Please refer to the previous post, Part 1, for some background information about non-nutritive sucking (NNS) habits and tips and tools for addressing persistent pacifier habits in particular. Below, I include my dos, don’ts, tips, and tools to help your child stop a persistent NNS habit. By persistent I mean beyond the age at which the habit naturally wanes (3-4 years) and when there is greater concern about the habit having lasting effects on the teeth and jaw positions. These tips are a compilation of my experience as both a mother and a pediatric dentist. They’re also informed by the recommendations put forth by the American Academy of Pediatric Dentists and the American Academy of Pediatrics.
Part 2 is significantly longer than Part 1. The psychological factors discussed in this post apply equally to all types of NNS, including pacifier habits from Part 1, I just didn’t want to scare you away with five pages of text right out of the gate.
The dos and don’ts of kicking a persistent non-nutritive sucking habit
DO
1. Consider the psychological backdrop
Have you recently moved? Did your child just start pre-school? Did her favorite babysitter head off to college? Is there a new baby sibling down the hall? I often find that a persistent (or re-emergent) habit in an older (3+ years) child correlates with a big life event that impacts him psychologically. In those cases, I recommend giving him time, as the habit is meeting an important need such as providing comfort or a sense of predictability. Waiting to initiate cessation interventions until he has stabilized from the change is more likely to have a positive outcome. Let me say that again another way. It’s only when a child is psychologically ready to stop a habit that it will be possible to successfully intervene and help the child stop.
It’s only when a child is psychologically ready to stop a habit that it will be possible to successfully intervene and help the child stop.
Another contributing psychological factor I sometimes encounter in a child with a persistent habit is the presence of shame. This is often brought on by an adult caregiver or older sibling who displays a pronounced negative attitude toward the habit. This is the person who, the moment that thumb pops into the child’s mouth, yells out across the room, “Get that thumb out of your mouth! You look like a baby!” Unfortunately, this has the opposite of the intended effect because the child will soon retreat to the comfort of that habit as soon as the person is out of sight. Shaming the child never works. It only ingrains the habit, deepens the need for the psychological comfort it provides, and encourages hiding the habit.
Shame is also why sucking habits might persist through the start of preschool even though all of your friends swore to you that the peer pressure would make it disappear. The embarrassment and peer pressure had an effect, but the resultant feelings left your child yearning all the more for the comfort of the sucking habit.
2. In a calm, positive, and age-appropriate manner, discuss stopping the habit with your child and come up with a plan of action together.
Beyond infancy, a child with an NNS habit is usually getting something more out of the habit than just the comfort of the sucking reflex. If the habit persists beyond age three and you want to begin cessation efforts, you first want to get to the bottom of what that something is. Have a conversation with your child (or a series of conversations) in which you’re genuinely curious and not judgemental. You want to get to the bottom of two things in these conversations: the INs and the OUTs. What positive things (comfort, calming, self-soothing, attention) are flowing IN to your child as a result of this habit, and what negative things (anxiety, fear, worry, restlessness, stress, loneliness) are moving OUT of your child as a result of this habit?
Describe what you observe him doing or how he might be feeling when he reaches for his thumb. Is he tired, stressed, hungry, lonely, or anxious? Help him put a name to those feelings. “I notice that when you’re really sleepy, that’s when Mr. Thumb tries to sneak into your mouth. Does he try to do that at any other times?” Then get to the bottom of what benefit he’s receiving from the habit. “It seems like Mr. Thumb helps you feel calm and relaxed, is that right?”
Sometimes this is a child’s first encounter with the topic of feelings. At the end of this post, I will list several books that helped me begin to explore the topic of feelings with my two older children. Inside Out is also a wonderful movie that can help begin the conversation.
One crucial point to get across to the child in this conversation is that your love and acceptance of him will not change based on his success or failure at stopping the habit. Sometimes it is that knowledge alone that frees the child psychologically. You’ll love him no matter what. It’s true! So why not tell him loud and clear.
One crucial point to get across to the child in this conversation is that your love and acceptance of him will not change based on his success or failure at stopping the habit.
Once you’re armed with the INs and OUTs unique to your child and his habit, you can discuss some options for exchange and replacement. Maybe he likes the idea of a new fluffy blanket to help him relax and feel calm when he’s sleepy. Or maybe he’s interested in a new stuffed animal or pajama set that he associates with his decision to stop the habit and it makes him feel empowered and calm. Maybe you both agree to ten minutes of quiet time together, no devices or distractions, after dinner. The key to success regardless of the method chosen is to get the child to buy in and to want to stop, too. You want him to be the one coming up with ideas as to what will help him meet the needs previously met by the sucking habit.
3. Involve the dentist.
What if your child is older than age three and isn’t interested in stopping? Sometimes a talk with another adult, like the dentist, can help, especially because we are well-versed in the art of explaining in kid-friendly language the impact of persistent habits on the teeth and mouth. Often the conversation is as simple as explaining that the habit can make the teeth crooked, and we want to work together to help the child have straight teeth.
A great tip for digit-suckers is to discuss the digit as an entity distinct from the child, e.g., Mr. Thumb or Peter Pointer. It provides a degree of separation between the child and the offending actor, which makes it easier for the child to imagine himself participating in a plan to stop the “bad guy.” Many a successful caregiver has reported to me that she adopted this language, calling out the habit with, “Oh no, don’t let that sneaky Mr. Thumb crawl in there and make your teeth crooked!” When accompanied by a mock expression of horror and giggles, the child will often play along and swat the offending hand away. Do you see how the child and caregiver position themselves as a team compared to the shaming and blaming described previously in part one with, “Get that thumb out of your mouth!”
