Thumb-sucking: When does it need to stop? Published Jan. 5, 2016 By Capt. Julie A. Anderson & Capt. Brian E. Blackwell 92nd Air Medical Squadron FAIRCHILD AIR FORCE BASE, Wash. -- An estimated 80 percent of children participate in thumb-sucking at some time in their life. It's an instinctual behavior that originates in the womb. In times of stress, separation from parents, or even simple fatigue, thumb-sucking functions to comfort little ones and may or may not become a continuous, hard-to-break habit if not addressed. What are the consequences of thumb sucking? At what age should it become worrisome? What can I do to ease my child out of the behavior? These questions are commonly brought to the dentist's attention, and in honor of Children's Dental Health Month, we will discuss the topic here. Aside from social implications as well as the acquisition and spread of germs, thumb-sucking can have an effect on a child's primary and permanent teeth. The most common consequence is a malocclusion - a misalignment of how the bottom and top teeth line up. This usually affects the front teeth and can lead to what's known as a 'buck toothed' appearance. While a malocclusion in the baby teeth may resolve when the teeth are lost and replaced by permanent teeth, it is important to note that if the habit continues the permanent teeth will be similarly misaligned. This can only be fixed with braces, and after the habit has been stopped. The first permanent teeth come in around age six, so I don't have to worry about my three-year old for three more years, right? Wrong. While it's often recommended children stop thumb-sucking and pacifier use by age 5, there are factors that can have lasting effects earlier on. Active and vigorous thumb-sucking versus resting one's thumb in the mouth can lead to an altered development in the roof of the mouth and/or exterior shape of the mouth. This can affect where the teeth come in and even airflow through your child's mouth. Children that can be heard 'popping' their thumbs out or seen actively sucking are at higher risk for malocclusion and other issues than those that simply place their thumbs in their mouths. As well as effects on teeth and breathing, there can be speech difficulties as well as troubles with the child's ability to socialize with other children. Research has shown positive reinforcement of the correct behavior (not sucking their thumbs) has a greater success rate than negative reinforcement when the child lapses and sucks their thumb. By the ages of four and five, children are often more socially aware thumb-sucking or pacifier use is not an acceptable habit for children their age. Often, though, anxiety or discomfort triggers the behavior in these children and so scolding or shaming them may cause more harm than good. There are a number of appliances that have been used in the past and still may be used by practitioners to help stop thumb-sucking or pacifier use. One study, however, suggests these appliances negatively reinforce the behavior and also can cause pain and suffering for these children. It is instead recommended in a different study and by the American Dental Association that positive reinforcement of the correct behavior be used instead. The ADA gives these guidelines for helping to stop thumb-sucking or pacifier use: · Instead of scolding the child for thumb sucking, offer praise for not doing so. · Children often suck their fingers when feeling insecure. Focus on correcting the cause of the anxiety and comfort the child. · Reward the child when he or she avoids thumb sucking during a difficult period, such as being separated from family members. Physical barriers such as bandages or bad-tasting treatments applied to the thumbs can be used in conjunction with these positive methods of reinforcement as well. If the child removes the bandage or manages to wipe off the treatment, reapply it without scolding or shaming them or making a big fuss about it. It is also helpful to explain to the child that it can cause long-term effects to their mouth and teeth. Thumb-sucking and pacifier use is a normal behavior for many children but as the child grows it should be eliminated through positive reinforcement and encouragement before it becomes a detrimental habit.