Pacifier and Thumb-Sucking: How to Break the Habit

by Daren F. Gehring, DDS, Cache Valley Pediatric Dentistry 

My wife and I have been blessed with five amazing kids. As babies, each of our kids needed something to sooth them. Three of them were thumb suckers, one liked a pacifier and one just needed her mom and a blanket. As new parents, we were always surprised at how strong the natural reflex of sucking truly was. We were able to see our daughter sucking her thumb on the ultrasound even before she was born! While it is nice that babies can have a way to soothe themselves, down the road that strong sucking reflex can become a problem when it comes the growth and development of the mouth and the alignment of their teeth.

As a pediatric dentist, I’m asked multiple times a day about the possible harmful effects of sucking on thumbs, fingers and pacifiers. My response is that if your child strongly or vigorously sucks on his or her thumb, finger or a pacifier beyond their first year of life, this behavior may affect the shape of their mouth or how their teeth line up.

The most common problems I see are open bites and narrow, underdeveloped palates, or roof of the mouth. When a child has an open bite, the teeth are not able to erupt into the mouth properly, and the result is a wide-open space in between the front top and bottom teeth when the child bites down. An open bite can cause three main problems:

• The child may not be able to make sounds correctly as they begin to speak. Sounds such as “S,” “D” and “Th” are difficult to master, and the child may need professional help with their speech.
• Parents are concerned about the aesthetic appearance of their child’s smile.
• If severe enough, the child cannot bite properly with their front teeth which can affect their ability to eat.

A narrow or underdeveloped palate can cause teeth to not line up properly and make it difficult for permanent teeth to fit into the dental arch. Many kids with this condition require an expansion of the roof of their mouth during adolescence.

Fortunately, many children stop sucking on their thumb, fingers or a pacifier on their own. Of course, a pacifier habit is easier to break than sucking on their fingers or thumb. A pacifier can be taken away. This is why the American Academy of Pediatric Dentistry recommends a pacifier over a thumb to comfort new babies. It is recommended that pacifier use be discontinued between six months to one year of age.

Our pacifier-sucking child REALLY loved his pacifier, especially at night. When he was a little over a year old, he had an unfortunate fall down a flight of stairs on his big wheel. He bumped his face and mouth hard enough that there was swelling for a few days. As a result of the swelling, he was physically unable to suck on his pacifier. We were forced to remove the pacifier “cold turkey.” We all suffered through three or four long nights along with some meltdown moments. But, after the swelling was gone, he seemed to forget about the pacifier altogether. Problem solved!

I must insert a disclaimer here: I DO NOT recommend this approach when weaning your child from the pacifier; a fall down the stairs is not necessary. I just use this as an example of a successful “cold turkey” approach. Planning ahead to find a convenient time when stresses are low and a parent can be close by for the first few days after the pacifier is removed is usually the best approach. Replacing the pacifier with a new cuddle toy or blanket can also be helpful.

Another, albeit slower, approach is to limit the pacifier to only nap or nighttime for a while and slowly remove it from them altogether.

Thumb and finger sucking can be a bit trickier. A few important things to consider when helping your child break the thumb or finger sucking habit are:

1. Instead of scolding the child for
   sucking his or her thumb, PRAISE
   them for NOT doing so. Children
   respond much better to positive
   reinforcement.
2. Reward the child when he or she avoids thumb sucking during difficult or stressful experiences.
3. Many children with thumb-sucking habits have a blanket or another trigger that encourages the habit. Sometimes removing the trigger will also help break the habit.

Most kids will stop on their own between the ages of two and four years old. If the child has not stopped thumb or finger sucking by this age, I recommend they be evaluated by their family dentist or a pediatric dentist to see if there is a need for therapy with a mouth appliance that can assist them in overcoming the habit.

We ended up needing to use one to help one of our children break the habit. He understood the reasons for it, and he wanted help breaking this powerful habit. It worked great for him and in a very short amount of time. A few preventive measures early on are definitely worth it in the end. Good luck!