Obstructive sleep apnea (OSA) can affect up to 5.7% of children, with consequent low school performance due to cognitive deficits, attention disorders, behavioral abnormalities, and sleepiness with cardiovascular and metabolic sequelae [1]. Although adenotonsillectomy (AT) is the first-line therapy in pediatric OSA, other available therapeutic interventions include continuous positive airway pressure (CPAP), rapid maxillary expansion, mandibular advancement devices (MAD), and orofacial myofunctional therapy (OMT), which has shown an increasing role in the last years. OMT utilizes exercise training targeted to oropharyngeal structures, aimed at improving coordination, strength, and endurance of orofacial muscles implied in the patency of the UA [2] with recognized benefits for children with. In this chapter, we will address the current literature regarding pediatric MFT, both active and passive, with a brief insight and hopefully trigger discussion and ideas, both for research and clinical practice.