I am worried my four year old is using a dummy/pacifier in school. Is it ok? Should I be worried and how do I stop them reverting to thumb sucking?

Helping your child stop pacifier and thumb sucking: a gentle approach

These behaviours, known as non-nutritive sucking, are common self-soothing habits that help young children feel secure, especially during times of stress, tiredness, or boredom. Whilst most children naturally outgrow these habits between ages two and four, some may need a little extra support.

Occasional thumb-sucking or pacifier use isn’t usually harmful, but prolonged habits, especially beyond age four or five, can affect dental development. Potential issues include:

• Open bite: Where the upper and lower front teeth don’t meet when the mouth is closed.
• Crossbite: When the upper teeth bite inside the lower teeth.
• Excessive overjet: When the upper front teeth stick out much farther than the lower front teeth, creating a noticeable gap.

However, it's important to note that many dental changes in baby teeth improve once the habit stops, especially if it ends before permanent teeth come in.

Additionally, pacifier use has been linked to a slightly increased risk of ear infections, while thumb-sucking doesn’t show a clear connection.

There are lots of gentle strategies to help your child stop.

Positive reinforcement.

Celebrate small successes with praise, stickers or a reward chart. Focus on encouragement rather than punishment.

Identify triggers.

Observe when your child tends to suck their thumb or use a pacifier. Is it when they’re tired, anxious or bored? Offering comfort, distraction or alternative coping strategies can help.

Empower your child.

Involve your child in the process. For example, read books together about kids who stopped thumb-sucking or let them choose a special toy as a “bravery reward”.

Reduce attention.

Sometimes, drawing too much attention to the habit can reinforce it. Gently redirect without scolding.

Provide comfort substitutes.

Offer them a soft blanket, stuffed animal or stress ball to help with self-soothing.

For older children or persistent habits...

Make use of reminder tools.

Bitter-tasting nail polish, fabric plasters or thumb guards can gently remind them without being harsh.

Seek professional support.

A paediatric dentist can discuss dental appliances if needed, or a child psychologist can help if the habit is tied to anxiety.

Use rewards.

Using positive rewards can be effective! Focus on celebrating efforts, not just outcomes. For example, praise your child for going a whole afternoon without thumb-sucking or for remembering to remove their thumb when gently reminded.

Seek help if needed.

If your child is distressed, the habit is causing significant dental issues, or you suspect underlying anxiety, consult your paediatrician or dentist. They can provide tailored advice and, if needed, refer you to a specialist. From a dental perspective, orthodontic braces can be used very successfully in the teenage years to correct any of the tooth movement caused by dummy/thumb use in the early years.

Remember, breaking a comfort habit takes time and patience. Be kind to yourself and your child during this process. With gentle support, most children successfully outgrow these habits at their own pace.

Dr Christine Riyad is a US board-certified paediatrician and a graduate of the Medical University of South Carolina. She completed her residency training in general paediatrics in the United States before sub-specialising in paediatric rheumatology at Great Ormond Street Hospital in London. She later became a Fellow of the Royal College of Paediatrics and Child Health, a designation awarded to paediatricians who have demonstrated advanced expertise in the field.