter to have surgery right away. But the mother remains racked by guilt, as she believes the family’s hesitation “cost our daughter her health.”

“She also has a problem with concentrating — I think that’s also the consequence of the untimely treatment,” says Yang. “But there’s nothing we can do to make up for it now.”

Editor: Dominic Morgan.

(Header image: Visual elements from Sylverarts, Theerakit, and nPine/VCG, edited by Ding Yining/Sixth Tone)