It is a common misconception that children who suck pacifiers will rarely suck thumbs or fingers. Many children become programmed to constant sucking through-overuse-of pacifiers and often begin sucking thumbs or fingers when the pacifier is no longer available to them. They may also begin sucking their tongue, lip, blanket or other object when the pacifier is taken away. For more information about pacifiers see Pacifiers

"Peer pressure will eliminate the habit when the child starts school."
Intelligent, caring parents do not want their children to be taunted and teased by peers. Research has clearly demonstrated that negative peer pressure can be devastating to a child's fragile, developing self-image, potentially resulting in a lasting sense of self-doubt and shame. And, the ridicule is counterproductive in that it produces anxiety and physical distress, the very cues that stimulate the desire for more sucking and the comfort that the behavior provides. These children can also become withdrawn and anxious or angry and aggressive toward those who taunt them.

Many children will not suck in front of peers or in the classroom setting. However, this does not mean that the behavior is eliminated. These children often resume digit sucking, almost instantaneously, while riding home in the car or on arriving home after school. Ideally, the sucking habit should be discontinued---before---beginning kindergarten because the behavior can have a negative impact on the learning and socialization processes whether or not the activity occurs at school. Digit Sucking and Related Learning and Socialization Problems

"Ignore it, your child will stop when he or she is ready."
Ignoring the sucking behavior beyond age five is ill advised because permanent teeth will begin erupting around age six. Research has found that the severity of dental malocclusion (crooked teeth and/or bite problems) related to the sucking activity is associated with the frequency and duration of the behavior. It is illogical and not in keeping with basic medical and dental tenets of prevention to ignore the behavior beyond age five when it can be the source of many problems that often improve or self-correct with early intervention. In addition, digit sucking is a comfort behavior. Children become very dependent on the activity to relieve emotional or physical distress. Life becomes more stressful with age, hence, the longer the habit persists-the more difficult it is to overcome.

"All children stop digit-sucking eventually."
This statement is simply erroneous. Google Adult Thumb Sucking to find numerous sites about adults who continue digit sucking.

"Don't worry about the sucking habit, nearly all children get braces anyway."
It is time for an attitude adjustment here, with more focus on-prevention! Approximately 5 million individuals in the U.S. and Canada are wearing braces. Some of these families have orthodontic insurance, however, it generally only covers a lifetime maximum benefit of only $500 to $1,500. Parents---who can afford it---are reaching into their own pockets to pay the lion's share of the cost, which could run from $3,000 to $5,000 for a basic set of braces. The cost of orthodontics is directly related to the severity of the problem and the time in treatment. Prolonged duration of the digit-sucking behavior frequently results in severe dental malocclusion (crooked teeth/bite problems). Dental and Speech Problems Associated with Digit (Thumb or Finger) & Pacifier Sucking Whereas, early elimination of the sucking activity often results in improvement or correction of these problems, inevitably reducing the time and cost of orthodontic treatment. The Dental Improvement Often Observed With the Elimination of Digit-Sucking Habits

Many health-care professionals do not provide treatment for their own children because of emotional involvement. Parents can also become very emotionally involved in their child’s digit-sucking habit, which precludes patience, objectivity, and often results in conflict. The BIG Mistake Parents Make or How to Entrench the Digit-Sucking Behavior This conflict causes children to "tune out" and resist any efforts on the part of their parents to eliminate the sucking activity.

A skilled professional can bridge the communication gap between child and parents and enter the child's world as a partner and facilitator. Trained to motivate children to---want---to stop digit sucking and take responsibility for their habit, these therapists do this by developing a strong trusting relationship. This encourages the child to feel secure in knowing the therapist will be tolerant, patient and empathetic. Thus, the child is not afraid to explore the option of trying to discontinue the habit.

