Oral Habits and Orofacial Development

Pacifier use and thumb-sucking are emotional and nuanced topics for many patients and their families. Oral habits are often developed as coping or self-soothing mechanisms and are correlated with increased dopamine release in the brain. While sucking can bring soothing to an upset child, it can also have a significant impact on the development of the face, mouth, airway and teeth. As noted in another clinical topics article, cells respond to repetitive movement patterns and alter physiology and structure as a result.  I wrote this article as a resource for parents who want the long “why” behind oral habit elimination and the ways prolonged oral habits can decrease the effectiveness of speech, language, feeding and Myofunctional Therapy.

First, what is typical swallowing? 

In the final weeks of gestation, a fetus learns to breathe-suck-swallow. This miraculous and nuanced breath and movement pattern provides foundations for a child to feed, swallow and breathe for the rest of their life. Sucking and oral exploration are normal and healthy parts of early infancy that provide needed oral stimulation and exploration and opportunities to bond with caregivers. But what happens when children engage in infantile sucking and swallowing patterns that exceed developmental age-appropriateness?

From roughly 0 to 4 months of age, infants demonstrate anterior (forward) tongue protrusion to feed and swallow. Some might comment that this tongue movement looks like tongue thrusting, but it is developmentally typical and necessary to keep an infant’s airway safe. At 4-6 months of age, after significant oral and airway growth, infants begin to develop lateral tongue movement, a very necessary movement pattern for eventual soft and solid food feeding. At a year, babies begin to bring the tongue tip to the alveolar ridge, a posture essential for matured correct swallowing. Prolonged pacifier use and thumb sucking reinforce infantile swallowing patterns and impede the healthy development of age-appropriate swallowing and feeding skills. Let’s break down why.

Why Oral Habit Elimination is Important

The thumb and/or nipple of a pacifier causes forward protrusion (forward movement) of the tongue and retraction of the mandible (backward movement of the jaw) during swallowing. Fingers and pacifiers also impede  a child’s lateral (side to side) tongue movement and impede the tip of the tongue from reaching the alveolar ridge (the spot right behind the front teeth). Pacifier use and thumb sucking have both been correlated with orofacial structural anomalies (more high, narrow palate), deformation of dentition (atypical tooth eruption, occlusion, specifically anterior open bite) and tongue thrusting or orofacial myofunctional disorder. Prolonged pacifier use has also been correlated with increased otitis media (ear infections) and a higher incidence of speech and language delays (as pacifiers are often left in the mouth during opportunities when a typical child would be exploring vocalizations, using words, socially engaging, etc.).

Thus, prolonged thumb and finger sucking and pacifier use reinforce infantile suck and swallowing patterns. They have significant detrimental effects on the healthy development of a child’s teeth and the bones and muscles of the face, mouth and jaw. A research study from Stanford Sleep Medicine has shown that such structural changes are correlated with increased risk for sleep-disordered breathing (SDB) and pediatric obstructive sleep apnea (POSA).

Is There a Time of Developmentally Appropriate Thumb Sucking and/or Pacifier Use?

Some clinicians think that pacifiers and finger sucking should be completely eliminated. Others argue that pacifier use and finger sucking are okay, but only during developmentally appropriate time periods.  Speech language pathologist and feeding expert Diane Bahr points to research that shows a correlation between pacifier use and a decreased risk of Sudden Infant Death Syndrome in young infants. She explains that thumb sucking and pacifier use are developmentally appropriate from 0-6 months of life. Bahr encourages parents to start weaning their babies off of pacifiers and digit sucking around 6 months of age and to completely eliminate these habits by 10 months to encourage healthy oral motor and facial development. The American Pediatric Association published an article with similar insights, explaining that pacifier use may be “beneficial” in the first 6 months of life, “however, the risks begin to outweigh the benefits around 6 to 10 months of age and appear to increase after 2 years of age.”

I was a thumb sucker and often joke that it is the reason I ultimately became a speech language pathologist. Oral habit elimination may seem daunting but is actually very liberating and fun! I provide a 30 day oral habit elimination program for pediatric and adult patients (yes there are adults who still use pacifiers and suck their thumbs. I am very eager to serve and support them!). The program is positive reinforcement and behavior modification based. At the end, if the patient chooses, we host a big celebration party with family and friends. Patients are empowered with tools and strategies that last far beyond therapy, building their self-confidence for years to come.

*The above topics are discussed in regards to typically developing children. Some children with developmental delays, genetic syndromes, cranial facial anomalies, dysphagia etc. demonstrate a different developmental pattern and may benefit from the the prolonged use of a pacifier and/or other tools outside of these parameters. Each patient presents with a nuanced story and different needs. That is why it is essential to discuss decisions with your doctor and/or have your child thoroughly evaluated by a professional who specializes in feeding and swallowing, such as a speech language pathologist or occupational therapist.