4. Understand it may take weeks
Research shows that even for an adult, the average length of time it takes to break a habit is twenty-one days. That’s three weeks. So please don’t expect a quick fix and instant results. I find that when parents see the habit from a psychological standpoint rather than as a simple on-off switch, they’re better able to praise the little successes and simply move past the slips and setbacks as expected parts of the process. Give your child and yourself some grace. Most of the time, the habit will stop with time, praise, encouragement, and, most importantly, the child’s belief in your unwavering acceptance of who they are, regardless of the outcome. Keep it fun, playful, and with you and your child on the same team!
DON’T
1. Give the habit excessive attention
The quickest way to make a habit stick around is to give it excessive attention, whether positive or negative, especially before the child is psychologically ready, willing, and able to stop. If the child isn’t ready to stop the habit and you continue to bring it up before the time is right, it will only more deeply ingrain the habit. This applies all the more to the shaming-type comments mentioned above in part one. Negative attention is still attention, and a child may persist in a habit even if a caregiver yells every time he does it because, “Hey, dad’s looking at me and not at his phone!”
2. Try to force the child to stop before he or she is ready
If an older child doesn’t want to stop a sucking habit, she won’t. If all the encouragement and positive discussion in the world isn’t helping, then you may want to consider involving a family counselor or therapist to help you get to the root of the INs and OUTs for your child and the habit. Though rare, persistent habits can point to abuse or other underlying psychological issues that the child is unable to or unwilling to share with the caregiver. There is no shame in seeking the opinion of a licensed professional in the case of a persistent habit.
Suffice it to say that paying hundreds of dollars for an orthodontic appliance to stop a sucking habit is money wasted if the child doesn’t want to stop the habit. She will pull the appliance out, repeatedly, and sometimes to the detriment of the teeth to which the appliance is glued. An orthodontic appliance or any other habit-halting equipment (thumb guards, gloves, mittens, fingernail polish, etc.) will only work for an older child when she wishes to stop the habit. Any equipment used must be viewed by the child as a desired tool and an aid to her decision. Otherwise, forcing these orthodontic tools upon the child may result in her experiencing a loss of the sense of control over her own body and invite resentment and shame.
Okay, doc, I’ve tried everything and my child is still sucking his thumb
Your child might be destined for dentistry, and I don’t mean just braces and retainers. Several dentists, hygienists, and dental assistants I know sucked their thumbs well into their elementary years. It probably reflects a certain degree of self-confidence and determination to persist in doing something despite the peer and parental pressure. If you’ve tried it all and you’re at your wit’s end, I’m not going to tell you to give up, but I am going to encourage you to let it go. Let go of your child’s habit and accept that it is not within your power to make your child stop. Ultimately, your child has to be the one to make that choice. You can help him, but he has to want your help.
Sometimes it is the simple act of the caregiver letting go and fully accepting the child as he is, habit and all, that results in the child choosing to do the same.
Sometimes it is the simple act of the caregiver letting go and fully accepting the child as he is, habit and all, that results in the child choosing to do the same. Many a caregiver has reported to me that when they finally stopped worrying about whether or not their child would ever outgrow the habit, the child stopped. But even if that isn’t the case for you and your child, at least you will no longer be worrying (about the habit, anyway). Please rest in the fact that there are some pretty amazing humans out there who sucked their thumbs well past age three (and a few who still do, even as adults)!
Tools to help your child stop a digit habit
If your child wants to stop and she just needs a little reminder or help, these are some of the tools I most frequently recommend in my practice. Start simple and inexpensive and work your way up as necessary. For bedtime thumb sucking, my first recommendation is to use a family member’s stinky socks as mittens. I know, it sounds ridiculous, but you’d be amazed how often this works. It’s just silly and gross enough that kids really like it. Place the socks over their hands at bedtime and see if it helps them resist the habit by morning. You can place a rubber band or elastic (loosely) around their wrists to help keep the socks in place. A similar concept, but less yucky, is scratch sleeves (Amazon). They’re great for stopping scratching due to eczema or mosquito bites, but also for thumb-sucking cessation.
Many families report success with using a bandaid wrapped around the offending digit as a reminder. A bitter-tasting fingernail paint or polish (e.g., Nixxit or Mavala on Amazon) on the fingernails could also do the trick, but again the important distinction is that the child wants to stop the habit and is choosing to use this as a tool to serve as a reminder. The finger paint will not work as a deterrent for a child who wants to keep sucking his thumb.
Slightly more aggressive interventions would physically restrict the child’s ability to move her hand to her mouth, such as a loosely wrapped ace bandage around the elbow or the Nipit arm brace (Amazon). A thumb guard (Amazon) works similarly, but wraps around the wrist and thumb and allows the child to still use her arm.
Orthodontic interventions such as bonded appliances work well for older children who need the reminder and don’t want to use any outwardly visible tools. There are several different types of appliances, such as thumb cribs and rakes (these have spikes and are not-so-gentle reminders) or bluegrass appliances (these have a bead which serves as both a gentle reminder and a distraction because the child can play with the bead using the tongue).
Questions?
I hope this brief (ha!) summary helped you and your child in your journey toward stopping an unwanted habit. If you’ve still got questions, please leave them in the comments below.
Books (Amazon)
- The boy with big, big feelings by Britney Winn Lee
- My many colored days by Dr. Seuss
- In my heart: a book of feelings by Jo Witek
- The color monster: a story about emotions by Anna Llenas
