Thumb Sucking

Although I have addressed the issue many times in other posts, I just realized I don't have a specific post on Thumb Sucking.  I hear all the time, "how do I get my child to stop sucking their thumb?"  Well, here is a rundown of some general advice that I give in the office. Basically, lots of kids suck either pacifiers, thumbs, or one or more fingers (digit sucking).  I will concentrate this post to thumb sucking as most information on pacifiers is here:  Pacifiers

What is going on:

1.  Pacifier and thumb habits in preschoolers are very common.  Kids find comfort in the habit.
2.  Sometimes these habits affect the teeth and jaws, sometimes they do not.
3.  There is often an associated habit that goes along with the primary habit.  For instance, a thumb sucker may hold a favorite blanket or twirl their hair.
4.  The habit tends to get worse when they are upset, tired, zoned out in front of the TV, or otherwise not occupied with other activities.
5.  The kinds of problems that involve teeth tend to fall into three categories:
     a.  Overbite, or protrusion of the upper front teeth, sometimes with the lower front teeth going backwards.
     b.  Open bite, or an opening of the front teeth to accommodate the thumb or pacifier.
     c.  A Posterior Crossbite or constriction of the upper arch resulting in the teeth shifting to one side or moving totally inside the lower arch.
6.  Anything in the front teeth, like overbites will tend to correct on their own once the habit is stopped--so long as it is in the primary dentition (no permanent teeth involved).  Posterior Crossbites do not tend to correct themselves and often need orthodontic correction.

What to do about it:

1.  Ok, first, there is no magic cure or magic technique that always works to get kids to stop sucking pacifiers or thumbs.
2.  Almost all kids eventually stop the habit, sometimes sooner, sometimes much later, but you don't see too many 25 year old executives sucking their thumbs--at least in public.
3.  Most kids who suck a pacifier stop by the age of 3 and a half.
4.  Most kids who suck fingers or a thumb stop a little later, about 4 and a half years of age.
5.  Because thumb and digit habits tend to persist and seem to cause more adverse dental movements, I prefer a pacifier habit to a thumb.  Of course, the child usually decides what they like the best, not us.
6.  If a habit persists beyond a time where the parent feels uncomfortable or it's getting close to the time for permanent teeth to come in (around 5 years old), then you can try the following things:

     a.  Gentile reminders are usually the first step--not scolding- (that can make things worse).  Get them occupied with other activities or interests.
     b.  If you are seeing a general decrease in the amount of sucking, then you are on the right track.  Although, do not be surprised if things relapse a little if you move to a new house, have a new baby brother come along, or otherwise have a disruption in their normal routine.  Night time sucking is the last to go, and the most difficult to stop.
     c.  You can try that yucky stuff you paint on the thumb to inhibit sucking.  This tends to work better on older children.  Even then it only works about 10% of the time, but it's sometimes worth a try.  Here is a website for the stuff (which is yuckier than when we were kids): http://www.stopbitingnails.com
     d.  What if that does not work?  There are all kinds of things out there to prevent sucking, like things that you put over the thumb to inhibit the habit.  These things tend to work best if the child really wants to stop, but just needs a reminder from time to time.  One of the most interesting ideas I remember is to get a long sleeve tee shirt and sew the sleeve opening up.  The child wears this as a nightshirt.  These kinds of things can initiate a lot of angst on the child's part and are usually very frustrating unless the child really wants to stop.
     e.  There are good behavioral techniques I have seen speech pathologists use to get kids to stop.  Sometimes it seems like magic.  So, a dentist may refer you to one of these folks to give it a try.
     f.  Ok, if all that does not work, we dentists can make a thumb guard which is a dental appliance you attach in the mouth with orthodontic bands.  This child wears it all the time.  It usually has wire loops up behind the front teeth that inhibit the placement of the thumb the way the child likes.  It actually works most of the time.  The key is it is usually not used on preschoolers.  This is for kids who are into the permanent dentition, usually about 8 years old or older and is often followed by orthodontic treatment (braces).  Crossbites can be corrected with a simple orthodontic appliance.