Wednesday, April 18, 2012

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):
     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.


Bjorn Button said...

Thank you for the helpful links and information. My kids have shown no signs of thumb sucking, (neither ever took to a pacifier), but I do worry about it coming out later down the road. My dentist said they will likely not develop it but it can exhibit itself later because of various triggers. How worried should I be? Thanks.

Rob said...

Hello Dr. Brandon,

My name is Robert Williams, I’m a web designer who graduated from the Art Institute in San Diego. I came across your Alabama Pediatric Dentists website a couple posts down and was very impressed with the design of your site. I think it’s 90x better then most pediatric websites I’ve seen!

I’d love to pick your brain for 5-10 minutes about your experience working with what I assume was a design agency. I’m developing a web design service specializing in helping pediatric dentistry, so I’m excited about the possibility of asking an expert in the industry a few questions.

Would it be possible for me to send you a few specific question in the future?


mamaski said...

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mamaski said...

Try Thumbuddy To Love to help break the habit of thumb sucking. Kids love it and it is a positive product for kids and parents. Here is the Thumbuddy To Love.

de philadelphiantist said...

Some great blogs here! Dentistry blogs are very important for any dental business. You can really learn a lot from them. Thanks

Miami Dentist said...

I knew someone once in their 20's who still sucks his thumb. It can be a terrible habit, and his teeth show it... The overbite is terrible.

Anonymous said...

Thank you so much!!! I have an 8 yr old that wont stop.. we tried so many things but nothing seems to work he now has shark teeth and he is not happy. thanks for the advice on this blog I think you will finally make it happen. he is 8 and we read the blog together he said he's finely ready to quit. Thanks

Anonymous said...

Dr. Brandon: thanks so much for the helpful info. Came to your blog initially as my 3 1/2 year old's front tooth had begun to turn a little grey after a fall a couple of weeks ago. Thought you wrote your blogs so helpfully, I visited its main page...low and behold, I see your article on thumb-sucking. And our little squirt sucks her thumb...once again full of kind, considerate and thoughtful information. Kind regards, and thanks,
Antony, Christina and our daughter, Fiona.

Marielaina Perrone DDS said...

Very nice write up

Mandy said...

Thanks for the great post, my child has had problems with the thumb sucking for a while. I found that putting yucky tasting things on the thumb is efective, but only for a while, as my toddler would start to become very upset that his thumb had a bizarre flavor and would try to wipe it off. It is strange that both my sister and I had over bites but our mother says we never thumb sucked, not once.

cavities in baby teeth said...

Thumb sucking is a really bad habit for children. Although this is natural, it might cause dental problems.

Jon said...

Wow, I am happy that I stumbled upon this blog! :)

Looking forward the the AAPD meeting in Sandiego next week!

Thanks for all the interesting posts!

Liverpool Dentist said...

Good and relevant write-up. We too get questions about thumb sucking every now and then.

courtney said...

As an orthodontist, I see the dental effects of this habit almost daily. It's a hard habit to break, but well worth the effort

Dental Implant London said...

I have three boys. The eldest is just about 7 now and he NEVER sucked his fingers or thumb and now I have 3 month old twin boys and both try sucking there thumbs. It just started too. They both have sucks but do use them a whole lot only going to sleep.
Dental Implant London

Tandlæge i Hørsholm said...

Dr. Brandon, your blogs are so much helpful and informative. My 4 year old niece was having thumb sucking problem, and her upper teeth's started moving. But now after the treatment from one of dentist in hørsholm, she has left this habit. Putting yucky tasting things on the thumb really worked.

Anonymous said...

Thanks for the post. I have a friend that sucked his thumb and his parents encouraged it as a calming technique. Now he is facing major orthodontic work and possible dental implants. Although the thumb sucking may not be the only source of the problem, it definitely contributed.

Orthodontist KC said...

I love this post- so much so that I book marked it for future reference. I have a sixteen month old daughter who, thankfully, has never been much of a thumb sucker. She is, however, somewhat relient on her pacifier (something we're hoping to break by age two). I'm curious to see if she'll end up resorting to thumb sucking or not. Never the less, I'm glad to have come across this post since I'll probably be needing it again in the near future. :) Thanks!

Children's Teeth said...

my daughter sucks here thumb. This makes me think I need to not let her anymore