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November 6, 2012

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Thumbsucking

November 6, 2012

 

Commonly Asked Questions about Thumbsucking

 

Should parents worry about toddler sucking?

 

Toddlers commonly suck on fingers and thumbs.  This sucking is essentially harmless and generally socially acceptable.  Actually, sucking can help the 1 to 3-year old adjust to his rapidly expanding world, in turn easing his parent’s responsibility.  For example, a young child who copes with the challenge of getting himself to sleep by slipping his thumb into his mouth does not need a parent to sit with him to ease the transition from wakefulness.

 

Although toddler sucking tends not to cause direct dental or social harm, it may establish habitual sucking patterns.   Therefore, setting thoughtful limits on how often and where sucking occurs can be worthwhile.

 

Does a preschooler harm his teeth by thumbsucking?

 

Occasional sucking is unlikely to harm teeth or mouth shape.  A child who does not suck strongly, but rather just hangs his fingers or thumb in his mouth, is also unlikely to suffer dental damage.  Many children do habitually suck in this casual manner.  By contrast, vigorous, frequent sucking on thumbs or fingers can profoundly alter the growth of the face, the shape of the mouth, and the angles of teeth.

 

When a child puts his finger or thumb in his mouth, the digit usually presses against the roof of the mouth.  This pressure is intensified by strong sucking.  Together, the suction and the pressure can create an opening between the top and bottom teeth molded to the shape of the fingers and thumbs.  Dentists call this opening either “over jet” or “overbite” depending on a particular way the teeth are moved.

 

Because vigorous sucking puts pressure on the roof of the mouth it can also change the shape of the soft bone structure inside the mouth.  The roof of the mouth may be pushed upward and the sides of the roof narrowed.  Dentists call this condition “crossbite” because it causes the upper side teeth to cross over and sit inside, rather than directly above the lower side teeth.

 

Movement of baby teeth from thumbs can cause problems with permanent teeth, because baby teeth forge the path permanent teeth take into their positions.  If upper front baby teeth have pushed forward and lower front baby teeth pushed backwards, adult teeth are likely to grow similarly.  Continuation of sucking after arrival of permanent teeth makes these conditions worse.

 

Is sucking a sign of emotional disturbance in preschoolers?

 

No.  Sucking becomes a comfortable habit.  The habit may be socially inappropriate by age four or five, but generally is not a sign of emotional disturbance.  Studies clearly indicate that sucking children are not more likely to be disturbed or emotionally needy than non-suckers.

 

Thumbsucking children are certainly not exempt from emotional difficulties and in certain instances, unusual sucking patterns can indicate a child in distress.  A child who sucks his thumb in isolation for long periods each day or who frequently runs to find his blanket and slips his thumb into his mouth may be signaling that he is unhappy.  A child who suddenly intensifies his sucking also may be undergoing difficulties.  If a child sucks pervasively during the day and the sucking seems to be one of several signs of emotional problems, parents might consider consultation with a psychological professional.  Situations requiring such intervention are the exception among sucking preschoolers, most of whom suck basically out of simple habit.

 

Do many school age children still suck thumbs and fingers?

 

A child six or older who sucks at school or with friends looks strange.  Peers will view him with surprise and are likely to comment.  Adults may mention the sucking to the child’s parents.  Consequently, past 1st grade, children rarely continue sucking in public view.

 

What they do in the privacy of their own home, particularly at bedtime, is another matter.  A surprising number of school age children continue sucking habits.  A small but significant percentage continue through their teenage years, particularly at bedtime and throughout the night. 

 

Older children and teenagers know that sucking is considered childish, and consequently usually feel embarrassed about the habit.  They often try to keep it secret.  At this age sucking lowers self-esteem and invites social humiliation.  These costs and self-respect generally outweigh the minor emotional comfort of sucking, but the habit may seem to them to be too difficult to break. 

 

What are the dental consequences of sucking for an older child?

