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Thumb sucking (and pacifiers): Thumbs-up or thumbs-down?

Jennie is always sucking her thumb—from the time her dad brings her here until her mom picks her up,” says Mr. Reyes to his director. “I watch her like a hawk and try to re-direct her hand, but I often miss. It’s making me crazy.”

“Have you talked to her mom?” asks Ms. Rachel, the program director.

“Yes, but she just shrugs, like she’s too busy,” says Mr. Reyes. “It’s a dirty habit and who knows what it’s doing to her teeth and mouth.”

“Jennie is only 3,” says Ms. Rachel. “Maybe we need to give her some time and allow her to quit on her own.”

Thumb sucking is a common habit of children. It’s often annoying to caregivers and bewildering to parents. Why do children suck their thumbs? What, if anything, needs to be done about it?

And while we’re at it, let’s look at pacifiers. These binkies, as their often called, seem fairly popular among parents for their babies. To some people, pacifiers can even seem cute and endearing.

A natural infant reflex
According to the American Academy of Pediatrics (2018): All infants are born with the need to suck. Some infants even start sucking their thumbs in the womb.

The Mayo Clinic (July 29, 2015) affirms this inborn reflex: “Babies have natural rooting and sucking reflexes, which can cause them to put their thumbs or fingers into their mouths—sometimes even before birth.”

Children may continue sucking their thumbs as toddlers when they feel hungry, restless, tired, or stressed. Sucking has a calming and soothing effect. It can help them fall asleep at naptime and bedtime. The same is true of pacifiers.

As toddlers encounter changes, such as staying overnight with Grandma or starting preschool, they may continue sucking their thumbs because they have begun to realize they’re separate from their parents and feel insecure. Many children cope with the stress by latching onto a blanket or a toy—known to early childhood educators as a lovey or transitional object. Like loveys, a thumb in the mouth brings a feeling of comfort and security.

Many children stop sucking their thumbs or using pacifiers on their own sometime between ages 2 and 4. Other children stop on their own in preschool when they see that none of their playmates indulge in the habit. Even after stopping, however, children may revert to thumb sucking when they feel stressed or anxious.

Pacifiers: Better or worse?
Some parents prefer use of a pacifier over thumb or finger sucking for babies. Perhaps Mom received pacifiers as gifts at a baby shower, or an early trial stopped a newborn from crying. Parents may also perceive a greater public acceptance of pacifiers or have been advised by a doctor or family member that sucking a pacifier is an easier habit to break.

Remarkably, sucking a pacifier while sleeping has been shown to lower a baby’s risk of sudden infant death syndrome (SIDS), although the reason is unclear (Biello, D., Dec. 9, 2005). The lower risk doesn’t mean, however, that sleeping on the stomach is OK if the baby is sucking a pacifier. Caregivers and parents must continue to put babies to sleep on their backs because the practice has dramatically reduced SIDS deaths.

On the negative side, research indicates that continual use of a pacifier increases the risk of ear infections (Hanafin, S. & Griffith, P., April 2002). Sucking opens the ear canal wider and allows throat secretions to seep in, thus allowing the growth of bacteria. One study showed that limiting pacifier use can cut the number of ear infections by nearly a third (Peck, P., Sept. 11, 2000).

Furthermore, pacifiers can be annoying when they fall out in the middle of the night and parents must get up to stop the baby’s crying. Not so much with thumbs. Babies know how to find them in the dark and can go back to sleep without waking others.

If parents choose to offer pacifiers to their babies, these guidelines may be helpful:
If mom is breastfeeding, delay introducing a pacifier until breastfeeding is well established. Some observers believe that early pacifier use can discourage babies from breastfeeding at 3 to 6 months, earlier than they would ordinarily (Wellington, L. & Prasad, S., May 2012).
Use for emotional comfort, not to lessen hunger or delay meals.
Buy only the one-piece type. A multi-piece model can come apart and pose a choking hazard.
Buy a brand that is free of bisphenol-A (BPA), a chemical with uncertain and possible hazardous health effects (Bauer, Brent A., March 11, 2016).
Don’t coat a pacifier with a sweetener, such as sugar, corn syrup, or honey, because these sweets can cause cavities.
Never tie a pacifier to the child’s crib or around the child’s neck or hand. This could cause strangulation (American Academy of Pediatrics, n.d.).
Wash pacifiers often with soap and hot water to rid them of dirt and germs. If you’re out on the playground, have a bottle of water handy to rinse it off if it falls on the ground (Ellis, R. May 27, 2015).
Limit use to nap and night time. During the day, babies need to be babbling and developing language.

When prolonged thumb sucking causes concern
If thumb sucking becomes worrisome, two factors are key in deciding what to do: 1) the intensity of the habit and 2) the child’s age.

First, gentle thumb sucking is not so serious as vigorous thumb sucking. The vigorous type can affect the roof of the mouth (palate) and the alignment of the permanent teeth—and even baby (primary) teeth (American Dental Association, n.d.). A timely visit to a pediatrician or dentist can determine whether the child’s teeth and mouth are developing properly.

Second, pediatricians and dentists typically say that age 5, when the permanent teeth start coming in, is the cut-off time. Actually, kindergarten peer pressure can influence children to stop on their own.

As a practical matter, however, habits don’t end overnight, and it may be wise to begin observing the habit more closely and curbing the behavior between ages 2 and 4 (Hatfield, Sept. 10, 2015).

