Dental Care Problem 1: Crunching, thump Sucking, and Sipping

This baby habit is a lot more common in adults than most people realize. When
facial muscles and bone structure are developing during childhood and
adolescence, thumb sucking can be the cause of crooked teeth, an open bite (a
space between the top and bottom teeth), an overbite (what we often call buck
teeth) or other facial deformities that would require orthodontic treatment to
correct. But if youve recently taken up thumb sucking as a soothing habit during
your adult years, its basically a harmless habit". If youre over 18 and sucking
your thumb...then youre probably not going to change your facial structure.
Sucking is a normal baby reflex, beginning around the 29th week of gestation.
Almost 100% of normal babies engage in nonnutritive sucking. Babies may suck
their thumb, fingers, hand, a pacifier, or other inanimate object such as a blanket
or toy.
What is thumbsucking?
Babies have a natural desire to suck. Thumbsucking is a common way babies seem
to comfort themselves. Thumbsucking usually begins by 3 months of age.
A child usually sucks his thumb when he is tired, bored, sick, or upset or when he
is not using his hands to play. A child may suck a finger(s) or fist instead of a
thumb. Sometimes a security object, such as a blanket, may become part of the
thumbsucking habit.

Why Nonnutritive sucking? .

It is an early step in an infant's ability to self-regulate emotions.
It helps the child to relax and focus his or he attention.
It provides comfort and security. Sucking tends to occur more often when
the child is tired, bored, anxious, or upset.

What is the cause?
An infant's desire to suck on the breast or bottle is a drive that is essential for
survival. More than 80% of babies do some extra sucking when they are not
hungry. With ultrasound many babies even can be seen sucking in the uterus.
Thumbsucking also appears to help a child comfort herself and often increases
when breast or bottle feedings decrease. It does not mean that a child is insecure or
has emotional problems.
How long does it last?
The sucking need is strongest during the first 6 months of a child's life. In a study
by Dr. T. Berry Brazelton, only 6% of thumbsucking babies continued the habit
past 1 year of age and only 3% continued beyond the age of 2 years. A more recent
study, however, found that 15% of 4-year-olds still sucked their thumbs. Those
children who continue sucking their thumbs after the age of 4 often have become
involved in a power struggle in their early years with a parent who tried to stop
their thumbsucking. Occasionally, the thumbsucking simply persists as a bad habit.
The American Dental Association advises that a child can probably suck his thumb
until he is 4 or 5 years old without damaging his teeth or jawline. However,
thumbsucking must be stopped before a child's permanent teeth come in (at age 6
or 7) because it can lead to an overbite (buck teeth). Another reason to encourage
children to give up the habit before they enter school is to prevent the teasing they
would otherwise receive.
By adolescence, most normal children abandon thumbsucking because of peer
pressure.

Although most children discontinue nonnutritive sucking between 2 and 4 years of
age, more than 20% still engage in the habit at age 3. Pacifier users typically
discontinue nonnutritive sucking earlier than thumb suckers. Older children who
are thumb suckers are often motivated to quit by peer pressure at school.
The dental effects of nonnutritive:
sucking directly correlate with the frequency, intensity, duration, and nature
of the habit.
The most common effect is movement of the central incisors upward and
anteriorly, which may result in an anterior open bite.
Intervention:
When a child persists with a sucking habit, consider the following
approaches:
Tell the child in basic terms why you want them to stop and that you
believe they can do so.
Implement reminder therapy, the use of aids such as rubber bands or string,
to help a child interrupt the habit.
Start a reward system.
Encourage the use of a stuffed animal or other comfort object.



Notes:
The success of any intervention depends on a childs willingness to
participate.
When discussing the childs sucking habit, it is important to plan a quitting
strategy together.
Reserve the use of rubber bands, string, and band-aids for older children
because they pose a choking hazard for young children.
Consider using a star chart, stickers, or a habit calendar for a reward system.
For physical intervention to work, the child must be ready and agreeable.
Techniques include:
Covering hands at night with mittens or socks
Dressing the child in a special shirt with the sleeves sewn closed
Placing a bandage or specialty plastic guard on the thumb or finger

