Thumb Sucking and Pacifiers

Parents of our littlest patients frequently ask us about oral habits such as thumb sucking and pacifiers.  These perfectly normal behaviors in an infant can become damaging to an older child’s facial growth and development.  There are many different opinions and treatment options, and this blog will give you a general overview as to the most widely accepted philosophies and treatments for prolonged habits.

Non-Nutritive Sucking Behaviors

Both thumb sucking and pacifier use are classified as “Non-Nutritive Sucking Behaviors” or NNSB.  All infants exhibit sucking behaviors because it is necessary for their nutrition, through either breastfeeding or a bottle.  Non-nutritive sucking behavior is performed with the same sucking motion, but no nutrition is received.  Its purpose is solely comforting or soothing.

What is “normal”?

Any non-nutritive sucking behavior in infancy is considered normal.  There are ultrasounds showing babies sucking thumbs or fingers in the womb.  Over 90% of children exhibit NNSB at some point during the first 2 years of life.  Researchers differ on what age at which NNSB is considered “prolonged”.  Most agree that by age 4 years, any NNSB should have naturally stopped.  On average, most children will discontinue thumb-sucking or pacifier use on their own at some point from ages 2 to 4 years.  Prolonged thumb-sucking or pacifier use is anything past 4 years of age.

Why is prolonged thumb sucking or pacifier use bad?

Short explanation: It causes improper development of the jaws and positioning of the teeth that can only be corrected with orthodontics.

Long explanation: During growth, the jaws are very susceptible to outside influences.  The suction forces can distort the shape of the upper jaw and the position of the teeth causing an incorrect bite (malocclusion).  The pressure of a thumb or pacifier on the roof of the mouth can increase the height or vault and narrow the dental arch, which reverses the proper bite relationship between the upper and lower teeth (a posterior crossbite).  The constant presence of a thumb or pacifier in between the upper and lower teeth pushes them into a position that accommodates the habit and leaves an opening (called an anterior open bite) rather than allowing the upper and lower front teeth to contact in the appropriate way.  This open bite can lead to tongue thrusting and lisping, as well as not being able to bite into foods with the front teeth.

What should a parent do about prolonged NNSB?

The first step to take in aiding your child to discontinue sucking thumbs or using pacifiers is talking to him or her about the negative effects of the habit.  Your child thinks the habit is a good thing because it makes him feel good, and he may not be able to understand the cause and effect relationship between the habit and the consequences to their teeth, jaws and face.  Children who verbalize that they are ready to stop the habit will have the quickest success.

• Gently discourage the habit and use positive reinforcement when he or she is successful.
• Start small with goals that are easier for him to meet, such as watching a movie without sucking his thumb.
• Do not punish the child for continuing the habit. Negative reinforcement is not recommended as a technique because the habit is something that comforts or soothes him.  Shaming or scaring him will only cause him to feel a greater need to suck his thumb or use his pacifier.
• Because stress or anxiety can increase the child’s need to self-soothe by thumb sucking or pacifier use, try to identify situations that make him feel anxious and address them as needed.
• If possible, gently and quietly remove the thumb or pacifier from his mouth after he has fallen asleep.

Pacifiers have one benefit over thumbs: they can be taken away or made dysfunctional (cutting the tip off a pacifier renders it useless).  If the child claims he is ready to stop, simply remove any pacifiers from his possession and go “cold turkey”.

Thumb sucking is a bit more difficult because the thumb is always available.  Because of this, thumb sucking typically persists longer than pacifier use.  Some try applying bitter-tasting nail polish or wrapping the thumb in a Band-Aid or covering the entire hand with a sock.

Ask your dentist and pediatrician for their input on the habit.  There are many different techniques used to help in stopping the habit before it causes long-term damage.

As a last resort, a dentist, pediatric dentist or orthodontist can fabricate a dental appliance that prevents the habit by removing the ability to create a suction and impeding the insertion of the thumb or pacifier.  The appliance does not contain sharp spikes or anything that would harm the child’s tongue or fingers; it simply prevents them from being able to enjoy the sensation of the habit.

Need more information?

Call to schedule a consultation with Dr. Jill or Dr. Cara to discuss your child’s habits.  972-347-1145