That little thumb can do an awful lot of damage!
A parent's guide to childhood thumbsucking issues and tongue thrust behavior

by Shari Green, Director of Oral Habits Specialist, the "Thumb Lady"

The mere thought of their child's thumbsucking behavior brings frustration and anxiety to many parents. Most parents know that thumbsucking is a common occurrence during childhood, but at what point should acceptance become concern?

What are the complications that arise if this non-nutritive sucking behavior continues into the later childhood years?

What methods can be utilized to help children stop in a loving, positive, and supportive way?

What if parents can't do it alone? Who can parents and children turn to for help when the going gets rough?

This article aims to address these very topics.

Why Children Suck Their Thumbs

Children are conditioned and learn at a very early age that they must suck to survive. Many children begin thumbsucking in utero.

Children are born with an instinctive suckling reflex. As you stroke your little baby's chin, you can see that instinctive response immediately. Minutes after my daughter was born, she knew exactly what to do for nourishment. She didn't have to be taught, (although, I needed to learn how to help!). It was pure instinct.

Babies begin to associate suckling with Mommy, warmth, love, togetherness, and a myriad of other wonderful feelings. Sucking actually produces endorphins, a natural-occurring chemical in our brain, which produces pleasure.

Endorphins are so powerful, they actually bind to "opiate-type"receptor sites in the brain. With all these early positive associations, and pleasurable experiences relating to the sucking process, what baby wouldn't love sucking? Babies soon learn that they can transfer this sucking action to other items, namely a convenient finger, toe, or thumb, and receive those same positive and pleasurable conditioned sensations.

Children find finger sucking can stave off boredom and they often use this as a means of soothing distress, illness, or fatigue. Soon sucking becomes a habit. Thumbsucking past age 4 is just that, merely a habit. No more. No less.

When Does Acceptance Become Concern?

Personally, I begin to become concerned at age 4-5. Between ages 4 and prior to the eruption of the permanent teeth, much of the damage that occurs to the palatal structure can be reversed.

Prolonged and vigorous sucking can act as a deterrent to the normal growth and development of skeletal, facial, nasal cavity, tooth alignment, lip structure, tooth eruption, palate, finger growth, speech, breathing and swallowing functions.

That little thumb can do an awful amount of damage that many parents are not aware of.

The more vigorous the sucking habit and the more fingers sucked, the greater the degree of damage likely. Two-finger sucking is considered the most damaging, and a thumbsucker who hooks the index finger above the nose will develop finger, nasal, and palatal damage simultaneously

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Negative effects of thumb and finger sucking.

The longer the sucking habit continues, the greater the chance of the negative effects of finger sucking (especially palatal narrowing), becoming resistant to spontaneous reversal.

As the mouth is propped open from the front teeth contacting a finger, the back teeth may begin to erupt excessively to fill that open space in back forcing the bite to become permanently open. In addition, when a child keeps a finger in the mouth, the tongue is forced into a downward and forward position. The roof of the mouth, the hard palate, depends on the tongue resting and molding it's shape for proper width and development.

Thumb sucking puts your child at risk for a narrow palate

When the palate does not have a tongue resting within it during the early formative years, it is at risk for narrowed development. In addition, the muscles utilized in a normal adult swallow, which encourage the tongue to lift to the palate for the swallow, are weakened and fail to engage at the proper time.

Additional forward and downward movement of the tongue occurs against teeth and beyond teeth influencing the child's palate and facial development further. In addition, the mere suction and pressure of the sucking act can create pressure against the upper arch forming a v-shaped arch, instead of a nice round arch, narrowing the palate even further.

What are the effects of a narrow palate?

• First that comes to mind, is that many teeth will not be able to erupt fully, on schedule, or straight, due to limited space in which to contain them.
• In addition, once the bite has been affected through crowded or abnormally erupted teeth, the lower jaw or teeth may shift as a result, to attempt to find a comfortable biting surface, forming an overlap situation on the back teeth, often referred to as a crossbite.
• Without enough room for the tongue to fit in during rest and swallows, the tongue, with already altered muscular patterns, will be perpetually forced into a situation where it has nowhere to go but out.
• A tongue which habitually thrusts forward, is termed a "tongue thrust". The entire facial muscular complex can often be affected, as children attempt to seal their mouth from the extruding tongue to avoid an embarrassing moment of food or saliva falling forward from the force of the tongue.
• Muscles are said to exhibit an "imbalance" situation, i.e., the muscles we normally use for facial expression are being called upon to do the work of chewing and swallowing, in a compensatory action.

Normally, infants use these same patterns of chewing and swallowing up until ages 4-6, and then a transition begins to take place, and proper patterns of swallowing develop as part of the maturation process.

