A note to the reader: This article is for information purposes only and is not intended as giving medical or dental advice. Always consult with your own dentist, doctor or pediatrician to guide health care decisions for you and your baby.
Do you have a child who is five or six years old who still sucks his or her thumb or is still using a pacifier? Have you been trying to put an end to either of these habits?
In this article, we discuss why children suck their thumb and how to help older children stop thumb-sucking and pacifier use.
We discuss pros and cons regarding pacifier use and also what consequences there are if your child cannot kick either of these habits at an appropriate age.
Why do children suck their thumb?
Sucking is a natural reflex and babies start thumb-sucking in the womb several months before birth. It's also a behavior found in other primates.
The sucking reflex is very important as it allows newborns to get nourishment. But babies like to suck even when they're not feeding, whether it's on their thumb, at the breast or on a bottle. It's thought that babies suck because they find it comforting, relaxing and/or pleasurable.
Every new parent wants a happy and calm baby, however if you're a new mom and your baby wants to be at your breast constantly this can be exhausting, so a possible solution is to introduce a pacifier.
The Canadian Academy of Pediatricians state that pacifier use is fine but they do recommend waiting until the baby is established at breastfeeding, so that means waiting about three to four weeks after birth. The fear is that if you try too early it may create what is called "nipple confusion". That's when the baby prefers the pacifier to the breast, making breastfeeding more difficult.
According to research, between 60 and 80 percent of babies in North America use a pacifier at some point.
If you are thinking about introducing a pacifier, check the end of this article for a good advice written by the Mayo clinic that has further tips about pacifier do's and don'ts.
Here are a few benefits of using a pacifier with your baby: - A pacifier can help your baby fall asleep
- It can soothe your baby when they're getting vaccinations or blood tests done
- It can help in an airplane to stop your baby's ears from popping during takeoff and landing due to the changes in cabin pressure.
- Using a pacifier may help prevent sudden infant death syndrome especially during the first six months of life
Now here are few of the downsides to using a pacifier. - If your baby loves their pacifier and wakes up at night when it falls out of their mouth you may be getting up initially several times a night to put a pacifier back in their mouth.
- Children who use a pacifier can be more prone to middle ear infections. However if you stop using the pacifier by the time they turn a year old, there is less chance of this becoming a problem.
Most children will stop using a pacifier on their own between ages two and four. But beyond that age, they may need help breaking the habit.
What age do children stop sucking their thumb?
There is no fixed age. However, research indicates that many children stop sucking their thumb between 2 and 4 years of age. But some children will persist in thumb sucking past the age of four, with girls more likely to continue than boys.
At what age does thumb-sucking or pacifier use become a problem?
Hopefully your child will have stopped sucking their thumb or using a pacifier by the time their permanent front teeth start to grow in. That is usually between five and six years of age. After that time, if your child continues their habit, it can create the following issues:
- It can affect the alignment of the teeth
- It can affect your child's bite and the appearance of their smile
- It can interfere with proper jaw growth
- It can cause speech problems
- It can affect your child's overall facial appearance
Note: Some children can suck their thumb or use a pacifier and not have any changes in their bite or in their facial development. It is likely that these children don't suck very hard and/or don't do it for long enough periods of time during the day or night to cause dental issues.
Here are some of the effects that thumb-sucking and pacifier use can have on a developing child:
1. Anterior open bite is a condition where there is a gap between the upper and lower front teeth
2. Tipping of Teeth: The upper front teeth can be tipped forward and the lower front teeth can be tipped backward.
3. Interference With Normal Jaw Growth
4. The alignment of back teeth can be affected. Instead of upper teeth being arranged in a u-shape or horseshoe shape a child who thumb sucks or uses a pacifier can develop a v-shaped upper tooth alignment. This is due to the cheeks exerting excess pressure on the upper teeth while the child sucks in.
This can throw the bite off and create what we call a crossbite in the back of the mouth.
Thumbsucking and pacifier use past the age of five or six can interfere with the normal dental development of your child. However, if the habit is stopped before or just as the permanent teeth start to grow in, sometimes these problems can self-correct.
How do you stop a child from thumb sucking or using their pacifier?
Note: A child has a better chance of quitting thumb sucking and pacifier use if he or she actually wants to stop the habit.
1. Sometimes peer pressure will provide enough reason for a child to stop thumb-sucking or using a pacifier by age 4 or 5.
2. A talk with your child and showing pictures of what their bite can look like if they don't stop thumb-sucking may help. You can search online for some more dramatic pictures than I have shown here.
3. If there is stress in the home or at school, you could consult with your family doctor or pediatrician to see if counselling could help your child develop other coping methods to deal with stress rather than thumb-sucking or using a pacifier.
4. Praise your child when they're not sucking their thumb. Try not criticize your child when they do suck their thumb as this can add to their stress, which could make them more likely to continue the habit.
5. You could try painting clear, bitter tasting nail polish on the fingernails that the child likes to suck. One popular brand is called Mavala Stop.
If none of the simple techniques listed above work, there are a few more advanced ways to help eliminate thumb sucking.
6. There is a dental appliance cemented in the mouth called a "Habit Breaker. or as one children's dentist I spoke with smartly calls it: a "Reminder Appliance".
