THE THUMB SUCKING DILEMMA
What? Me worry?…
One troubling concern for parents of small children is non-nutritive sucking of thumbs, fingers, pacifiers, or bottles. Will non-nutritive sucking (NNS) lead to orthodontic or facial growth problems? At what age does damage start? Should I encourage my child to stop sucking or wait until the habit is given up naturally? Will forcing a child to give up NNS cause them to develop a substitute habit or psychological disturbance?
Authorities in the field of dental and facial development agree that prolonged NNS can lead to disturbances in tooth position, facial growth and speech development.
The amount of damage is related to the frequency, intensity and duration of the habit, and often needs to be professionally evaluated. The important thing to realize is that the digit or pacifier sucking habit is only part of the picture. The real danger is that the sucking habit changes the dental and oral environment in ways that encourage other, more permanent, problems such as tongue thrust swallowing and abnormal resting position of the tongue. These habits are dangerous because they are more difficult to observe. They are subconscious and therefore, hard to break, and they often continue the problems of facial and dental development even after the NNS habit has been given up.
Studies show that 50%-70% of children have NNS habits in the first year of life. During this period, NNS is considered normal and perhaps even beneficial. By age four, this percentage is reduced to 25%. By this age, any real benefits of NNS are gone, and all that remains is empty habit. The danger of permanent effects on teeth and jaws is becoming very real. In addition, there are other health and social adjustment problems such as peer rejection which can become problematic as a child makes the transition from close ties with parents at home to a school environment.
Methods of discouraging NNS habits vary greatly, ranging from simple behavior modification problems, to reminders and mild impedances like a sock or glove, to dental devices such as “rakes” or “spurs” that definitely make sucking less pleasurable. Scientific studies have shown that encouraging a child to give up an NNS habit rarely causes the development of nervous habits. To the contrary, giving up sucking usually marks a period of improved self-esteem and social adjustment.
Factors common to all cessation methods are; the desire to stop on the part of the child, the maintenance of the child’s self-esteem and the caring support of family and involved professionals. It is important that the child views the habit correction not as punitive but as something that is beneficial and will help him or her accomplish a goal.
Age five is then the upper limit of when non-nutritive sucking should be discontinued. Warning signs to look for are:
DENTAL AND FACIAL WARNING SIGNS
*Upper front teeth spaced or protruding in front of lower front teeth.
*Upper front teeth don’t show enough and seem pushed up under the lip.
*Bite is “open” in front and upper teeth don’t cover the lowers.
*Tongue seems visible or protruding.
*Upper row of teeth appears to narrow for the face.
*Lips are apart at rest.
*Lower jaw often seems to be moving or wiggling.
*Lower jaw and chin are shifted to one side.
BEHAVIORAL WARNING SIGNS
*Age five or older.
*Sucking at school or during the day at home.
*Family arguments regarding the habit.
SPEECH WARNING SIGNS
*Lisping (using the tongue to help pronounce sounds like “S”).
*Substitution of “th” for “s” as in “thither” instead of “sister.”
(Note the above speech signs are normal when upper front baby teeth are missing while being replaced by permanent teeth.)
Dental, speech or other professionals can help in ways other than by placing discouragement devices. It is often possible for an interested bu independent authority to have more impact and success in convincing a child to abandon sucking habits by pointing out the damage that is occurring. When professionals become involved, and the issue is no longer confined to the parent and the child, the sucking habit is less likely to become grounds for a parent/child power struggle.
We recommend examination by an orthodontist at age five if a habit persists, and at age seven if a habit has been given up but any of the above warning signs remain.
An excellent book with more information on this subject is “David Decides” by Susan M. Heitler, Ph.D. It is available at some book stores. We have a copy at our office which we would be pleased to loan.