Orofacical Muscular Imbalances

However, in over 80% of children who continue thumbsucking beyond the early years, a proper swallow transition does not occur, and the swallow pattern remains infantile in nature. Children who develop these problems are said to have "Orofacial Muscular Imbalances".

Development of other hard structures may also become altered. In these children, the roof of the mouth grows vertically, instead of horizontally, narrows, and becomes vaulted, often taking on the shape of the finger.

Nasal Cavity and sinus problems

The nasal cavity floor is also associated with the growth of the roof of the mouth. If the palate is narrow, the nasal cavity and sinus may also develop with a narrow and shallow anatomy.

Speech can be effected

In addition, speech can be effected because the tongue has difficulty raising to the palate, or with tongue tip placement, due to structural and muscular changes, to articulate various sounds, especially n,t,d,s,l,z, and ch. R, formed with the back of the tongue raised, may also be problematic. Incompetent lips may affect letters p, b, and m.

Orthodonic treatment can be slowed

Oftentimes, the area where the finger sits in the mouth has provided a nice gaping open area for the tongue to thrust out of during rest and swallow function. The more the tongue continues to exert pressure by resting against teeth, or through them, the more at risk teeth are to continued movement.

If this tongue thrust issue is not addressed during orthodontic treatment, orthodontic movement of teeth may be slowed, as the tongue pushes forward, exerting pressure in a continuous slow manner in the opposite direction the orthodontist is attempting to move the teeth into.

When the orthodontia is completed, continued movement of the teeth may occur as a result of the tongue continuing to exert pressure at rest and swallows against those beautifully straightened teeth. This can lessen the possibility of a beautifully maintained and retained orthodontic correction.

Lips don't develop properly

Lips may assume a flaccid appearance, with little muscle tone, when at rest and not actively sucking. The lips are unable to remain together easily. Lips that remain closed at rest act as a natural retainer to the front teeth, and help keep them from drifting forward in the mouth.

Average normal lip strength is aprox 4-6 lbs. of pressure. This is measured using a spring tension gauge. Most of the children with orofacial myofunctional disorders, have lip strengths of only 1-2 1/2 lbs. of pressure. Luckily, this is easily reversed.

I personally use a custom molded exercise device to work with the children on improving lip strength, and more importantly, closure. I am usually able to increase lip strength significantly in a few weeks, and improve lip closure after the sucking behavior has been discontinued.

Other Factors in the Development of the Tongue Thrust

The second most common cause of orofacial muscular disorders is mouth breathing. Children who breath habitually through the mouth, due to allergies, tonsils, adenoids, or other airway difficulties also tend to hold and rest the tongue and jaw downward, yielding similar narrow palates, resultant bite changes, tongue thrust behavior, and lips apart posture.

In fact, these disorders are on the increase currently for two reasons.

• Sheer demographics-the large percentage of the population falling into this age group where we begin to detect these problems
• increased mouth breathing issues from an increase in the incidence of allergies in our society.

A handful of dentists I have spoken with perceive there may be a less aggressive nature of treatment of tonsil and adenoid issues as compared with the baby boomer generation in their own personal patient populations, noting an increased incidence of children with mouth breathing as a result.

In addition, hereditary factors, neurological problems, short tissue attachment under the tongue (frenum), and an abnormally large tongue can also be labeled causative factors contributing to the development of tongue thrust swallow behavior, and orofacial myofunctional disorders.

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How Common is Thumbsucking?

In preschoolers, it is believed that 1/3 to 1/2 of 3-5 year olds suck fingers and thumbs when tired, although there is a decline in overall time of fingers in the mouth.

Some quit sucking entirely once they begin preschool and peer pressure kicks in. However, even though most daytime sucking decreases during this time period, often nighttime sucking continues.

Many preschoolers will return home from a finger-free day, snuggle up to a blankie, t.v. or other familiar object in a comfortable spot, and automatically, the thumb goes in.

Approx. 13% of children who are entering kindergarten suck a finger, and in 7-11 year olds, aprox 6%, with the most finger sucking occurring at night.

Many children begin other oral habits as a substitute, however, such as pen chewing, a more socially acceptable form of oral stimulation than a thumb. (These other oral habits may also be harmful to the oral structure, and are less commonly addressed.)

If thumbsucking continues much past this age group, often orthodontic and orofacial muscular therapy are not enough to help these children. In addition, surgical intervention may become necessary to address jaw discrepancies.

About Shari Green - Director of Oral Habits Specialist The "Thumb Lady©" Shari Green received her I.A.O.M. Certification in Orofacial Myology in 1998 following her professional internship, through the International Association of Orofacial Myology.

She received her Dental Hygiene degree and license in 1979, She retired from dental hygiene practice after working for 19 years as a Pediatric Dental Hygienist. Shari has also been a featured guest on NBC News and Mom Talk Radio, and as read in National Jewish Parenting, Seventeen Magazine, and PEOPLE Magazine.

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