Pacifiers and Thumb Sucking “Non-nutritive Sucking Habits”

For babies, sucking is an inherent reflex, which first starts at approximately the 29th week of gestation. Oral habits developed by babies include two types: nutritive and non-nutritive. Nutritive habits include breast or bottle-feeding and supply imperative nutrients. Non-nutritive sucking includes habits like digit sucking or pacifier sucking, which are typically developed by babies very early and naturally in response to frustrations or to self soothe their need for contact. Research shows almost 100% of babies engage in some kind of non-nutritive sucking, most often pacifier use, thumb sucking, or both. Other non-nutritive habits include but are not restricted to sucking on blankets, toys, etc. Non-nutritive sucking does not usually cause dental problems unless the child’s habits persist past the age of 3 years. Most of these habits, however, disappear by the time the child reaches school age. Sucking that persist past this time may result in abnormal dental development and facial bone growth, which may further cause abnormal speech development. 

Dental Issues Caused by Non-Nutritive Sucking Habits

Non-nutritive sucking does not become truly harmful unless these habits persist past a child’s 3rd birthday. At this point, however, the upper incisors may become inhibited and fail to erupt. They may also become tipped towards the front, giving the appearance of “buck teeth.’ In general, the amount teeth change as a result of non-nutritive sucking habits depends entirely on the prevalence, intensity, and full time span of the habit, as well as how the baby positions the finger or thumb in his or her mouth. The most notable detrimental dental effects of non-nutritive sucking habits include an anterior open bite, movement of the incisors, and maxillary constriction. 

Benefits of Non-Nutritive Sucking Habits

For infants or toddlers under the age of 3 who develop a non-nutritive sucking habit, like thumb sucking or using a pacifier, numerous related benefits do exist. Forming an oral habit as such indicates a baby’s ability early on to self-soothe and cope with his or her own emotions. Permitting infants to suck their thumb or use pacifiers can also help them improve their ability to de-stress on their own and focus their attention. Non-nutritive sucking tends to happen more frequently when an infant is sleepy, experiencing some sort of distress, bored, or anxious. As a result, non-nutritive sucking can aid in the comfort of an infant and the establishment of a feeling of safety.  

Pacifier Suggestions

According to the American Academy of Pediatrics (AAP), parents are advised to put their infant to sleep with a pacifier for the full 1st year of life. For unknown reasons, a pacifier is clinically proven to reduce the risk of Sudden Infant Death Syndrome (SIDS), which can happen anywhere from birth until a baby turns 1 year old. Providing a baby with a pacifier during a nap or bedtime is widely promoted as a health increasing practice. If pacifier use persists for too many years, however, this habit may lead to dental problems later on. Ultimately, use of a pacifier is highly advised for the first year of a baby’s life according to the following guidelines:

Offer a pacifier when putting an infant down for a nap or bedtime, but never force a baby to use a pacifier. Also, do not reinsert the pacifier into a sleeping infant’s mouth if it falls out. 

• Never glaze a pacifier in any sweet solutions.  
• Replace and sanitize pacifiers frequently.
• When a pacifier begins to look worn, always replace it.
• For breastfeeding infants, wait until they are 1 month old before introducing a pacifier. This helps insure the successful establishment of breastfeeding.
• Offer a pacifier only when you are sure the baby is not hungry. Never use a pacifier as a substitute for meals or to delay feeding an infant. 
• Acceptable pacifiers are one piece only and made of hardwearing material. 
• Only use pacifiers that include a shield wider than the infant’s mouth and ventilation holes. 
• Never tie a pacifier by a string to a baby’s hand or neck or to the crib. This significantly enhances the risk of strangulation. 

When to Stop Thumb Sucking and Pacifier Use

Children commonly quit using a pacifier or sucking their thumb anytime between the age of 2 and 4 years. At 3 years old, over 20% of toddlers still engage in these habits, and usually pacifier users stop before thumb suckers. In fact, older kids who suck their thumb usually give up the habit due to peer pressure at school. 

The American Academy of Pediatric Dentistry (AAPD) officially advises that children discontinue their non-nutritive sucking by the age of 3. This affords the mouth a stronger opportunity to re-align itself before the permanent teeth start to erupt. If the child quits early enough, any problems with the child’s bite may actually fix themselves. If the adult teeth begin to emerge while the habit persists, these teeth may present the same issues as the baby teeth, due to non-nutritive sucking. 

Intervention Tips for Non-Nutritive Sucking Habits

To help your child give up non-nutritive sucking, the following should be tried in the order listed, beginning around the age of 3 years:

• Talk to the child—Explain the problems his or her habit will cause for their grown up smile in a way that the child can understand easily. This sometimes is enough to get the child to stop sucking.
• Remind the child—When a child has communicated that he or she wants to stop sucking but has trouble remembering, sometimes simply providing a reminder does the trick. Keeping a waterproof bandage around the child’s finger or thumb may also serve as a helpful reminder not to suck. Some parents have luck with putting a mitten or sock over the child’s hand at bedtime, but make sure he or she knows this is simply a reminder, not a punishment. 
• Use a reward system—In this case, usually the parent, child, and sometimes a health professional all concur the child will give up their sucking habit in a particular amount of time. If the child accomplishes this goal, he or she will be rewarded with something that will genuinely influence the child to quit.
• Physically obstruct the habit—If the parent finds none of these other techniques to be successful and the child does want to quit his or her habit, a couple other approaches may work. For some children, loosely and gently wrapping the arm in an elastic bandage at night helps them from putting their hand in their mouth during sleep. For others to stop, it may be required that a dentist put an appliance in the child’s mouth to keep him or her from being able to suck.