Bottles, sippy cups, pacifiers, and thumb sucking are quite common during children's early years of development, yet many parents are unaware of potential risks associated with oral habits.
It is estimated that 40% of children use a pacifier during their first year of life and 30% suck on their thumb. At three years of age, about 12% of children continued to suck on their thumb, while only 4% of children continued to use a pacifier (Davidson, 2012).
Research has found that using a pacifier during the first 6-12 months of life reduces the risk of sudden infant death syndrome (SIDS) (Fern, Olanrewaju, & Mir, 2005). As well, pacifiers provide opportunities for non-nutritive sucking (sucking for the purpose of soothing rather than eating), which can calm children and may help children prepare for nutritive sucking (Zimmerman, 2019). For a great analysis of the pros and cons of pacifier use, check out this Blog from Becky McArthur, Speech-Language Pathologist with We Communicate. For additional helpful strategies for eliminating the pacifier, check out Melanie Potock's video on youtube.
Today's blog will focus on oral habits that persist beyond the first year, as the risks of speech delays/disorders or oral structure changes is lower during the first year (O'Brien et al., 1996; Adair, 2003; Ravn, 1976; Helle and Haavikko, 1974).
ORAL HABITS CAN IMPACT:
Dentition (teeth): an open bite, over jet, and diastema (space between teeth) (Larsson, 1987; Proffit et al., 2007; Tanaka et al., 2004; Santos et al., 2012, Ramesh et al. 2016, Rasheed, 2009)
Oral structures: high arching palate, and/or a forward tongue resting position
Swallowing: tongue thrust (infantile swallow rather than mature swallow pattern)
Speech sounds: While there is a wealth of evidence that prolonged pacifier use and thumb sucking can result in differences in oral structures, the evidence is unclear on whether these habits negatively impact speech. Some research has found that oral structure differences are linked to speech sound challenges (Leavy, Cisneros, Leblanc, 2016), and therefore it is not unlikely that significant oral structure changes would have an impact on speech sounds, particularly the /s/ and /t/ sounds.
Speech and Language Development: Children that have a pacifier or thumb in their mouth throughout the day have less opportunities to practice making sounds and using words (Marshalla, 2004)
The impact of the oral habit will depend on the intensity, frequency, and duration of the activity. If the child sucks profusely on their thumb they are more likely to have oral structure (Tanaka et al., 2004) and speech changes (Profitt et al., 2007). Likewise, the more often or the longer that the child sucks on a pacifier, bottle, sippy cup, or their thumb, the greater the chance of a negative impact.
STRATEGIES TO HELP:
1. Reinforcement - Praise your child when they are not sucking on their thumb. Provide a reward for reaching specified goals.
2. Look at the underlying cause - Sucking on a thumb, pacifier, or chewing on clothing or fingernails can be a sign of heightened anxiety (this is why we often see an increase in these behaviours when children go through big changes).Try to find other ways to reduce the anxiety, such as breathing techniques, a stress ball, or a fidget spinner.
3. Plan - Create a plan with your child that incorporates a measurable goal (e.g., "Johnny will fall asleep without sucking on his thumb for 7 days"). Make sure to incorporate strategies into your goal to ensure it is successful (e.g., "Johnny will squeeze a stress ball when he feels like he wants to suck on his thumb").
4. Keep their hands busy - Have your child work on something with their hands during quiet time (e.g., art, lego, etc.). Have your child hold onto a fidget spinner or a stress ball during moments when they are more likely to suck on their thumb.
5. Talk to your child - Talk to your child about the rules (e.g., "no fingers in the mouth") in a way that they will understand. It is also important to talk to them about the reasons (e.g., "sucking on your thumb puts more germs in your mouth"). A great book that you could use to start the conversation is, "The Berenstain Bears - The Habit" book.
6. Gloves or bandaids - Use something that covers the thumb, particularly during bedtime, to build awareness of when they are thumb sucking and to make it less desirable.
