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Sunday, June 6, 2010

When do you give the boot to thumb-sucking & paci-addictions?

By Guest Blogger, Dr. Grant Coleman, DMD, MS

My 3-year old son loves his pacifier. It's pretty much a requirement for him to have a successful nap or bedtime, and given that my wife and I like sleep, we gladly give it to him. The paci has also given him what we in orthodontics call an "anterior open bite," which in means that even when he's biting down on his back teeth, his top and bottom front teeth don't overlap at all. In fact there's now a hole in the front that you could probably fit a McNugget in without him even opening his mouth if you tried....

Some of the most common questions that we get in our orthodontic practice from parents of younger children relate to oral habits. Parents are often scared that their child is doomed to a decade in braces because of a thumb-sucking habit, but a little bit of information may put those fears to rest.

First of all, sucking habits in young children are completely normal. It's a comfort thing, and if it helps your kids sleep better or calm down, then you usually let it continue. When a child has a persistent habit with a thumb or pacifier, you'll likely see some effects on their teeth from the habit. Orthodontics is nothing more than the process of putting pressure on the teeth to move them-it doesn't matter where that pressure comes from. So, a persistent habit tends to push the upper teeth up and the lower teeth down, which leaves a hole or "open bite" in the front where the thumb or pacifier fits.

So when should you try to get your child to stop the sucking habit? Ideally before the first adult teeth erupt, which is typically around age 5 or 6. The side effects of sucking habits that are seen in the baby teeth are typically temporary, but once the adult teeth begin to erupt the orthodontic effects of habits can create more involved problems. Difficulty eating or biting through certain foods and speech problems are a couple of things you might encounter if the habit continues.

Getting your child to stop this kind of habit isn't necessarily hard to do, and I usually recommend starting with the most conservative/least expensive method possible:
1) Begin with a simple, positive reward system at home. Create a "reward jar" that gets $1 put in it for each day your child doesn't suck his thumb or pacifier; each time he falters and does the habit, you take out 50 cents. At the end of the week, he gets a fun trip to Target where he gets to spend the money he earned in the jar from stopping his habit. This is usually really effective but takes some time to work. It's also relatively cheap!
2) Use a removable orthodontic thumbguard. You can get this from your dentist or orthodontist, and it is really designed for finger/thumb habits. It is a plastic sleeve that fits over the thumb or finger, held by a wrist strap that the parent snaps on. This can be quite effective because the child can't take it off by himself-the parent has to actually cut the disposable strap to get it off.
3) Have your orthodontist make a custom "thumb guard" or "thumb crib." This is a lab-fabricated, metal appliance that is cemented to the upper teeth, and it has a metal mesh just behind the front teeth. It doesn't hurt, and basically all it does is block the finger/thumb/pacifier from fitting in the mouth like it normally does, taking away the pleasure from the habit. Although more expensive, these appliances almost always work because they are cemented in the mouth and aren't removable.

Above all, the most important thing is to keep the experience of stopping the habit a positive one! It doesn't help to call your child a baby or to embarrass him for what he's doing. You have to create in your child the desire to stop, and positive reinforcement is the best way to do that. Even trips to the dentist or orthodontist can be framed in a positive light to help your child see how he's growing up.

So, here are the take-home points: if you have a younger child (below age 6) with an oral sucking habit, don't worry! It's normal and can provide a lot of comfort, and the dental side effects are typically temporary in the baby teeth. Once the adult teeth start to come in, try the above methods to help your child stop. Stay positive and make it a rewarding experience, not a punishment. And if you're not having any luck with your at-home methods, talk with an orthodontist about taking the next steps to help your child quit. You and your child will be glad you did.

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Anonymous said...

Are you kidding me? Age 5 or 6? I think that is completely ridiculous. When I walk by and see a pacifier in a toddlers mouth or a child that is almost at school age I cringe. I feel that the habit has a hold on the parent and that's why the child is continuing with the problem. I understand about the comfort levels because I have nursed both of my children. You stop nursing once you have discovered that your child is just using it out of habit. Be the parent, let your children grow up and get out of those habits before it really turns into a problem. I had my soon off is passie before he was even a year old. Stopped it in one night and I didn't have to hear the crying for it and he didn't even remember it!!! Good luck to all you parents dealing with the struggles on this subject

Jill said...

Anonymous - I agree that kids should not be walking around with a pacifier at age 5, but harsh judgement is not necessary or helpful.

My first child used a pacifier, and we let her have it only while in the crib or carseat once she was 9 months old. We took it for good before she turned 3, and all was fine - her speech was excellent, and her teeth were fine. We were fortunate in that it was an easy transition - not everyone shares that experience.

Our second child, however, sucks her fingers - not so easy to take away. Oh, how we tried to get her to take a pacifier instead! Our rule is no sucking at pre-school or church, which her school teachers have helped "enforce" (church, not so much). Now that she's five, the rule is no sucking while out of bed, at all. She's old enough to understand the rules, and is dealing ok, although I do have to remind her sometimes. The dentist told us not to worry about it, but she will need an appliance when her 6-year molars come in to correct her cross-bite. I know we can get her a finger guard to prevent her from sucking while she falls asleep. But at this point, she's already going to need the appliance regardless of whether or not she stops sucking now, and that appliance will prevent her from sucking.

maythi said...

Neither of my children were ever interested in pacifiers or their fingers. Although when they were infants, I used to wish so badly they would do one or the other to calm their cries. I would see other parents out and about with quiet babies because they had pacis or thumbs in mouth. Guess I should be really thankful.

Anonymous said...

Thank you so much for your insight on this topic. I have two thumb suckers a home. My girls are 3 1/2 and 17 months. My husband and I have been talking about when its best to start dealing with thumb issue and I'm going to take your advice and let the subject be for a while longer. Thumb sucking is my daughters way to comforting herself when she is tired, cranky, or feeling sad. I would hate to force her to stop before she is emotionally ready to deal with these feelings on her own.

danny said...

Hi there,

I had the same experience with my son. All he loves to do is suck his thumb. I've tried all these different thing but he just switches to this other thumb.

I then just thought I would give up; I figured he isn't hurting anyone and that was his security blanked. Then I asked his doctor about it and he told me all the bad things that can happen as far as his teeth are concerned & its stops your chin development!

He told me to look at adults with no chin form and that most likely means they sucked the them...

So I searched the internet and found these pair of gloves...he loved wearing them & after a couple of months he has stopped sucking his thumb!

The funny part is we just bought him another pair because he loves wearing them...he calls himself Sonic the

Here is the site in case anyone else is looking

Anonymous said...

My son was actually potty-trained and 3 1/2 before he gave up the pacifier (or the "pa" as he called it). I too went cold turkey. He really, really wanted a marble track. So, I told him that was a big present for the Easter Bunny to bring, but if he gave his pa to the Easter Bunny, then the Easter Bunny could do magic and turn them into a marble slide. I know, pathetic, but it WORKED! We gathered all his pas and put them in his Easter basket, then I laid down with him to snuggle him to sleep that night. It took about half an hour for sleep, then the next day, marble slide fun, and no pa!

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