My daughter,grade 5(2years playing),puffs her cheeks. She uses a Keilwerth SX-90 lacquered tenor w/ a Rouassuea NC3 mthpc(hemke 2 reed). Her private teacher and I(30 years playing)think she will outgrow it. She has won a $500 sholarship. 1st place for playing spanish dance no2. The judge who is a bassoonist cautioned her about the perils of cheek puffing. My sister in law who toke a chinese kodai music course but never played in elementary school or jr sr high for that matter,really makes a big deal of it(she hates foot tapping too). I wonder if the great sax/mouthpiece helps mask the problems caused by puffing. She sounds great despite puffing. Her younger sister who is in 3rd grade and played since kindergarten has a well formed embouchure(she plays quite a bit of soprano-a yani sc-991).