Consider enlisting the help of an orofacial myologist if:

• Gentle reminders have turned into nagging, and the atmosphere in the home has become one of conflict, antagonism, and frustration regarding the sucking behavior.
• The child has reached the age of five, has speech problems, appears to be developing dental malocclusion (crooked teeth/bite problems) or is beginning kindergarten and still has a digit-sucking habit.
• One parent is not consistent about following through or supporting a habit elimination program.
• There are two or more children in one family with a sucking habit.

To find out if there are any *orofacial myologists who are trained to work with children who have digit-sucking habits and are practicing in your area, contact:

The International Association of Orofacial Myology (IAOM) Website: www.iaom.com - Click Directory – C in the Status column indicates certification

*Not all orofacial myologists or members of IAOM are certified or trained to work with children who have prolonged digit-sucking habits. Courses are available for dental professionals, speech-language pathologists, child psychologists and other allied health professionals to facilitate the development of clinical skills to help children discontinue prolonged digit (thumb or finger) sucking. For more information see Training Courses.

Because children depend on digit sucking to relieve stress, careful deliberation must also be given to picking a time to eliminate the habit when the child and parents are not experiencing excessive stress or change in lives. A well-trained professional can help you determine, based on the individual child's stage of development, what types of events can create excessive anxiety that might preclude successful treatment. Starting kindergarten is a transition that is often difficult. Treatment to eliminate the habit is best initiated soon after the child reaches the age of five, prior to the arrival of permanent teeth, and ideally BEFORE the start of kindergarten to avoid the development of other detrimental oral habits as well as learning and socialization problems. Digit Sucking and Related Learning and Socialization Problems

Understand cause-and-effect relationships
Grasp another person's point of view
Comprehend concepts of time (today, tomorrow, next week)
Have some appreciation of intrinsic values (doing something out of a sense of pride because it is the right and desirable thing to do)
Discriminate between right and wrong
Practice some degree of self-control and self-denial

Most five-year-olds are developmentally ready to meet these criteria. Preschool children are not. See Intellectual & Emotional Development of Preschoolers.

Preschoolers have difficulty understanding logical reasoning and cause-and-effect relationships. Comments about crooked teeth from digit sucking have little impact on this age group because they are not concerned about appearances. Their thought processes are dominated by sensory impressions. They only understand the pleasure derived from the sucking activity and cannot comprehend why adults want them to quit.

When parents promise a reward next week for not sucking, they may as well be talking about 100 years from now because preschoolers live minute-to-minute, understanding only the here and now. They remember the promise of a reward because they are oriented toward self-gratification and the need for this gratification is-immediate!. They know nothing about patience, self-control or self-deprivation.

All children rely on the sucking activity to induce relaxation and sleep. Nightmares are common in preschoolers, with their "fantasy oriented" stage of development and vivid imaginations. It is unreasonable to expect these children to give up the comfort of the sucking activity when they truly believe that monsters lurk under their beds.

Preschoolers can be cajoled into trying not to suck by the promise of a reward, but will often hide under a blanket and sneak a little suck, then deny the transgression. They are not deliberately lying because they have not reached the stage of development where they can understand being dishonest. They simply do not want to miss out on the promised treat and cannot sort out what they wished had happened from what really did.

Because many preschoolers are very articulate, parents assume that they are more mature than they actually are. If pressed beyond their capabilities, these children suffer "burnout" and frustration to the point where they resist any program to eliminate the sucking habit. Each time they try and fail, they lose self-confidence and eventually come to believe they cannot succeed.

Abnormal tooth positions or development of the bony dental arches can influence changes in the oral and facial muscle function. This is because form and function are reciprocal, the muscles of the tongue, lips and cheeks must adapt to the malformation created by the sucking behavior to maintain a functional relationship. This adaptation or orofacial myofunctional disorder (OMD) (also commonly referred to as "tongue thrust"), can then contribute to the development of speech problems, making the dental malocclusion worse as well as orthodontic relapse (a condition where teeth migrate back to their original positions after braces are removed). What Is Tongue Thrust or Orofacial Myofunctional Disorders?

