Thumbsucking: A Seemingly Innocent Habit Can Have Serious Consequences
NOTE FROM DR. EMILY WATSON: One common habit children have that can lead to such problems as improper jaw growth and misaligned bites is thumbsucking. Some children rid themselves of the habit easily by the time they are 2 or 3, but for others it hangs on stubbornly and that’s when problems can develop. I asked Lorraine Frey, an orofacial myofunctional therapist who helps children overcome the more intractable instances of thumbsucking, if she would provide a guest article on the subject. She graciously agreed.
By Lorraine Frey
Thumbsucking can be a natural action for babies and, amazingly, we have even observed thumbsucking in utero with ultrasounds. Fortunately, most children shed the habit in the first few years of life, but for some, thumbsucking can still remain and become problematic by the age of 4.
Some parents might view thumbsucking as an annoying and, eventually, an embarrassing habit for the child. In truth, it is much more than that. Thumbsucking can lead to serious oral development problems.
The most serious consequence is craniofacial deformity. The tongue’s natural resting place is the palate. When you aren’t speaking, eating, or drinking, the tongue should naturally gravitate to the roof of the mouth.
But consider what happens when a child sucks their thumb. The thumb becomes an obstacle blocking the tongue from resting against the palate. Over time, if the thumb is pressed upon the palate and not the tongue, the palate may develop an undesirable high and narrow arch form as a result.
Unfortunately, this does not take long. Even by the age of 3 or 4, the palate can be vaulted and narrow, and no longer provides a hospitable fit for the tongue.
In addition, the child’s front teeth may not come together when they bite, a condition known as an anterior open bite. Cross bites, dental crowding and other malocclusions may also be observed. All of this misalignment in the mouth can affect how the other craniofacial bones grow, and can affect the child’s breathing, sleep, and the way they eat.
Something worth noting: Although thumbsucking is the most common example, any similar noxious oral habit can also be problematic, including sucking on fingers, nail and/ or cuticle biting, and even chewing on hoodie strings.
Is the Child Ready?
The good news is that, in most cases, children don’t need a professional like me to help them end their thumbsucking habit. Many children can stop on their own.
Those children who are referred to me by a medical or dental professional have a much more deeply entrenched habit for a variety of reasons. They are the more challenging cases where, oftentimes, the parents have tried everything they can think of to end the habit, without success.
I provide a 30-day habit-elimination program that requires a different approach. Because you can’t take a thumb away, this adds to the challenge! The temptation to suck can be constant.
When I meet with a child for the first time, my initial step is to assess if they are emotionally and mentally ready and capable of successfully completing the program. If they are too young or too immature, and we are not successful, I will have created an even more difficult challenge for the future. Not every child is ready at the same age.
I will also ask whether anything has happened in the child’s life recently that represents a major change, or was difficult for them to deal with. This could be the death of a family member, the death of a pet, their parents separating, a surgery, or anything else that was traumatic or unsettling for the child. If this is the case, I suggest waiting a little longer before we attempt to eliminate the habit.
It’s important that the child is willing to express to me that they want to quit; not just the parents. It is important for me to find the child’s motivation to quit. They may not know how, they may be uncertain about what to do, but they need to have a strong desire to be done with thumbsucking. Once again, if the motivation is not there, the time is not right.
Understandably, this may not be what parents want to hear. They want the habit taken care of now, not at some point in the future. Meanwhile, the dentists and the orthodontists want it taken care of yesterday. But the child must be ready and motivated in order for me to take their case. Forced approaches often create more trauma for the child and are rarely successful, in the end.
The parents must attend the therapy sessions with their child, but they must remain an observer, not a participant. They can’t step in and speak for the child. They must turn over control of the effort to me. This is a hard ask, and can be difficult for parents, but it’s critically important if we are to be successful.
Another thing parents may find frustrating is that they may see me using similar techniques they tried themselves, but without success. Why would something work for me and not for them? Simple. The relationship I have with the child is very different from the parent-child relationship and, as a result, the child will often respond differently.
Thumbsucking and Airway Issues
It’s worth noting here that, although thumbsucking needs to be corrected because of the problems it creates, in some cases the habit may have been covering up another potential problem: an airway related issue. The thumb in the mouth helps to open the airway, but once the child stops thumbsucking, the parents may begin to detect signs of breathing issues. Many times this can be a red flag, indicating a need to investigate further, such as sleep breathing issues, enlarged adenoids or tonsils, and/ or structural issues.
One step that can be taken when there is a concern for airway issues is a sleep study, which can determine if the child suffers from obstructive sleep apnea or other sleep related breathing issues. Diagnosing and addressing airway issues requires a collaborative approach that may involve a dentist, an orthodontist, a sleep medicine physician, an ear, nose and throat (ENT) physician, an orofacial myofunctional therapist, among others.
Why the Habit Can Be Persistent
In most cases, thumbsucking is a habit associated with small children, but there are exceptions. I have worked with teenagers and even adults who still have the habit, although you aren’t likely to know because they refrain from doing it openly. They reserve it for when they are in private, usually at home or in the company of someone they feel safe with.
Why is it that such a persistent habit can follow some people into maturity? In addition to being a habit which, by definition, is a recurrent and often unconscious behavior, endorphins are released that provide a sense of calm, relaxation and safety. The comfort that thumbsucking provides makes it a difficult habit to overcome.
Sadly, for some children experiencing a difficult or traumatic childhood, thumbsucking may be one of the only coping mechanisms they have. I once had a case involving a 7-year-old child. The child had previously been living in an on-going abusive situation. During those years of abuse, thumbsucking was a way the child found in order to cope. The child’s dentist was concerned because the thumbsucking had already caused a severe craniofacial deformity.
I would not have accepted the case had I been approached before the child had spent some time in a new, healthy and stable environment. My advice would have been to wait because the thumbsucking habit was the only coping mechanism helping to alleviate the child’s distress. The timing was right by the time the child was brought to me, and I was able to successfully help the child to finally eliminate the habit.
In this particular situation, and in all cases where the thumbsucking habit is conquered, it’s a major accomplishment for the child because it is their accomplishment. Not mine. Not mom’s or dad’s. I make sure they know that the success is their success, and they can take great pride in it. It’s a very empowering experience for a child, not to mention all the health benefits that come with it.