Thumb- or finger-sucking is a very common habit of infants and toddlers, occurring in about 20% of children ages 2 to 6. The behavior is an outgrowth of a child’s natural sucking reflex, which is necessary to ensure that babies can get the nutritional requirements they need in order to thrive. The habit is self-reinforcing as it provides youngsters with a sense of security and comfort.
Most kids will naturally give up the habit on their own before they start kindergarten. The remaining ones usually stop within the next year or two. Conventional advice given by dentists has said that there is little damage done to the teeth or supporting jaws if the habit is stopped before the permanent teeth start to erupt, which is around ages 6 or 7. However, more recent research seems to show that significant damage can be done even if the habit stops before this time. Therefore the problem should be addressed as soon as it is noticed by parents.
The impact of thumb-sucking
The most damaging result of thumb-sucking is a poor bite and a deformed smile referred to as Anterior (the front of the mouth) Open Bite. Teeth will move and bone will reshape under pressure. This is essentially how braces work. With sucking, however, these changes are not favourable. The upper front teeth are pushed out, the lower front teeth are pushed down, and the upper jaw collapses or constricts inwards. Ultimately these changes lead to crowded teeth and a large space between the upper and lower front teeth. Once an Anterior Open Bite is established, the child will often find a new way to position his or her tongue for swallowing and speaking. This new positioning is called a Tongue Thrust. A person swallows from 1,200 to 2,000 times every 24 hours with about four pounds (1.8 kg) of pressure exerted each time. That is a lot of force that will now keep the open bite from closing. This is why digit-sucking interventions should also address tongue thrusting. Even if bite correction is perfectly achieved by orthodontic treatment (braces), the result is likely to relapse if the tonguethrusting habit is not addressed first.
Causes and strategies
It is important to recognize that thumb-sucking habits are often the result of insecurity and possibly unmet emotional needs. Even boredom can be a cause. Keeping young ones busy and addressing their emotional concerns is a very effective early strategy. Following this, I always advise parents to discuss the situation with their child and encourage their little ones to want to quit. A reward system based on positive feedback is far more effective in changing kids’ behavior than is anything negative such as scolding or punishment. One good method is a token (stickers or stars on a calendar) that is given every thumb-sucking-free day. After the child earns a certain predetermined number of tokens, he or she gets a parent-approved prize of his or her choice. If a behavioral method such as this is not successful, parents can explore glove-wearing or the placing of unpleasant-tasting liquids on fingers. However, this latter method should be used as a reminder for the child not to suck, NOT as something that the child will perceive as a punishment. Punishments will only make a child less secure and therefore increase his or her desire to engage in the habit.
Advanced treatment
Once the mouth has changed shape and an Anterior Open Bite and Tongue Thrust have been established, more advanced techniques may be required, even if the sucking habit has stopped. In these cases, I advise a child be evaluated by a dentist which will help to confirm the problem and determine its underlying causes. Your dentist can train a patient on how to swallow normally, or can provide or recommend advanced strategies such as oral physiotherapy. There are also many fixed and removable dental appliances your dentist can offer to help reprogram the abnormal or ‘infantile’ swallowing habit which can produce some amazing results and sometimes even eliminate the need for braces.
Steven Deskin is a Dentist in general practice.
