Worried About Thumbsucking? You Probably Don't Need To

As a dentist I get a lot of questions about thumb sucking - a very common childhood activity that occurs in about 80% of infants and children. It's been observed in utero starting as early as 15 weeks of gestation and is pretty common in the first three months of life. About 30% of children still suck their thumb at age one. Most give it up spontaneously between the age of 2 and 4, with little if any damage as a result. The habit no longer serves its purpose so they stop. About 12% of children are still sucking their thumb at age 4.

I’ve never encouraged parents to get overly concerned about stopping their small child from thumb-sucking. It's a normal behavior up to age 4 and can even have an adaptive value in that it can provide a sense of security and helps children self-soothe. And anyway, parents aren’t usually successful in getting their child to stop — their peers are. It's when their friends at their preschool or playgroup bring the habit up that children are motivated to stop.

So when should parents start to worry? According to the American Dental Association, children who vigorously suck their thumbs, suck for a long duration, and continue to do so beyond age four, risk causing damage that may require orthodontic treatment to correct. The thumb can exert pressures upon teeth, bone, and soft tissues in the mouth causing problems with positioning of teeth and growth of the jaws. The most obvious consequences of a persistent thumb sucking habit are:

• Pushing the upper front teeth (incisors) out and the lower incisors in causing a "buck tooth" smile.
• Preventing the front teeth from erupting all the way together causing an openbite.
• Stopping the lower jaw from developing normally, resulting in a recessive or “weak” chin.
• Narrowing of the soft tissue in the palate of the mouth, resulting in a crossbite.

However, before getting too worried, parents should keep in mind that the likelihood of changes in dentition depends on genetics as well as the duration and intensity of sucking. Tooth movement generally requires 4-6 hours of force per day. So thumb sucking for a few minutes before falling asleep - even for a child who is 4 or 5 - is not normally going to be a problem.  If the thumb sucking stops while your child is still growing, most of the dental problems that may have occurred can self-correct, but sometimes the help of a dentist or an orthodontist is required to correct the position of the teeth and align the jaws.

The American Dental Association recommends that parents start encouraging their children to stop sucking their thumb after age 4 — but even then, they advocate a gentle, positive approach. Here are five tips we offers parents to proactively encourage their child to stop a damaging thumb sucking habit.

1. Explain to your child the damage their habit is causing to their mouth and teeth. Kids today are smarter than you think. Pictures of buck teeth and openbites go a long way helping drive home the point.
2. Develop a program with your child’s input to stop the habit. Let them be proactive in determining the best way to correct their own problem. They are more likely to cooperate if they have a choice in the process. Suggest aids like wearing a sock on their hand when they go to bed, or a band aid on their thumb while watching TV to remind them at times when they may unconsciously put their finger in their mouth. With some children, there is a blanket or stuffed animal that goes hand in hand with thumb sucking. It's difficult to stop one, without removing the other. I know it sounds like a double whammy… but it's often what's needed to be successful.  Try letting them pick out a new blanket or plush toy - one they don't associate with sucking their thumb, to help them through the transition.  
3. Set up a calendar to track progress with small rewards at the end of every day, week and/or month acting as an incentive. With older children, offer a larger incentive after the habit has stopped for at least 4-6 weeks. Anyone (including myself) who has tried to stop a persistent habit knows it can be emotionally stressful and very hard work.  Expect some tears and even tantrums as your child figures it out.  A new Lego or special day at the park is definitely in order once they succeed.  
4. If you notice your child relapsing, work on alleviating what's causing the stress and anxiety which underlies the thumb sucking, rather than the habit itself.  You already know they can stop sucking their thumb if the environment is right - so work on that.  
5.  Children always respond more favorably to positive praise vs. negative criticism. In addition to reminding them to take their thumb out of their mouth, praise them when they are proactively decreasing or eliminating the habit.  Catching them in the act of NOT sucking their thumb (and praising them), will have a much greater impact than catching them doing it and then telling them to stop.  

No matter what method you try, be sure to explain it to your child and enlist them as a partner. Don't forget that we - your dental team - are partners in this as well. Our Dental Hygienists and I have talked to thousands of children over the years about thumb sucking and we can kindly and compassionately offer them support and encouragement from a different perspective.

If you have successfully helped your child stop sucking their thumb please share your strategies. Don't hesitate to contact us via our website or give our office a call at 919.755.3450 if there is any way we can help.

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