7. Aversive tasting nail polish - Some families use a nail polish that is designed to taste bad to discourage their child from putting their fingers in their mouth.
8. Dental appliances - If you feel like you have tried every strategy with no success, an orthodontist may be able to help by installing a dental appliance that prevents the thumb from getting into the mouth.
9. Replace - It is often easiest to replace a behaviour with another. For thumb sucking, that might be holding a ball, for pacifiers, it might be a special stuffed toy, for sippy cups or bottles, it might be a new special straw cup or a munchkin 360 cup.
10. Be consistent and stay positive - Once you have decided that you are going to overcome an oral habit, do not give in or give up.
SUMMARY:
Pacifier - It is recommended that pacifier use is eliminated by 1 year of age.
Thumb Sucking - The longer that this habit goes on, the harder it is to overcome. If your child sucks on their thumb, start talking to them about thumb sucking at a level they can understand. Be consistent and don't give up!
Bottles & Sippy Cups - Begin teaching your child how to use a straw or an open cup early (you can start working on this as early as 6 months - with a great deal of support).
References:
Adair, S.M., (2003). Pacifier use in children: a review of recent literature. Pediatr Dent. Sep-Oct; 25(5):449-58.
Davidson, L., (2012). Thumb and Finger Sucking. Pediatrics in Review. 29;207. http://http//pedsinreview.aappublications.org/content/29/6/207
Fern, R. H., Olanrewaju, O.C., & Mir, S.S., (2005). Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrom? A Meta-Analysis. Pediatrics. Vol 116: 5.
Gupta, B.I., Bhavna, G., & Indushekar, K.R. (2012). Childhood thumb sucking habit: the burden of a preventable problem! Journal of Dentistry, Medicine and Medical Sciences Vol. 2(1) pp. 1-4. Available online http://www.interesjournals.org/JDMMS Copyright ©2012 International Research Journals
Helle A, Haavikko K (1974). Prevalence of Earlier Sucking Habits revealed by Anamnestic Data and their Consequences for Occlusion at Age Eleven. Proc. Finn. Dent. Soc. 70:191-196.
Leavy, K.M., Cisneros, G., Leblanc, E. (2016). Malocclusion and its relationship to speech sound production: Redefining the effect of malocclusal traits on sound production. American Journal of Orthodontics and Dentofacial Orthopedics. 150(1): 116-123
Marshalla, P. (2004). How to Stop Thumbsucking and Other Oral Habits. Marshalla Speech and Language.
Proffit W. R., Fields H. W., Sarver D. (2007). Contemporary Orthodontics.St. Louis, Mo, USA: Elsevier Mosby.
Ramesh, N., Guruanthan, D., Karthikeyan, S., (2016). Association of nonnutritive sucking habits and malocclusion: A cross-sectional study. Department of Pediatric Dentistry 1(1): 15-16.
Rasheed, N.A., (2009). Prevalence of Thumb sucking habit and its relation to malocclusion in preschool children. 7(1).
Ravn, J.J., (1976). Sucking habits and occlusion in 3-year-oldchildren. Scand J. Dent. Res; 84:204-209.
Santos Neto, Edson Theodoro dos, Oliveira, Adauto Emmerich, Barbosa, Rodrigo Walter, Zandonade, Eliana, & Oliveira, Zilda Fagundes Lima. (2012). The influence of sucking habits on occlusion development in the first 36 months.Dental Press Journal of Orthodontics,17(4), 96-104.https://dx.doi.org/10.1590/S2176-94512012000400019
Tanaka O., Kreia T. B., Bezerra J. B. G., Maruo H., (2004). Malocclusion and thumb-sucking habit. Jornal Brasileiro de Ortodontia & Ortopedia Facial. 9:p. 276.
Turgeon-O'Brien H, Lachapelle D, Gagnon PF, Larocque I, MaheuRobert LF., (1996). Nutritive and nonnutritive sucking habits: a review. ASDC J. Dent. Child. Sep-Oct; 63(5):321-7.
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