One troubling concern for parents of small children is non-nutritive sucking (NNS) of thumbs, fingers, pacifiers, or bottles.

Authorities in the field of dental and facial development agree that prolonged NNS can lead to disturbances in tooth position, facial growth, and speech development.

Oral damage depends upon the frequency, intensity, and duration of the habit; and often, it needs to be professionally evaluated. The important thing to realize is that the digit- or pacifier-sucking habit is only part of the picture. The real danger is that the sucking habit changes the dental and oral environment in ways that encourage other, more permanent problems, such as tongue thrust swallowing and abnormal resting position of the tongue. These habits are more difficult to observe, subconscious, and hard to break. Long-term problems with facial and dental development may continue even after the NNS habit has been given up.

Studies show that 50%-70% of children have NNS habits in the first year of life. During this period, NNS is considered normal and perhaps even beneficial. By age four, this percentage is reduced to 25%. By this age, any real benefits of NNS are gone, and the danger of permanent effects on teeth and jaws is very real. In addition, there are other health and social adjustment problems, such as peer rejection, which can become problematic as a child makes the transition to a school environment.

Methods of discouraging NNS habits vary. They range from simple treatments like wearing a glove to invasive practices like dental devices (“rakes” or “spurs”) that make sucking difficult. Scientific studies have shown that encouraging a child to give up an NNS habit rarely causes the development of nervous habits. To the contrary, giving up sucking usually marks a period of improved self-esteem and social adjustment.

The difficulty of breaking the NNS habit depends upon the child's desire to stop and the caring support of family and involved professionals. It is important that the child views the habit correction as beneficial to his or hear health not punitive.

Because of these factors, age five is the upper limit of when non-nutritive sucking should be discontinued.

Dental and Facial Warning Signs

• Upper front teeth are spaced or protrude in front of lower front teeth.
• Upper front teeth don’t show enough and seem to be pushed up under the lip.
• Bite is “open” in front, and upper teeth don’t cover the lowers.
• Tongue seems visible or protruding.
• Upper row of teeth appears to narrow for the face.
• Lips are apart at rest.
• Lower jaw often seems to be moving or wiggling.
• Lower jaw and chin are shifted to one side.

Behavioral Warning Signs

• Age five or older.
• Vigorous sucking.
• Sucking at school or during the day at home.
• Family arguments regarding the habit.

Speech Warning Signs

• Lisping (using the tongue to help pronounce sounds like “s”).
• Substitution of “th” for “s” (such as “thither” instead of “sister”).

Dental, speech, or other professionals can help in ways other than by placing discouragement devices. It is often possible for an independent authority to successfully convince a child to abandon sucking habits by pointing out the damage that is occurring. When professionals become involved and the issue is no longer confined to the parent and the child, the sucking habit is less likely to become grounds for a parent/child power struggle.

We recommend examination by an orthodontist at age five if the NNS habit persists, and at age seven if a habit has been given up but any of the above warning signs remain.

An excellent book with more information on this subject is David Decides, by Susan M. Heitler, Ph.D. It is available at some bookstores. We have a copy at our office, which we would be pleased to loan.