Binkies, Bottles and Thumbs, OH NO!

"So cute!" 

Babies with a thumb in their mouth always elicit coos and smiles from adults.  Until recently, even I thought that pacifiers were "okay", and that at least it wasn't the thumb in the mouth.  Now, though?  When I see babies and young children sucking on a thumb, pacifier, bottle, or sippy cup, I think oh nooo!  This baby, this child is permanently altering bones of their face, a change that can lead to severe consequences for their entire life.  Nobody is talking about this very real health issue that we are allowing to be created.    

When you know more, you see more.  Now I know, and am here to share with you what happens when things other than food or breast nipple are introduced to a baby's mouth.


Thumbs, fingers, sippy cups, arms, cheeks, blankets, you name it- babies and children suck on it, some for years and years.  You, as the caregiver, are charged with the well being of this child and it is up to you to give them the best upbringing you can.  I realize it's hard to take away that pacifier or sippy cup (more on this in a moment), but look at the lifelong consequences of not intervening early.    Here's a list of very real, very detrimental repercussions from what we, in the profession, call "Non Nutritive Sucking":  


     Crooked teeth                                Deviated nasal septum
     Underdeveloped jaw                     Jaw joint pain/dysfunction
     Wisdom teeth impaction               Snoring
     Obstructive sleep apnea                Sinus infection
     ADHD                                           Head and neck pain
     Ear infections                                Poor eye sight
     Allergies                                        Early wrinkles
     Elevated stroke risk                      Relapsed orthodontics
     Long face syndrome 

How does this happen?

Your baby's wellness begins on day number one!  It starts with oxygen, and creating/developing a great airway.  

Brace yourselves, here's the technical why: When thumbs, fingers, blankets or pacifiers are in the mouth, baby's bones mold around it because of the strong vacuum the sucking creates, and this then results in incorrect swallowing habits, that are likely life-long.  This non-nutritive sucking pattern also trains the tongue to rest on the floor of the mouth.  When the tongue rests down, behind the lower front teeth, facial development and growth goes awry.  The face bones grow down and back, resulting in an underdeveloped jaw, chinlessness and crooked teeth.  This then creates a narrow airway.   No air equals obstructive sleep apnea (OSA), even in children and sets them up for a lifetime of problems such as attention deficit disorder, stroke, heart attack and early death, yes- it's that serious. (Click on the underlined words for more information on sleep apnea and breathing.)   

When the tongue is down, the mouth is open.  When the mouth is open, the child "mouth breathes".  Mouth breathing, open mouth chewing, and lisping are all signs there's a problem with proper tongue placement and breathing.  The nose is made for breathing, that's its job.  The mouth is made for eating and talking, and only in an emergency, breathing.  The tongue, the mighty tongue! is the keystone of the head- it sets the groundwork for all facial development.  It's place, it's home, is on the roof of the mouth about a half inch behind the front teeth (not down on the floor of the mouth).  This placement encourages proper facial growth and development.  People always wonder why our jaws are shrinking and teeth "don't fit".  Folks, we are doing it to our own children.  We are  allowing the creation of crowded, crooked teeth and small, underdeveloped jaws.  This process is called klinorynchy.  We are speeding evolution along, and not in a good way. 


Sippy cups - even I'm guilty of giving them to my children.  I didn't know how bad they were for facial development (but boy, are they convenient - click here for a better, healthy spill proof cup and click here for a fabulous cup for little hands) unfortunately, they teach the tongue to sit down low behind the front teeth.  They interfere with developing a mature swallow.  Drinking from bottles and sippy cups instead of drinking properly and eating hard food also leads to insufficient jaw joint size and bone density as well as smaller, weaker face and neck muscles.  Pacifiers, blankets and fingers do the same.  


Here's the even sadder part, but probably the most important part- most pediatricians and dentists say: "no worries, the child will outgrow this habit by the time they are five years old, and that there's no real damage to them".   These doctors heard this in school and have never bothered to update themselves.  They could not be any more wrong!  Sixty percent of the child's facial development occurs by age four, and by age nine it's 90% completed.  Click here for my reference.  Most orthodontists wait until age 12 to start braces.  In my opinion, that's way too late. The jaw is too developed by this point, and the tongue's too big for the underdeveloped jaw - breathing problems continue, teeth are crooked, and bad habits are hard to break.  I attended the AAMPD Airway Summit in Tucson, AZ in September and heard Dr. Kevin Boyd, orthodontist, discuss how important it is to develop a good airway in children before the jaw develops.  A six year old in his orthodontic practice is an old child, almost too late to fix!  Crowded teeth are an indicator the face is NOT developing and forming properly and is actually collapsing.  Braces may fix the crowding but ignores the real root of the problem- the tongue position and the airway development.   Did you ever wonder why your ortho failed and you needed a redo?  Yep, it's a tongue and airway issue that was never corrected.  


Infants- breastfeeding is best, for as long as possible.  Breastfeeding provides unmatched nutrition.  The immunoglobulins and human protein in the breast milk help infants resist allergies.  Formula, on the other hand, provides a significant source of protein allergies and stuffy noses- and stuffy noses cause mouth breathing.  Breastfeeding teaches baby to swallow correctly and breathe while eating.  If you need to use formula, and most parents do at one time or another, please, sit baby nearly upright and use a nipple with the smallest hole possible so baby works his jaws to get the milk out.  Laying baby down with a bottle can result in ear infections. 


Okay, moving along from that intense section- take a deep breath (in and out through your nose!)

