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.
