expander

If you are parent to a child who has a thumb or finger habit, you are in good company. One study indicated that 15-20% of children under age 6 engage in thumb or finger sucking habits. Even orthodontists' children suck their thumbs! (See cover photo to see my daughter in action).

Below are 4 considerations for parents with a child who engages in thumb sucking. All of the following are evidence-based and established by clinical research, to help your child avoid dental health problems while building self-confidence associated with overcoming a challenging task.

Impact on Dental and Facial Growth and Development

After age 6 and with the corresponding eruption of the first permanent teeth, sucking habits will begin to have an irreversible negative effect on the development of the jaws, bite relationship, and positioning of teeth. In most cases, the habit will contribute specifically to a narrow upper jaw (causing crossbite), protruded upper teeth (overbite), and a failure of the front teeth to bite together properly (open bite).

Stopping By Age 6 or 7 Will Minimize Most Long Term Effects

In my experience as an orthodontist, I find that most children begin to establish social awareness of thumb sucking around age 5-6 and develop an internal motivation to cease the habit when it is observed that peers at school are not engaged in the habit. Fortunately for children and parents, this period coincides with the time in development at which irreversible negative effects can by prevented. Research has shown that cessation of thumb and finger habits prior to the eruption of the permanent incisors (central teeth) at age 6 or 7 will prevent lasting negative impacts on the development of the upper jaw and permanent teeth. This key age to stop also aligns with the American Association of Orthodontists' (AAO) recommended age for the initial evaluation of your child (age 7) by an orthodontic specialist.

Techniques for Stopping Thumb and Finger Sucking

The single most important aspect in helping a child to stop sucking a finger or thumb is to determine self-motivation. In the clinical setting, I typically begin by simply asking the child if he or she would like to stop the sucking habit. If your child is not ready and motivated, then it is not time to attempt to stop the habit. It will only lead to frustration and negativity. The focus, instead, should be on education. Explaining to your child how it would be helpful to them to stop and pointing out that others in their social group or class at school may be in the process of stopping. Acknowledging the difficulty in stopping is also very important. For example, if either parent had a sucking habit as a child, explain to your child how you recall how hard it was to stop, but how rewarded you felt once you were able to tackle the  difficult challenge.

Once established that the child is motivated, I recommend the following techniques to positively reinforce stopping the habit:

1. Continuously reaffirm the child's self-motivation and goal to stop. Examples: "That is so great that you set this goal." and "You can do this, we are so proud of you."
2. Set up a reminder system to help the child stop when the body may be unconsciously initiating the habit during sleep. This can include sleeping with glove or bandaid on the sucking hand and using nail polish on the sucking finger (Mavala Stop is one brand name).  The goal is not to physically prevent your child from performing the habit, but helping to provide reminders so they can willfully stop the habit in a positive, supportive environment. Positive reinforcement is the key.
3. Use a reward calendar on the refrigerator. Every full day/night your child goes without engaging in the habit, place a star on the calendar. Arrange for a reward after 14 consecutive days are achieved without the habit. After 14 consecutive days, the chance of relapse of the habit is very small. (Link: I Can Do It Reward Chart)
4. In many cases, early orthodontic intervention will help your child if he or she is actively engaged in a sucking habit over age 7. Most often, a constricted (narrow) upper arch and possible associated crossbite will indicate the need for a maxillary expander to orthopedically widen the upper jaw. In this case, this very common appliance will change the dynamics of the thumb habit just enough to serve as a reminder and aid the child in stopping the habit.

Consider the BIG PICTURE

Your child will overcome this habit. Your role as a parent is to educate, to motivate, and to provide a positive and supportive environment. Keep in mind that this may be the very first conscious, difficult sacrifice your child makes to improve his or her health and well-being. It must be our goal as adults (parents and healthcare providers alike) to foster self-motivation, encourage that little girl or boy that they are up to the challenge, and celebrate with them when they achieve what they set out to do. Comments like "how am I going to get him to stop" or  "she will never stop this" do little to motivate and will undermine the child's self-expectations. This habit should be looked at as a profound opportunity that can be used as a very important confidence builder for a young child. We adults must create an environment that encourages children in our sphere of influence to learn, to set goals, and to succeed- in thumb-sucking and beyond!!