Mouth breathing- what to look for in your child

               Tongue should not be obvious when they talk except for the TH sound.
                Dark circles under the eyes from allergies
                Slumped shoulders

Flaccid lips, lips parted, upturned nose

                Poor sleep
                Large tonsils and adenoids
                Open mouth chewing
                Parted lips
                Upturned nose
                Flaccid lips


We'll talk about what do do in a minute.

 Next: the Thumb. 

I totally understand that babies need to suck to learn to soothe themselves.  I nursed my babies far longer than most folks thought "normal" for that very reason.  They need to suck.  One hundred percent of babies suck.  And I have no intention of ever shaming a child because they suck things.  I also understand they won't quit until they are ready.  


However- Parents, pay attention to what's happening.  The thumb pushes the lower jaw backward.  A lower jaw that is pushed backward creates an airway issue- no ifs, ands, or buts.


Often thumb sucking is accompanied by a bed wetting issue.  I wonder if this isn't linked back to lack of oxygen and a narrow airway?  When a child or adult is in deep sleep, they do not produce urine. When there's a lack of oxygen, the body puts out a hormone that makes more urine.  I wonder if the child, by sucking on something never reaches that deeper stage of sleep, but doesn't wake up enough to use the bathroom?  This is only my hypothesis, for now.  I'm still looking for data that discusses how deep babies and children sleep while sucking. 



Another ponder-able thought: the connection between tethered tissue under the tongue (tongue tie) to thumb sucking.  When the tongue is tethered to the floor of the mouth, it cannot reach "the spot".  (I did an entire post on The Mighty Tongue and discussed how important the spot is to correct facial development.)  "The spot" is the proper "rest posture" for the tongue, which I alluded to earlier.  It's just against the ridge you feel about a half-inch behind your front teeth.  This special spot is where the nerve endings from the trigeminal nerve open to the mouth.  When this place is rubbed, it releases endorphins.  (I know that sounds funny, but here's the source.) Also, rubbing this area stimulates the pituitary gland to release growth hormones.  Chewing, sucking and rubbing this area makes your child feel good.     

Again, I have a hypothesis- could the child have what's called a tongue tie?  There's a little piece of skin under the tongue,  and sometimes this short tissue holds the tongue down so it cannot reach the roof of the mouth. Read my blog post on tongue ties.  This can be gently cut to release the tongue.  Again sadly, most professionals don't know about or even recognize a tongue tie and the value of releasing it.  There is an association of professionals knowledgeable about tongue and lip ties called the International Affiliation of Tongue Tie Professionals if you have any concerns your child may have a tethered tongue.  

How Do I Help My Child?

1. Read Helping the Thumb Sucking Child by Rosemarie Van Norman.  Learn about the cause(s) of your child's habits,  so you can understand and address the whole behavior.  There are indeed gentle, constructive, and effective techniques to help your child.  Begin your efforts by reading Rosemarie's fabulous book to help guide you.  (Available on Amazon).   

2.  Seek out a myofunctional therapist.  When there's a finger or thumb involved, get help.  A myofunctional therapist can help your child in a positive way with behavior modification.  It is an extremely complex behavior.  Ignoring it and hoping it'll go away is not constructive. 

 3. Pacifiers are easiest to make disappear if they are "disappeared" one by one. (Again, I confess that I am guilty of encouraging my children to use a pacifier because it soothed them to sleep, and I admit, I wanted a decent night's sleep.) 


I've heard of parents snipping a tiny hole at the tip of the pacifier, which renders it un-suckable.  I suggest you keep pacifiers only in the crib to be used at bedtime.  Often, pacifier use will accompany a blanket.  Blanket and pacifier stay in bed.  Sometimes, when the blanket disappears, the accompanying habit may stop as well. 

  4. Sippy cups.  Use a real cup. Throw away those sippy cups.  Four-year-olds should not be using them. Period.     

My least favorite approach:

Palate expander and crib - do you want that in your mouth? 

Many dentist will recommend an appliance called a "crib".  It's basically a rake that pokes out so the thumb or fingers won't want to go in the mouth.  The problem with that, in my opinion, is the tongue needs to be on the roof of the mouth to expand the palate organically and with those spikes there, no tongue will rest up on the roof of the mouth.  Read my post on The Mighty Tongue to see why that's so important.  Once the crib is removed, the thumb goes right back in.  The root of the problem was never resolved. 

I have not touched on speech issues or speech-related issues, this is because I am not a speech language pathologist, so I cannot address speech issues with any authority.  

The benefits of proper facial development: 

               Strong jawline
               Optimal growth and physical performance
               Straight teeth
               Balanced facial features
               Higher IQ 


So: Moms, Dads, Grandparents, and relatives, the precious bundle you'd give your life to protect is in your care. Will you allow this to happen now that you know the very real consequences?
Put away those sippy cups, throw away the pacifiers, work with a myofunctional therapist to teach your child how to keep those fingers out of their mouths.  Your child needs you to be the parent.  Being nice and ignoring these problems is detrimental to their total health, development, and life-long well being. 

A healthy face looks good and has good tone.   
Do you want your child to look like Jamie (I'm a big Outlander fan) or Napoleon Dynamite when they reach adulthood? I vote for Jamie.

Sam Heughan as Jamie in Outlander 

Jon Heder in Napoleon Dynamite

It's in your control.
Til next time,

Health starts with you.  Now, you know more and see more.

Keep smiling,
Barbara 
Dental Hygienist Extraordinaire ;) 
Specialist in Orofacial Myofunctional Therapy