How can I help the child overcome thumbsucking? How can I as a dentist assist
parents to deal with it?
1. If your child is less than 5 years old, distract your child or ignore the
thumbsucking.
Thumbsucking should be considered normal before the age of 4 years and
usually ignored, especially when your child is tired, sick, or stressed. Help
your child overcome any stressful situations. However, if the thumbsucking
occurs when your child is bored and he is over 1 year old, try to distract him.
Give him something to do with his hands without mentioning your concern
about the thumbsucking. Occasionally praise your child for not
thumbsucking. Until your child is old enough for you to reason with, any
pressure you apply to stop thumbsucking will only lead to resistance and
lack of cooperation.
2. After 5 years of age, help your child give up thumbsucking during the
day.
Most 5-year-olds have reached the age of reasoning and are developmentally
ready to cooperate with their parents and work on a bad habit. They must
have an understanding of cause and effect relationships, the ability to
discriminate between right and wrong, and the capacity to practice some
degree of self-control and self-denial.
First get your child's commitment to giving up thumbsucking by showing
her what thumbsucking is doing to her teeth and body. Show her the gap
between her upper and lower teeth with a mirror. Have her look at the
wrinkled rough skin (callus) on her thumb. Discuss the unhealthy aspects of
placing the thumb in the mouth when there are germs or dirt on it. Appeal to
her sense of pride. At this point most children will agree that they would like
to stop thumbsucking.
If your child expresses the desire to stop, the next step is careful planning.
Young children may become frustrated easily and want to stop trying. To
help succeed, parents will want to be available for the first difficult days and
focus on keeping the child distracted from the sucking behavior by planning
some activities to occupy the child's hands such as drawing, craft projects,
puzzles, and games. If the hands are busy they won't be going in the mouth.
Because most children with sucking habits are unaware of the activity, it will
be important to use some sort of reminder on the thumb. Character Band-
Aids work well for daytime, but children generally need assistance placing
the bandage comfortably on the top part of the thumb. However, it is
important that it is the child's choice to wear the reminder and not to be
enforced by parents. Introduce the reminder as a special helper to let the
child know when the thumb is trying to sneak in the mouth. Limit television
watching for the first couple of weeks and avoid other situations that
stimulate the sucking habit.
Older children may also want an outlet for dealing with the urge to suck
their thumb. You can suggest doing something else with her thumb, such as
holding her thumb inside a closed fist for 10 seconds or twirling her thumbs.
Although self-reminders are the most effective, parent reminders may
occasionally be helpful if the child approves. Ask your child if it will be all
right if you remind her when she forgets. Do this gently with comments such
as "Guess what?" and put an arm around your child as she remembers that
she has been sucking on her thumb again.
3. At the same time, help your child give up thumbsucking during sleep.
Most children depend heavily on the sucking activity to relax and fall asleep
at naptime and bedtime. The sleeping habit is the strongest part of the
behavior and it takes the longest to eliminate. It will be important to address
the sleeptime sucking at the same time you are working on the daytime habit
to minimize frustration and enhance success.
Parents will also want to plan to be available at bedtime for the first week to
help the child adjust to falling asleep without sucking. Your child can be told
that the sleeptime thumbsucking is not his fault, because "that old thumb just
sneaks in and he doesn't even know it because he is sleeping." He will need
a powerful reminder, one that covers the entire hand. A long cotton tube
sock is the most effective reminder. A glove or puppet sock are other
options. Help your child look upon this method as a clever and a fun idea
rather than any kind of penalty. Again, parents should assist with putting on
the bedtime reminders but not enforce cooperation. It is important to
remember that parents cannot eliminate the habit for their child. The habit
belongs to the child and the child must willingly cooperate and accept
responsibility if the habit is to be eliminated.
4. Incentives
Praise your child whenever you notice she is not sucking her thumb in
situations where she previously did. This will build her self confidence. Give
her a star on her chart and a reward (such as a dime, a snack, or an extra
story) at the end of any day during which she did not suck her thumb at all.
5. Consult with a thumbsucking expert if these techniques are not
successful.
When the permanent teeth come in, thumbsucking carries the danger of
causing an overbite. Eventually an overbite will require orthodontic braces,
which are expensive.
An expert on thumbsucking is called a certified oral myologist (CMO). They
are trained to help children stop their sucking habits quickly using
motivational programs. Ask your doctor about CMOs or call The
International Association of Orofacial Myology at 303-765-4395.
6. What to avoid
The following techniques are generally not helpful and may prolong the
thumbsucking habit because the child looks upon them as punishment:
o Dental appliances: This is usually a reminder bar that is placed in the
upper part of the mouth.
o Elastic wrap or splints: Placing these around the elbow to keep it from
bending often causes some discomfort. It can also cause temporary
blueness, swelling, and numbness of the arm in the morning.
o Bitter-tasting medicines applied to the thumbnail: If the parent applies
this medicine without the child's permission, the child will usually just
wash it off or switch to another finger. Only if your child wants to use
it as a reminder it may be helpful.
How can a dentist assist parents to prevent thumbsucking?
If your baby needs to suck a lot, try to interest him in a pacifier instead of his
thumb when he needs to be comforted, but is not hungry. However, avoid
overusing it. Unlike thumbsucking, pacifier use can be controlled as your child
grows older because you can take away the pacifier. If they are older than 1 year,
children who use pacifiers do not switch to sucking their thumbs when they give
up the pacifier. Children are always able to give up their pacifiers by age 4 or 5
years.
Thumbsucking lasting beyond age 5 can usually be prevented if you avoid pulling
your child's thumb out of his mouth at any age. Also, don't comment in your child's
presence about your dissatisfaction with the habit. Scolding, slapping the hand, or
other punishments will only make your child dig in his heels about thumbsucking.
If you can wait, your child will usually give up the thumbsucking naturally. If you
turn the issue into a showdown, you will lose, since the thumb belongs to your
child.
The use of pacifiers has been shown to decrease the incidence of Sudden Infant
Death Syndrome (SIDS).
Consider offering a pacifier at nap time and bedtime. Although the mechanism is
not known, the reduced risk of SIDS associated with pacifier use during sleep is
compelling. The evidence that pacifier use interferes with breastfeeding or causes
later dental complications is not. The task force recommends use of a pacifier
throughout the first year of life, according to the following procedures:
The pacifier should be used when placing the infant down for sleep and not
be reinserted once the infant falls asleep.
Pacifiers should not be coated in any sweet solution.
Pacifiers should be cleaned often and replaced regularly.
For breastfed infants, delay pacifier introduction until 1 month of age to
ensure that breastfeeding is firmly established
Pacifiers should never be used to replace or delay meals and should be
offered when the caregiver is certain the child is not hungry.
Pacifiers should have ventilation holes and a shield wider than the childs
mouth (at least 1 inches in diameter).
Pacifiers should be one piece and made of a durable material, replaced when
worn, and never tied by a string to the crib or around a childs neck or hand.

When should parents call their child's healthcare provider?
Call during office hours if:
Your child is over 4 years old and sucks her thumb constantly.
Your child is over 5 years old and doesn't stop when peers tease her.
Your child is over 6 years old and sucks her thumb at any time.
Your child's teacher has expressed concern about thumbsucking in class.
Your child also has emotional problems.
The permanent teeth appear to be crooked.
The thumbsucking does not improve after trying this approach.
You have other concerns or questions.