There are various designs but this type of appliance has metal situated behind the upper front teeth. When the child puts their thumb in their mouth, it touches the metal and prevents the child from putting their tongue into the roof of their mouth. This takes the fun out of thumb-sucking and also works to stop for pacifier habits as well. The appliance may be left in the mouth for at least six months until the habit is stopped and the open bite has corrected. Note: I refer my patients to an orthodontist for insertion of this type of appliance and the following one.
7. Another appliance is called Bluegrass appliance. This appliance has a few tiny round beads sitting on a wire right behind the upper front teeth, instead of metal cage. The child can actually spin these beads with their tongue. So when a child puts their thumb in their mouth, they feel the beads. So instead of sucking on their thumb, they are encouraged to instead roll the beads with their tongue, which many children find fun. In time, the tongue sucking and pacifier habit is eliminated.
8. For interest, I am including an option for children who for some reason cannot tolerate having any sort of dental appliance in their mouth (which would seldom be the case). In that case, you could try the Modified RURS’ Elbow Guard. This is a clever device. It looks like an elbow guard that a child may wear when cycling or roller blading. But on the inner side of the elbow guard, there is a button that is pushed if the child tries to bend their elbow and bring their thumb towards their mouth.
This in turn activates a little speaker inside the elbow guard and music will start to play. This will immediately alert the child to the fact that they have their thumb in their mouth, and the music will continue to play until they take their thumb out of their mouth.
Children often aren't even aware of the fact that they're sucking their thumb because it's such an ingrained habit. So this device can create awareness and reminds the child they are trying to quit the habit.
Summary
If your child is 4 or 5 years old and they are still sucking their thumb or using a pacifier, it is recommended you start working with your child towards having them stop. If you cannot get your child to stop thumb-sucking or using a pacifier on your own, you can speak to your children's doctor or your child's dentist for help.
If you have any questions or comments about this article or have suggestions for future articles I would be very happy to hear from you. Please use the comment section below.
Yours,
Dr.Jeff Shnall
Further reading:1. A good article from the Mayo Clinic discussing pros and cons of pacifiers and tips for their use. From The Mayo Clinic July 22, 2017,
By Mayo Clinic Staff: Pacifiers: Are they good for your baby?, https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/pacifiers/art-200481402. An article with information on how pacifier use relates to prevention of SIDS Sudden infant death syndrome (SIDS). By the Mayo Clinic Staff. Undated.
https://www.mayoclinic.org/diseases-conditions/sudden-infant-death-syndrome/symptoms-causes/syc-203528003. Regarding how to wean a baby off a pacifier:Article: 10 Pacifier Weaning Tips for Babies and Toddlers. From the website: DreamBabySleep.com https://dreambabysleep.com/10-pacifier-weaning-tips-for-babies-and-toddlers/4. An article discussing the positive aspects of breast-feeding beyond just nutrition for the baby:The Taboo of Being a Human Pacifier. A mother’s thoughts on the complicated politics of "comfort feeding,” or breastfeeding on demand.
MEGAN MARGULIES, The Atlantic. MARCH 29, 2016
https://www.theatlantic.com/health/archive/2016/03/breastfeeding-pacifier-comfort-feeding/475836/
5. An article for women who are having a very trying time breast-feeding:The Pressure to Breast feed Can Hurt Moms. And Doctors are Finally Realizing It. By Catherine Pearson. Huffington Post. 09/19/2019
click here for link6. An article about adults who still thumb-suck:
Can Thumb-Sucking Be Addictive?From psychology today: A brief look at the research into those who constantly suck their thumb.
Mark D. Griffiths Ph.D. Posted Sep 15, 2016.
https://www.psychologytoday.com/ca/blog/in-excess/201609/can-thumb-sucking-be-addictive
7. A short, fun article about what lead to the design of the modern day pacifier:
Who Made That Pacifier? By Dashka Slater. The New York Times Magazine, June 20, 2014.
https://www.nytimes.com/2014/06/22/magazine/who-made-that-pacifier.htmlOther Sources I Used:
Recommendations for the use of pacifiers M Ponti, Canadian Paediatric Society, Community Paediatrics Committee. Paediatrics & Child Health, Volume 8, Issue 8, October 2003, Pages 515–519,
https://doi.org/10.1093/pch/8.8.515 Published: 01 October 2003
Thumbsucking and Pacifier Use From the webpage: Healthy Mouth.
Brought to you by the American Dental Association
https://www.mouthhealthy.org/en/az-topics/t/thumbsucking----------------------------------------------------------This is the article discussing the Elbow pad device I mentioned:Shetty RM, Shetty M, Shetty NS, Deoghare A. Three-Alarm System: Revisited to treat Thumb-sucking Habit. Int J Clin Pediatr Dent 2015;8(1):82-86.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4472878/Khayami, Shahrzad. Bennani, Florence. Farella, Mauro. Fingers in mouths: from cause to management. The New Zealand Dental Journal. Vol 109. 06/01/2013.https://www.researchgate.net/publication/239943508_Fingers_in_mouths_from_cause_to_management
Modified Bluegrass Appliance: A Nonpunitive Therapy for Thumb Sucking in Pediatric Patients—A Case Report with Review of the LiteratureAmish Diwanji,1 Preet Jain,2 Jigar Doshi,3 Prakash Somani,2 and Dhaval Mehta4Case Reports in Dentistry. Case Report | Open Access.Volume 2013 |Article ID 537120 | 4 pages |https://www.hindawi.com/journals/crid/2013/537120/