The following are some of the dental malocclusions associated with digit and pacifier sucking. Each of these malocclusions can be exacerbated with the longevity of the sucking habit and contribute to other dental and functional problems such as: speech disorders, difficulties with efficient chewing and digestive problems, Physical Problems Related to Digit Sucking, stress on the gums and supporting bony structures, difficulty cleaning teeth, trauma to protruding upper front teeth and the very serious problems of root resorption and temporomandibular joint disorders (TMD).

Overjet or maxillary protrusion is the second most common type of dental malocclusion associated with digit sucking and root resorption. Excessively protruding incisor teeth are more likely to be fractured or traumatized and require longer orthodontic treatment, which predisposes them to the risk of root resorption.

Females experience more root resorption and the resorption is more severe in females. Digit sucking is both more common and more prolonged in females than in males.

Since anterior open bite and overjet as well as lengthy orthodontic treatment time are undeniably linked with both prolonged digit sucking and increased risk of severe root resorption, it would be prudent to eliminate digit sucking prior to the eruption of permanent maxillary incisors (around age seven) to mitigate the severity of anterior open bite and overjet malocclusion, subsequent duration of orthodontic treatment and risk of severe root resorption.

Pain or tenderness of the jaw
Aching pain in and around the ear
Difficulty chewing or discomfort while chewing
Aching facial pain
Clicking sound or grating sensation when opening the mouth or while chewing
Locking of the joint causing difficulty opening or closing the mouth
Headaches
General discomfort when upper and lower teeth come together
Neck and shoulder pain
Spasm or pain in the muscles used for chewing

TMJ disorders are one of the most complex, least understood, and most controversial health disorders in existence today. Many insurance plans—do not pay—for treatment of TMJ disorders, or only pay for limited procedures because research has not clearly demonstrated that treatments are effective.

There are a number of factors that have been associated with TMJ disorders. The following are some of the factors that are associated with TMJ disorders—and digit-sucking:

• Females experience more TMJ disorders than males. Digit sucking is both—more common and more prolonged in females than in males.
• Anterior open bite, posterior crossbite and extreme overjet dental malocclusion have been positively associated with TMJ disorders. To see these bite problems see Dental and Speech Problems Associated with Digit (Thumb or Finger) & Pacifier Sucking These types of bite problems are—very commonly associated with digit-sucking—require compensatory jaw movements (laterally and excessively forward) and subsequent muscle adaptations to maintain functional relationships (biting and chewing) between upper and lower teeth. These compensations can lead to unbalanced muscle hyperactivity, which influence the morphology (form) of the temporomandibular joint, craniofacial (skull and face) growth and TMJ disorders.
• Numerous studies are finding that digit sucking, fingernail biting, excessive chewing on pencils, pens or other objects are significantly associated with the oral facial pain symptoms that are common in the diagnosis of TMJ disorders. These symptoms have been found in children as young as five-years of age. Many children with digit-sucking habits also bite their fingernails as well as chew on pencils and other objects. The genesis of these biting and chewing behaviors often begins when children start school. Many children will not suck in the classroom setting for fear of critical comments from teachers and peers. However, because of oral fixation, frustration and in an effort not to suck, they often begin chewing on pencils, clothing, hair and fingernails. Subsequently, they end up with—two—oral habits, sucking and chewing. Digit Sucking and Related Learning and Socialization Problems

The temporomandibular joints are necessary when we talk, chew and swallow. They are the most frequently used joints in the human body and act as a pathway for all sensory nerve information between the brain and the spinal cord. TMJ disorders during stages of growth may leave long-term damage that is complex and difficult to treat. Considerable evidence exists that digit sucking, associated dental malocclusions, subsequent compensatory jaw and oral muscle adaptations as well as other related parafunctional behaviors are significantly associated with symptoms of TMJ disorders. It makes sense to remove the risk factor of prolonged digit sucking when children have adequate intellectual and emotional development (age five), prior to the arrival of permanent teeth, and ideally—before—the start of kindergarten to avoid the development of other detrimental oral habits associated with TMJ disorders.

