Thumb Sucking In Older Children

My daughter is almost six and recently started sucking her thumb! I believe she was influenced by friends at a new school. I've tried just about everything to get her to quit, but nothing seems to work. What should I do?

Question:

There is a definite possibility that sucking habits which persist after the permanent teeth begin to erupt can cause changes in tooth position. These changes can include flared and spaced upper anterior teeth, lingually positioned (pushed back) lower anterior teeth and a narrow upper arch. Displacement of the teeth generally correlates with the number of hours per day this habit is maintained. Getting a child to stop this habit can be extremely difficult, if not impossible, if the child is not ready and willing to quit.

In younger children (four years old and younger), naming the thumb (such as "Mr. Thumb") and forming an alliance against the thumb may be helpful. This may help control Mr. Thumb who wants to get in the child's mouth. Telling the child that his or her teeth will feel better without Mr. Thumb or telling them how bad Mr. Thumb tastes may be of some benefit.

If a child is still sucking his or her thumb when the permanent incisors begin erupting (usually six or seven years old), a discussion between the dentist and child might be of more benefit than between parent and child. There are many techniques for helping a child cease this habit, such as a reward system and/or removing the pleasure of sucking (such as placing a Band-aid over the thumb or cotton glove over the hand).

There are also a couple of orthodontic appliances which can serve as reminders to stop sucking the thumb or finger. These appliances should not be used, however, until the child is willing to cease and just needs some extra help to break the habit. If arch constriction is already apparent and some expansion is necessary, a quad helix can be used to accomplish both the arch expansion and cessation of thumb sucking. Otherwise, a fixed "reminder" appliance which is fabricated out of heavy wire to eliminate flexibility can be cemented to either the permanent or primary molars. Part of this appliance is crib which sits toward the front part of the palate. This crib is bulky, but not sharp, to impede the ability to suck. Part of the success of this appliance is to address the psychological aspect. The appliance should be viewed as a "helping hand" or a reminder rather than a punishment. In addition, any type of removable device is generally not beneficial as compliance can be a problem.

Once the sucking appears to cease, the crib appliance should remain in place for about three months to ensure the habit has completely ceased. If an open bite is apparent but the child had a normal jaw relationship to begin with, the original jaw relationship often returns after cessation of the habit. It is possible that wearing an appliance for a short term to expand a constricted upper arch or to bring in flared or spaced anterior teeth may be necessary. If the open bite does persist, it is usually because some type of skeletal discrepancy already existed. If this is the case, orthodontic treatment would have been necessary to repair this discrepancy despite any prior thumb sucking habits.

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