Got a toddler or preschooler who won’t stop thumb sucking? Find out how to help children stop the Thumb Sucking Habit. Dental Health is super important in a child’s overall health, so we felt it was important to get advice from a professional so we found Dr. Virdee who is an orthodontist at Hometown Orthodontics(this will be linked to your page)  in Mississauga, ON. 

Why Babies and Toddlers Develop a Thumb Sucking Habit:

Babies start sucking their thumbs in the womb to comfort themselves, which can often be seen as early as sonogram photos. By the time babies are infants they have become experts at thumb sucking as a way to calm themselves to sleep or to self-soothe when upset. While this isn’t a problem as an infant, as the child ages and becomes a toddler it can have negative impacts on their teeth. Once a child turns 2 and begins to develop language skills is the perfect time to work with your child to stop thumb sucking behaviours.

Thumb Sucking: When does it become a Problem?

As a first time mom, Dr.Virdee was always concerned for my infant daughter who constantly had her fingers in her mouth.    I worried that this would develop into a habit that may possibly have an effect on her teeth later on. As a way to circumvent this, I decided that I  would give her a pacifier rather than letting her suck her thumb. I thought, at least with a pacifier if she developed an attachment to it, I could take it away – her fingers….not so much.  After about 6 months, my daughter stopped using her pacifier on her own. As an orthodontist, I felt relieved that I wouldn’t have to struggle with breaking a thumb or pacifier habit that I have helped so many of my patients with.

So what if your child refused to give up their thumb or pacifier?  How can you help them? As a clinician, my recommendation is always to try behavioural modification first.  Orthodontic treatment with a thumb habit appliance is always left as the last resort. Remember, a habit is harder to change the longer it has been present. 

ariabottle

The earlier you try to help your child break a habit the easier it is.  Doctors recommend getting rid of bottles at 12 months, however easier said than done when your child refuses to drink milk out of a sippy cup.That’s not to say that it is easy to train a toddler out of a thumb habit – it’s not!   At 18 months old, my daughter refuses to give up her bottle, which is the only way that she will drink her milk. Any mention of a sippy cup sends her into hysterics! 

Effects of Thumb Sucking

Most parents bring their kids to see a dentist or orthodontist at around 5-8 years of age. At this age, two things are happening – children are starting to lose their first set of baby teeth and the adult teeth are growing in.

They also have some sort of concept that thumb sucking is socially unacceptable.  In fact, if you ask them when they suck their thumb or finger, it is usually at home and not at school in front of their friends.   The concern for most dental professionals is that a prolonged digit habit (pacifiers, thumb sucking, etc) will have serious effects on the teeth and development of the jaws. This is why habit breaking appliances are suggested when the permanent teeth first start to erupt.   


Five Tips to Stop Thumb Sucking in Children:

I always say that a patient is more likely to break their digit habit if they are motivated to change their behaviour.    The following is a list of methods to help “break the habit” for kids over 5 years old.

Calendar or Positive Reinforcement

 Reward System:

This type of behaviour modification is one of the easiest to use at home and requires positive reinforcement and encouragement.  Remember it takes about 21 days to break a habit. One of my favourite methods is using a calendar, although other reward systems could be used.  Put a calendar in a visible area – ie. stick it on the fridge or in your child’s room. Before getting started, discuss with your child what the goal of the game is and come up with a reward that both of you agree on.  Remember you and your child have to be part of this discussion as the more the child wants the reward the more they will buy into the reward system. Display the reward where they can see it as a reminder of what they can get for achieving their goal. For each day that your child goes without putting their thumb in their mouth, a sticker is placed on the calendar.  Once they go 21 consecutive days without using their thumb, they get their reward – don’t forget to make a big deal about it too! Having the courage and discipline to break a thumb habit is hard work – especially because it is innate in human beings. If they regress after a couple days, start over. You can decide to break it up and give small rewards after a week – some kids just need an extra push and need reinforcement sooner than waiting the whole 21 days.