Classroom digit sucking can impede a child’s scholastic achievement and interaction

A child who sucks a digit at school is likely to be rejected by peers, resulting in feelings of inadequacy.

The first dental habit appliance, commonly referred to as the “hayrake”, appeared in the dental literature in 1936 and is—sadly—still in use today. This barbaric device has wire points directed downward from the roof of the mouth to inflict pain on the offending digit. Unfortunately, children can also impale their tongues on this device. Other appliances are designed to act as reminders when the child puts a thumb/finger into the mouth. These various devices are left in the mouth anywhere from three months to a year or more, and children can experience difficulty with speech (see additional information Speech and Habit Appliances below), eating and hygiene. It is not uncommon for an unmotivated child to push and tug on the appliance until it is mutilated or displaced so s/he can resume sucking. Tugging or pushing on it can also cause the device to become imbedded in palatal tissues, which can lead to infection, discomfort, anxiety, and tipping of the molars to which it is cemented. No doubt these appliances require a high level of maintenance, which can make them an unpleasant experience for the dentist as well as the child.

The problems and Injuries resulting from the use of digit-sucking habit appliances are clearly reported in the dental literature. The most comprehensive study of the literature, Suffer the Little Children: Fixed Intraoral Habit Appliances for Treating Childhood Thumbsucking Habits: A Critical Review of the Literature, was published in 2002 (Volume XXVIII) in The International Journal of Orofacial Myology. The author, Nicholas Moore, reviewed all 67 of the published studies in the dental literature about dental habit appliances from 1936 to 2002. He also contacted several of the authors for updated comments or to address specific questions about their research. His conclusion in part, “This review clearly reveals the chaotic state of the literature of fixed intraoral habit appliances over the past 60 years. There are many different designs of fixed appliances but no consensus as to which is the best type of appliance to use, or even how long to use them in treatment. There also exist indications that therapy is potentially extremely dangerous yet this appears to be completely ignored by many practitioners. This lack of coherent thought, coupled with the potentially injurious nature of the therapy begs the question as to why so many children have been made to suffer so much for so long without any effort being made to put a stop to the practice.” Dr. Robert Mason, practicing orthodontist with considerable experience as a professor, researcher and past-chair of the department of orthodontics at Duke University, reviewed Moore’s article and wrote an editorial including the following: “The preparation of these materials by the author represents the most extensive and comprehensive treatise on this topic within the past decade and beyond. As an orthodontist, I share the conclusions of Mr. Moore and defend his challenge to the dental community to adequately justify the use of habit appliances, many of which can cause potential harm to the oral environment and children selected for appliance treatment. The impact of this impressive effort by Mr. Moore will hopefully stimulate a dialogue within dentistry that will be positive and beneficial to patients.”

There isn’t an oral dental habit appliance or any other device or liquid application that can force a child to discontinue a sucking habit if h/she is not motivated to do so. Some children will tolerate the misery of an oral appliance and stop the sucking activity only to quickly relapse back to the behavior when the apparatus is removed. All too often, when an appliance is not effective, the child is blamed for non-compliance and the parents are left feeling frustrated, helpless and incompetent. It is the method that is at fault. Prolonged digit sucking is a behavioral problem, which can and should be treated, as are other behavior issues, through motivational and cognitive therapy, not with mechanical devices. Dental-habit appliances only treat a symptom of the behavior and do not address its biological, physiological or psychological elements. The—least invasive approach—to the management of issues affecting health and well-being should always be the treatment of choice. Positive behavior modification based on a thorough understanding of the whole behavior and when utilized by a well-trained and skilled clinician is very successful and does not require the use of invasive, intra-oral appliances. The child is highly motivated to discontinue the behavior and he/she does so quickly and without coercion. Children embrace this concept and parents are not required to enforce compliance. Their role is simply one of a well-informed, empathetic and positive support system, which enhances the parent/child relationship.