The following suggestions may be helpful:
Work together with parents as partners to help children stop thumb sucking.
Avoid pressuring or ordering a child to stop. Scolding, criticizing, and ridiculing the child may only make the habit worse.
By age 4 or 5, children can understand the reasons that thumb sucking can be harmful. Hearing it from a dentist can be more effective than hearing it from parents.
Talk to the child in private to spare embarrassment and involve the child in choosing a method for stopping.
If stress is a factor, offer comfort—give hugs, say reassuring words, or offer a soothing object (such as a parent’s scarf or handkerchief) to hold during the day.
If Jennie sucks her thumb without thinking about it, consider making a gesture, perhaps tapping your thumb to your chin, to her as a reminder.
Distract the child with something that requires using hands and mouth, such as clapping hands while singing a song.
Catch the child not sucking the thumb and recognize the effort to stop. Acknowledge the difficulty of stopping and say something like, “When you’re ready to stop, I’ll be here to help.”
Encourage parents to use their instinct in deciding whether to follow a dentist’s suggested techniques. Wearing a dental appliance, bandaging the thumb, applying a bitter substance to the thumb, or covering the child’s hands with socks may be too severe or even cruel.
Read books about thumb sucking to help children understand they’re not the only ones who have this habit. (See children’s books at the end of this article.)

Rule of thumb
Sucking, whether on the thumb or pacifier, is a natural reflex in babies. It’s self-soothing and helps children calm down and go to sleep. By about age 3, children typically give up the habit on their own.

If, however, thumb sucking is vigorous or persists to age 5 when permanent teeth begin to emerge, it may cause long-term problems in the shape of the mouth and alignment of the teeth. A visit to a pediatrician or dentist can determine whether to curb the habit. Work with parents on ways to limit thumb sucking that are practical and respectful of the child.

With regard to pacifiers, research has shown that continually putting babies to sleep on their backs with a pacifier lowers the risk of SIDS. One drawback, however, is an increased risk of ear infections, which can be important to parents whose children are prone to such infections.

So relax. With time and adult support, children will grow up with their mouths free to eat and drink, talk and sing, laugh and kiss.

Books for children
Jake’s Best Thumb, by Ilena Cooper. 2008. New York: Dutton Children’s Books. Jake can do everything while sucking his thumb—even tie his shoes and ride his bicycle. Family members remind him to stop, but only Uncle Matt understands the need for comfort. When Jake starts to kindergarten, one boy teases him mercilessly. In a poignant twist, Jake realizes he needs to quit.

Mia’s Thumb by Ljuba Stille. 2014. New York: Holiday House. Mia loves her thumb. Family members try different techniques to help her break the habit—ordering her to stop, bribing her with money, and buying her an ice cream cone if she quits for a half hour. But nothing works—until Grandma starts sucking her thumb.

My Thumb by Karen Hesse. 2016. New York: Feiwel and Friends. In delightful rhymed text, a child describes the love for her thumb: “It’s like there is some kind of glue/that no one, nothing, can undo.” Though she recognizes things she cannot do—“beat a drum/and eat a plum”—she does not give up the habit. Her story ends: “If it were yours, you’d love it too.”

Thumb Love by Elise Primavera. 2010. New York: Robin Corey Books. Anyone familiar with a 12-step program will smile at Lulu’s method of giving up thumb sucking. Consider the first page: “My name is Lulu and I’m a thumb sucker.” After a nightmare motivates her to quit, she offers the reader 12 steps to overcome dependency.

References
American Academy of Pediatrics. (n.d.). Pacifiers. www.aap.org/en-us/about-the-aap/aap-press-room/aap-press-room-media-center/Pages/Pacifiers.aspx.
American Academy of Pediatrics. (2018). Thumb sucking, www.aap.org/en-us/about-the-aap/aap-press-room/aap-press-room-media-center/Pages/Thumbsucking.aspx.
American Dental Association. (n.d.) Thumb sucking and pacifier use. Mouth Healthy, American Dental Association, www.mouthhealthy.org/en/az-topics/t/thumbsucking.
Bauer, Brent A. (March 11, 2016). What is BPA, and what are the concerns about BPA? Mayo Clinic, www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/bpa/faq-20058331.
Biello, David. (Dec. 9, 2005). Pacifier greatly reduces risk of sudden infant death, Scientific American, www.scientificamerican.com/article/pacifier-greatly-reduces/.
Chandler, S. (2012). Breaking the thumb-sucking habit, WebMD.com, www.webmd.com/baby/features/breaking-thumb-sucking-habit#1.
Ellis, R. (May 27, 2015). Pacifiers: In or out? WebMD.com, www.webmd.com/parenting/baby/features/using-pacifiers#1.
Hanafin, S. & Griffith, P. (April 2002). Does pacifier use cause ear infections in young children? www.ncbi.nlm.nih.gov/pubmed/11979200.
Hatfield, H. (Sept. 10, 2015). Nine ways to wean a child off thumb sucking, WebMD.com, www.webmd.com/parenting/features/9-ways-to-wean-a-child-off-thumb-sucking#1.
Mayo Clinic staff. (July 29, 2015). Thumb sucking: Help your child break the habit. www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/thumb-sucking/art-20047038.
Peck, P. (Sept. 11, 2000). Continuous pacifier use linked to ear infections. WebMD.com, www.webmd.com/cold-and-flu/ear-infection/news/20000911/continuous-pacifier-use-linked-to-ear-infections#1.
WebMD.com. (Nov. 18, 2017). Pacifiers or thumb sucking: Which is worse? www.webmd.com/parenting/baby/pacifiers-or-thumbsucking-which-is-worse.
Ubelacker, S. (June 30, 2012). Are pacifiers bad for baby? Parents debate pros and cons. Huffington Post, www.huffingtonpost.ca/2012/04/30/are-pacifiers-bad_n_1465915.html.
Wellington, L. & Prasad, S. (May 2012). Should breastfeeding babies be given pacifiers? Journal of Family Practice 61(5); E1-E3. In US National Library of Medicine, www.ncbi.nlm.nih.gov/pmc/articles/PMC3343725/.