THUMB SUCKING
Why do children suck their thumb/fingers?
Sucking during infancy is a natural and healthy reflex, essential for survival. From around 6 months of age we expect to see a significant reduction in non -nutritive sucking (thumb and finger), however this is not always the case, and approximately one third of children continue to suck beyond 4 years of age.
→ It feels good
Sucking initiates the release of neurotransmitters:
Dopamine- released when the brain is expecting a reward, and contributes to feeling of alertness, focus, and motivation
Serotonin- the happy/wellness hormone, acts as a mood booster and stabiliser. It also is related to healthy sleeping patterns, and can convert to melatonin which initiates sleep
→ Its addictive, calming and may even be pain relieving
Sucking initiates the release of beta endorphins (a calming chemical), which attach to the opiate receptors in the child’s brain and creates a pleasurable feeling that is addictive. This endorphin release is addictive, so it can be hard for a child to stop.
→ To open their airway
It is thought by many professionals in this field that thumb sucking may be a compensatory behaviour done by a child in an attempt to prop the lower jaw forward to open up the airway. Airway focused dentists may fit an adult patient who has airway issues with a mandibular advancement splint (MAS)- a devise worn during sleep that brings the lower jaw forward to open the airway and therefore improve sleep. It is possible that for some children thumb sucking is not just done for the good feelings it creates, but for a much more important reason; to open the airway so they can breathe better.
→ It soothes reflux
Sucking produces saliva, which when swallowed helps to dilute acidic stomach juices which cause discomfort to the oesophagus.
→ It can help relieve ear pain
Sucking can reduce the pressure built up in the eustachian tubes which are located between the middle ear and back of the nose and throat.
EFFECTS OF LONG TERM THUMB SUCKING
Poor development of the maxilla (upper jaw), and in turn often the other facial bones are affected. This can include the eye sockets, the nasal septum and the mandible. Thumb sucking not only affects the position of the teeth, but can also affect the shape of the jaw
Poor development of the mandible (lower jaw) as sucking can push the lower jaw down and back
Anterior openbite where the back teeth meet but at the front there is a gap between the top and bottom teeth
Overjet where the upper front teeth are significantly forward of the lower teeth (protruded/‘buck’ teeth)
Crossbite where an upper tooth (or a number of upper teeth) rest on the inside of the lower teeth
Speech problems
Tongue thrust swallow
Incorrect resting posture of the muscles of the face and mouth
WHEN SHOULD I BE CONCERNED ABOUT MY CHILDS THUMB OR FINGER SUCKING HABIT?
2 1/2- 3 years of age: This is a great time to start having the chat with your child about their thumb/finger sucking habit. For some children, all it takes is gentle reminders, lots of praise, and a good sticker/reward chart and the habit is kicked. But for a number of children it’s not that easy.
4-6+ years of age: Now is the time to seriously look into your child’s sucking habit. If your child is ready to ‘quit’ sucking, and you would like some guidance and support along the way then the ‘Double Thumbs Up’ program is something you might be interested in looking into, see below.
The extent of the damage to the orofacial complex caused by a sucking habit is dependant on a a number of factors including the:
- Intensity of the sucking - Frequency of the habit - Duration of sucking -Which digits are being sucked - Position of digit in mouth -
This is a typical orthodontic presentation of a child who has a thumb sucking habit.
Note the anterior open bite (where the front teeth don’t meet together), and the posterior cross bite (where the top back teeth close inside of the lower back teeth).
It’s not just the position of the teeth that are affected from long term sucking habits, it is also the shape of the bone, and the function of the muscles of the face and mouth.
what about orthodontic appliances like cribs and rakes or plastic thumb guards?
Cribs and Rakes use metal prongs or barriers to prevent the thumb or fingers from making contact with the palate. Some of these appliances use sharp prongs to deter the child from sucking. Punitive appliances like this should be avoided as they do not restore optimal function.
Thumb guards work for some children as it is physically impossible for a child to suck their thumb whilst wearing it. Some children will chew through the thumb guard or find every way in the book to remove it. If this is your experience, and your child is still sucking their thumb/fingers please consider an orofacial myology assessment.
What to look for in a thumb/finger sucking quit program
It is important to choose a program that not only supports the child in quitting, but also restores correct oral resting posture. Children that struggle to quit sucking rely on their thumb/finger to stimulate the nerves on the palate for the release of neurotransmitters as their tongue is not resting up in the palate. By not replacing the thumb or finger with the tongue resting in the palate, it is going to be much more difficult for the child to quit.
