Pediatric airway management is a complex puzzle. Dentists, orthodontists, myofunctional therapists, and pediatricians are all trying to figure out the right treatment workflow. When a child presents with mouth breathing, a high palatal vault, or enlarged tonsils, knowing who takes clinical priority is essential for patient safety.Legally, medical doctors hold ultimate diagnostic power. Only a physician can diagnose systemic conditions like Obstructive Sleep Apnea and provide surgical clearance. Dentists screen for airway issues and modify skeletal structures, but they cannot diagnose sleep apnea. Myofunctional therapists retrain soft tissue function, placing them subordinate to both medical and dental clearance. Dentists should design treatment around orthodontic needs, and therapists should not utilize mouth taping on a child without an evaluation from an Ear, Nose, and Throat specialist.An objective way to determine the treatment order is by evaluating the patient’s tonsil grade. Grade three and four tonsils occupy more than seventy-five percent of the oral pharynx and represent an acute mechanical airway hazard. Palatal expansion or tongue exercises will not shrink this tissue overnight. In these cases, treatment must halt, and the patient must go directly to an ENT. Placing an appliance in a severely compromised airway risks further obstruction at night. Conversely, grade one and two tonsils with a high palatal vault indicate a structural plumbing problem. Here, the orthodontist can safely initiate Phase One skeletal treatment to widen the nasal floor.Myofunctional therapy serves as the final piece of the puzzle because function follows form. A therapist cannot successfully retrain tongue posture if large tonsils push the tongue forward or if a narrow arch lacks physical space. Therapy takes the primary position after the ENT clears the airway and the orthodontist builds the skeletal framework. To eliminate long medical wait times and streamline care, major dental and medical organizations must collaborate to establish a standardized, interdisciplinary workflow.