If your dentist recommends a habit appliance to eliminate your child’s digit-sucking habit, you may want to inquire about a non-invasive, motivational/behavioral approach. If your dentist is not aware of, or trained to offer this treatment option, you can check Why Many Children Need the Help of a Trained Professional to Eliminate Digit-Sucking Habits to find out if there are any members of the International Association of Orofacial Myology (IAOM), who have this training and are practicing in your area. Training programs are also available should your dentist be interested in offering this approach to his or her patients. Training Courses

Anything that adversely influences the normal development of the bony dental arches or tooth positions such as prolonged thumb, finger or pacifier sucking can be a significant factor in the development of OMD. This is because form and function are reciprocal, the oral muscles of the tongue, lips and cheeks must adapt to the malformation created by the sucking behavior to maintain a functional relationship. This adaptation can then contribute to the development of speech problems and to making the dental malocclusion worse. Some other factors that influence the development of OMD are:

• Chronic upper respiratory disorders, such as allergies, sinusitis or enlarged adenoids, which may make nasal breathing difficult, thus encouraging habitually open-lip posture, which then affects the correct resting position and function of the tongue as well as eruptive patterns of the teeth.
• Enlarged tonsils or frequent throat infections may promote an excessively forward position of the tongue.
• Short lingual frenum – This is the tissue that attaches the tongue to the floor of the mouth. If it is unusually short, the tongue may not be able to elevate adequately to make appropriate contact with the palate.
• Large tongue – The tongue may be large in relationship to the size and shape of the dental arches.
• Skeletal, neurological and other physiological abnormalities.

The International Association of Orofacial Myology (IAOM)
Office of the Executive Coordinator
2000 NE 42nd Avenue PMB 295
Portland, OR 97213-1305
Phone: (503) 280-0614
Email: iaomec@msn.com
Website: http://www.iaom.com

Thumb, finger or pacifier sucking can all cause essentially the same types of dental malocclusion (crooked teeth/bite problems). Pacifiers can cause dental malocclusion regardless of the type (orthodontic or traditional) of pacifier used. The degree of malocclusion is related to intensity, duration, frequency and the direction of the force during the sucking activity. Dental and Speech Problems Associated with Digit (Thumb or Finger) and Pacifier Sucking

Difficulty with maintaining sanitation of pacifiers exposes children to more viral/bacterial infections. For example, pacifier-sucking children experience 33 percent more occurrences of acute otitis media (ear infections) than children who do not use pacifiers. Chronic and severe otitis media can lead to secretory otitis, which can cause permanent hearing loss, along with delayed speech development. It may also contribute to the development of other, irreversible kinds of middle ear disease including atelectasis, adhesive otitis, and cholesteatoma.

Pacifier-sucking infants are less interested in breastfeeding and tend to stop breastfeeding earlier than infants who do not use pacifiers.

In 2005 the American Academy of Pediatrics recommended the use of pacifiers for the first six months of life at naptime and bedtime to possibly prevent sudden infant death syndrome (SIDS). The recommendation was based on retrospective studies relying on parents recall about past use of pacifiers. Undoubtedly, the recommendation was a big boost to the $50 million-plus pacifier industry! Unfortunately, all too often, the use of the pacifier is not restricted to the first six months of life or to—excluding its use to bedtime or naptime.

The effect of frequent pacifier sucking on speech and language development is unknown. It is certainly plausible, however, that excess pacifier use may limit babbling and imitation of sounds or words. Children may try to vocalize around the pacifier or make no attempt to speak.

Sucking on a pacifier is definitely soothing for a baby who is often distressed. If the infant is sufficiently contented and can be comforted in other ways, however, it is best to avoid using a pacifier. The mouth helps babies to learn about and explore everything in their new world. What a shame to