So Long Sucker

For some parents the word thumb-sucking will evoke happy memories of their little ones blissfully sleeping through the night. For others it will bring back less happy memories of struggles to break the habit.

Thumb or finger-sucking is a natural reflex for a baby that may begin whilst in the womb. It is a simple comforting behaviour: however, when it becomes a long term habit, thumb-sucking may cause problems such as the undesirable movement of the teeth and a poor bite.

When Should the Habit Stop?
As a general rule, pre-school age is a good time for your child to stop. The aim is to give up the sucking habit before the permanent teeth come through. Any effects thumb-sucking might have on the baby "mild" teeth are unlikely to be long term.

What Problems can it cause?
The most common problem caused by thumb-sucking is a poor bite in the form of:

• Buck teeth: Prominent upper front teeth
• Open bite: The teeth do not meet together at the front
• Cross bite: The lower side teeth bite outside the upper teeth
• Tipping back or crowding of the lower front teeth

While the appearance of the teeth is affected, changes in the bite may also affect the way your child chews, swallows and talks. Speech changes may include a lisp.

Fortunately, not all sucking habits cause the teeth to move noticeable. Important factors include the strength, frequency and duration of the habit. A thumb or finger that lightly rests in the mouth throughout the night may have more detrimental effect than one which is sucked on vigorously but for short periods of time.

Apart from dental effects, some children may become withdrawn while sucking their thumb, focussing on their own world rather than on what goes on around them. This can be problematic if it interferes with learning and participating in activities at home and at school.

What can be done to help stop it?
As out-of-house activities increase, many children gradually stop the habit on their own accord, especially as they reach school age. A small number of children will persist into their teenage years.

Gentle discouragement and motivation
Always use a positive approach and choose a time when daily life is settled. If you are moving house, have a new sibling arriving, or your child starts a new school, it is recommended that you delay proceeding until your child feels settled because they may use thumb-sucking as a means to relieve stress.

Young children have limited logical reasoning capabilities, so easy concepts will be more successful. For instance, tell your child that "Mr Thumb" is a problem and that together you form a partnership to control "Mr Thumb" who wishes to sneak into the child's mouth. Useful aids to act as reminders include bitter tasting nail applications, a band-aid on the thumb, wearing a mitten, or a sock taped over the hand at night. If your child sucks while asleep, you should attempt to gently remove the hand from the mouth.

Children older than six or seven years are better able to understand the concept of "cause and effect". They also have the capacity for self-control and may choose to end their habit when it is explained to them that their teeth will benefit if the habit is stopped. The best approach may be to go "cold turkey", with a few nights of discomfort. Rules such as no TV, or reading a book to them only when they wear their new woolly mitten may also help.

Positive rewards can be a good approach for many children with successful days, weeks, and months being recorded and rewarded accordingly. As with all habits "lapses" may occur and it may take several attempts to stop.

Ultimately, any attempts to stop thumb or finger-sucking habits should be tactful, constructive, and involve the full co-operation of your child. Encourage them and praise their successes.

Oral Appliances
A number of simple devices can be employed to help break the habit. One, which is commonly used by orthodontists, is a thumb crib appliance. This is generally a last resort for older children and teenagers. It consists of a smooth metal framework, which sits behind the upper front teeth and is cemented to the back molars. These appliances are very successful at breaking sucking habits, and although passive, some improvements in the bite may be seen within a short period of time.

Further correction of problems - such as a poor bite or crowding - are generally left until the thumb-sucking habit has stopped as it will be counterproductive to any comprehensive treatment undertaken by an orthodontist.

Thumb-crib appliance

"Thumb or finger sucking is a natural reflex for a baby that may begin whilst in the womb."
By Dr Rachel Moore BDS, MDS, Orthodontist.

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