Reminders

The reward system can be used in combination with physical reminders.  These examples include a bandaid on the thumb during the day or a glove or sock at night that covers the hand.  These methods are used for kids who don’t necessarily use their thumb to sooth during the night. Using these methods may not be all that successful for chronic thumb suckers.  It may be easy to use another finger or the thumb on the opposite hand, or they may remove the glove or sock. Even if you pin it to your child’s sleeve, chances are, if they are motivated enough, they will find a way to remove it to soothe themselves with their thumb.

Thumb Guards 

Nipit Hand Stopper
Source: Amazon.com (Nipit Hand Stopper)

The reward system proves difficult for kids who use their thumb or finger for soothing when they are upset or need their thumb to get to sleep.  In this case, there are plenty of thumb guard appliances that can be bought online or at the store that may prove to be successful. A few of the more popular brands include the Thumb Guard, TGuard, Thumbsie, and Nipit Hand Stopper.  All of these have varying degrees of success. The Thumb Guard, TGuard and Thumbsie physically cover the thumb and are difficult to remove. However, they do not prevent the oral fixation related to thumb sucking. This means that a patient with a significant thumb habit may start use another finger or the opposite hand.  The Nipit Hand Stopper has anecdotal evidence at being one of the best over the counter methods to help stop the habit as it prevents flexion at the elbow and prevents a child from easily or comfortably inserting their thumb or finger into their mouth.

Covarying Response

This is a big word but highlights a pretty basic concept.   A study published in the Journal of Psychiatry showed that thumb sucking in childhood is usually accompanied by other behaviours, such as holding or manipulating an object like a doll or a stuffie.  My niece is a great example of this. She frequently soothes herself with her thumb when she has her stuffed duck in her hand. She has been doing this since she was a toddler and will ask for “ducky” when she is upset or wants to go to sleep before she uses her thumb.  Researchers showed that chronic thumb sucking can be controlled if the covariant (the doll or stuffie) is removed or eliminated from the child’s environment. Obviously, loosing a favoured stuffie can be quite difficult for some children so this must be done with care – using positive reinforcement and a rewards calendar may do the trick!  

Thumb crib


 Orthodontic Appliances

By the time I see young patients for treatment of a thumb habit, their parents have already tried most of the “home remedies’ ‘ discussed above.  Thumb sucking can persist for many reasons, from a psychological disorder or just for the simple reason that it provides comfort or pleasure for the patient.   

The concern for most orthodontists is that if it remains for a long time, it becomes a damaging habit, especially if it remains once the permanent teeth start to erupt.  Thumb sucking can cause narrowing of the upper jaw and teeth, spacing and protrusion of the upper front teeth, retrusion or a backward inclination of the lower front teeth, and an open bite where the upper and lower front teeth do not meet.  Overlap of the upper and lower front teeth aid in biting food and creates a seal when swallowing. If an open bite is present, biting with your front teeth becomes difficult and the tongue will come forward between the teeth to create a seal for swallowing.  This abnormal movement of the tongue then becomes a secondary habit and maintains the open bite even after thumb sucking is stopped.  

A thumb crib is one of the favoured appliances that are used for a thumb habit.  It is fabricated specifically for your child and is attached to the six year molars with orthodontic bands or rings.  The working part of the appliance joins the bands in the front and prevents the thumb from touching the roof of the mouth immediately behind the upper front teeth.  Orthodontists usually leave this appliance in place for approximately 6 months to minimize the risk of relapse of the habit. One important aspect of treatment is that the patient must have the desire to give up the habit prior to any type of treatment, otherwise, the habit is likely to return.  If the case is mild, the position of the teeth and the bite will improve with just a habit breaker. In more severe cases, appliances other than a habit breaker may be needed to correct the deformity of the jaws and teeth created by the habit.

Parenting is hard!  There are so many things we worry about when raising young children.  I would say that if you can’t help your child with a thumb habit with behaviour modification at home, don’t worry, it’s not the end of the world.   Many children will “grow out” of the habit on their own. However, it is recommended to see an orthodontist once they turn 6 years old or when they start to lose their first set of baby teeth so that the side effects of the thumb habit aren’t carried forward on to their permanent dentition.  

 

 

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