“When children are ready to give up the thumb sucking habit, there is most often very immediate and predictable success through a program of habit elimination and myofunctional therapy to retrain normal resting tongue posture”
DOUBLE THUMBS UP PROGRAM
So you’ve tried it all.
You’ve done the sticker charts, the nagging, the bribing, the nail polish, the guards, the bandaids. You’re at your wits end and you feel like you’ve tried everything…
You are not alone. You don’t have to struggle any longer!
Our Double Thumbs Up Program is a fun and rewarding program taking the stress out of quitting. For many children over the age of 4 who suck their thumb/fingers and have difficulty quitting, the cause is not anxiety. Its often a much larger issue that needs professional help.
If your child is over 4 and they are still struggling to quit, then a Double Thumbs Up Assessment is a great place to start. At this appointment we don’t just look at the thumb/finger sucking habit. We actually dig deeper to seek to find the cause of the habit and address the issue as a whole. Its not just about stopping the sucking habit and getting the thumb/fingers out of the mouth; its also about retraining the orofacial muscles to be functioning as they were intended, for optimal craniofacial growth and development.
the goals of orofacial myology
→ Nasal breathing day and night
→ Healthy breathing, using the muscles of the diaphragm
→ Competent lip seal (where the lips are sealed at rest)
→ The tongue must be resting up in the roof of the mouth (palate), and be able to function correctly
→ The cessation of non-nutritive sucking (finger/thumb/dummy etc)
→ Bilateral chewing with lip seal and nasal breathing
→ Relaxed face and jaw muscles, and adequate Freeway Space (back teeth should be a few millimetres apart at rest)
other oral habits
Prolonged Pacifier/Dummy use
Non-nutritive sucking habits (any sucking when fluid is not entering the mouth) are very common during childhood. Children with (or a history of) prolonged non-nutritive sucking habits often display anterior open bites, tongue thrust swallows, overactive cheek muscles and changes to the growth of their jaws.
Ideally, we like to see the pacifier removed at 6 months of age (this is the easiest time to do it).
The following research paper concluded that: Pacifier use beyond the age of 3 contributes to a higher incidence in anterior open bite, posterior cross bite and high narrow palate. The greater the longevity and duration of pacifier use, the greater the potential for harmful results.
Sippy cups and 360 Cups
Whilst Sippy Cups are convenient and prevent spillage, they do nothing positive for proper oral motor development as they perpetuate suckling, which should only be present during breast and bottle feeding.
The spout of the Sippy Cup prevents the tongue tip from moving upwards, and forces the tongue down into the floor of the mouth, and then forward and backward as the child sucks on the spout to drink. This creates atypical orofacial patterns, and can lead to a number of issues including jaw fixing, biting on the spout in an attempt to stabilise, overuse of the orofacial muscles (especially the cheek muscles), atypical use of the lips and even a tongue thrust.
Sippy cups also cause the child to extend their neck backwards, which is a very uncomfortable position to swallow in.
When a child has the core support to sit by themselves, they are ready for a cup. By 12 months of age the bottle should be removed. If you would like to use a straw cup, choose a cup with a short straw (that does not need to be bitten on to get water out). The tongue needs to be able to retract and elevate for correct swallowing.
360 cups cause the over activation of the upper lip to get liquid from the cup, and overuse of the jaw for stabilisation. Remember, we want all of the orofacial muscles to work harmoniously , rather than overworking individual muscles, so these cups are not recommended.
other oral habits include:
Tongue sucking (often caused by tongue tie)
Fingernail, cheek, cuticle, lip biting
Biting/chewing of objects (e.g. remote control)
Chewing of clothing (often the collar of a shirt)
Clenching/grinding teeth:
This causes strain on the muscles of mastication (chewing muscles), and can result in facial pain, jaw joint pain, worn teeth and broken teeth. It can also cause bony growths on the jaw bones called Exostoses or Tori (more common in adults)
Lip Trapping:
Where the lower lip is positioned behind the top front teeth- this can cause further displacement (Overjet) of the teeth
Mouth breathing:
In some cases mouth breathing is habit. Mouth breathing that continues once the nasal obstruction is cleared (for example, after tonsillectomy/adenoidectomy) is a habit. This is different from habitual mouth breathing, which means that someone mouth breathes on a regular basis.
If a person has a mouth breathing habit, Orofacial Myofunctional Therapy works to restore nasal breathing and correct oral resting postures, because we know if you don’t use your nasal airway you ‘loose’ it. Through breathing exercises and correcting oral resting postures and orofacial muscle function, nasal breathing can be restored.
Remember, we want to create healthy lasting orofacial habits for optimal growth and development!