 

Past age six and the arrival of permanent teeth, serious dental consequences from habitual sucking are almost inevitable.  Unattractive teeth and bite positions will no longer improve spontaneously once permanent teeth have erupted.  The only remaining remedy is orthodontic treatment.  Furthermore, children who continue to suck past age six can develop dental malformations that orthodontic treatment cannot reverse.  In these extreme cases surgical techniques can sometimes reform the mouth structure to pre-sucking appearance, but prevention is clearly preferable. 

 

When should parents start helping children to end sucking habits?

 

By the time children reach age five they generally are ready to stop finger and thumb sucking.  Pacifiers can be eliminated before age three.  By age five, sucking creates more problems than it solves.  Sucking becomes an increasing social and psychological liability as a child grows older.  Furthermore, elimination of sucking before age six and eruption of permanent teeth is essential to minimize undesirable effects on facial appearance.

 

The five-year-old child can usually understand cause and effect.  He can comprehend that although sucking may be pleasant, it may also be harmful.  He has the maturity to understand that the consequences of sucking, although gradual, are real.  And he has the capacity for self-control to be able to choose to end the habit.

 

What factors indicate that a sucking habit needs to be stopped?

 

The presence of any of the following factors suggest sucking habits that may be detrimental to a child’s development:

 

·      Age five or older

·      Vigorous sucking

·      Frequent sucking during the day

·      Sucking throughout the night, rather than only at bedtime

·      Any sucking that is causing visible distortion of tooth position, mouth, or lips

·      Sucking in conjunction with tongue thrust and speech difficulties

 

If some or all of the above factors are present a dental examination can be helpful.  A dentist can clarify the extent to which a child’s sucking is likely to be affecting mouth formation.  Teachers also can help parents by assessing if the sucking is interfering with healthy social or verbal development.

 

Two other considerations are vital if the habit looks like a harmful one.  The first, is the energy state of the parents.  Parents are best off launching an anti-sucking campaign during a period when they do not feel overloaded by other obligations or worries.  Second, current stresses in the child’s life should be considered.   A time of coping with a family death or divorce, or ill health, is obviously a less appropriate time.  On the other hand, starting in a new school may be a positive movement for growing out of an old habit.

 

Can parents become overly concerned about their children’s sucking habits?

 

Absolutely.  Thoughtful evaluation of sucking patterns is helpful.  By contrast, anxious, guilty, angry or alarmist responses can further create problems.  An exaggerated sense of urgency can result in overly forceful, nagging, critical or punitive attempts at solution.  Over-involvement in the child’s struggle makes parents become too emotional.  They may then add to the child’s frustration and inhibit progress.  Good-humored patience and persistence work best.

 

Parents can keep sucking problems in perspective if they bear in mind that sucking habits are a relatively minor concern and do not merit panic.  Sucking is merely one of the many dimensions for parents to note as their children grow.

 

Why not let children suck as long as they want, and then straighten their teeth with braces?

 

A pleasing physical appearance helps people feel good about themselves and elicits positive responses from others.  Fortunately, orthodontics can correct most dental-skeletal deformities.  However, the process is costly, time-consuming and somewhat uncomfortable; and until the braces are taken off, the child looks less attractive.  Self esteem is formed during childhood.  If sucking can be ended young enough to prevent problems, why should any child be burdened with a less attractive facial appearance from sucking?

 

Many children who do not suck still require orthodontic treatment to look their best.  Sucking, however, will tend to exacerbate pre-existing malalignments.  Again, prevention is preferable.

 

Finally, damage to mouth structure after the arrival of the first four permanent teeth may not be correctable by traditional orthodontics.  In these cases complex bone surgery may be able to correct the changes wrought by sucking.  However, the malformations may be irreversible.  Lips stretched by protruding teeth for instance may never return to a normal position.  Reducing toddler sucking and eliminating sucking habits altogether by age five can preserve attractive facial features.

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