The DCO Team is here to help you. Please email me at any time (info@dco-ortho.com) if I can provide any additional information to help you or your child.

**Pictured above: DCO patient Sofia (8yrs old) completing early treatment (also called Phase 1) which consisted of upper and lower expanders to make more room for her permanent teeth. Dr. Cassarella also helped to positively motivate her to stop sucking her thumb.  Her treatment represents a typical 9-12 month intervention that corrects the course of a child’s facial and dental development to reduce complexity in the early teenage years.

For most parents, orthodontic treatment is one of the most significant and impactful healthcare decisions you will make for your child. You may wonder when is the most ideal time for your child to be examined by an orthodontist. The short answer, as recommended by the American Association of Orthodontists (AAO), is age 7. The WHY behind this simple answer is one of the most fascinating aspects of orthodontics. In my experience in practice as an orthodontist, I find that many parents and even dentists are not aware of some of the profound benefits of early evaluation of a child for orthodontic treatment. Bringing your child to see an orthodontist at age 7 for a baseline examination can reduce future length, cost and complexity of treatment and also lead to the most ideal end result. Many children do not have the need for orthodontic intervention at a young age, but for those who do, the positive impact that can be made is very significant. It can also help to set your child on a pathway to healthy facial, dental, and psychosocial growth and development.

Below are the top six benefits to early orthodontic treatment:

1. Improvement of Airway
Few parents consider the impacts that jaw development may be having on their child’s airway. There has been recent research that has used 3D imaging techniques to demonstrate the extent to which expansion of the upper jaw can significantly improve the size of airway and volume of airflow during breathing. This occurs by orthopedically increasing the width of the nasal airway. In children who snore at night, have early signs of sleep apnea, or are mouth breathers, early orthodontic treatment can present an opportunity to improve quality of life in ways that you may have never considered. This includes better quality sleep and associated performance in school, improvement in overall health and better performance in athletics. 

2. Improvement of Confidence and Self-Perception
In certain cases, space between teeth, crowding of teeth or severe bite problems may begin to impact a child’s confidence. One study actually showed that some teachers unknowingly had lower expectations for children with severe bite and tooth alignment problems. If a small orthodontic intervention can change the confidence and self-perception of a young child, one may ask the question- what greater benefit can there possibly be?

3. Identification of Severe Crowding or Bite Problems
Many parents of patients recount their own orthodontic treatment experiences which consisted of extraction of permanent teeth. In most children, the future need for extraction of teeth can be avoided by making adequate space for permanent teeth as they grow and develop by using expansion appliances. Early identification of crowding and expansion treatment also can prevent permanent teeth from becoming impacted in the future, and thus decrease future treatment time and complexity.

4. Facial Growth Assessment
One of the most important considerations that is made by the orthodontist is the initial examination of a child’s facial structure. Children who are growing rapidly can undergo very simple and easy orthopedic growth modification treatments that can help the child’s own growth be the corrective force in treating problems relating to facial growth, jaw size and jaw position. In some cases, particularly in underbites, these easy procedures can possibly prevent future need for jaw surgery for your child.In other cases, it can help to prevent developing facial growth asymmetry from becoming a long-term, complicated problem.

5. Reduction of Risk of Trauma to Teeth
In children who have protruding teeth, particularly the upper front teeth, early orthodontic treatment can reduce the risk of damage to these teeth during activities, sports or if your child sustains any facial trauma.

6. Assistance in Stopping Thumb and Finger Habits
Thumb or finger sucking habits, particularly those persisting after age 6, can have lasting effects on the development of the jaws and teeth. Often times, one or two conversations between your child and the orthodontist can provide the motivation and encouragement needed for your child to overcome this challenge.

Timing is everything and knowledge is power. Having your child examined by an orthodontist at age 7 will ensure that treatment needs are recognized early and that treatment is recommended at the most ideal time. This can give your child a better experience, fewer complications and the most ideal outcome.