Suburban Myofunctional Therapy Clinic
Christine Stevens Mills BS, SLP, COM
IAOM Certified Orofacial Myologist
Speach Language Pathologist
After thirty-nine years as an Orofacial Myologist, I have heard it all!
Children truly are unique for they have a special way of seeing and saying the funniest things when I ask the $64,000 question, "Why do you suck your thumb?”
“I suck my thumb because it keeps me busy.”
“I am always so thirsty, so I suck my thumb instead of getting a drink of water.”
“I suck my thumb because it tastes so good.”
“I suck my thumb because everything is boring: It helps with boredom.” (This is a teenager talking)
Another question I like to ask, "What does it taste like?"
“It tastes like chocolate.”
“Both thumbs taste like chocolate?” “No, just the right one.”
Case Study #1 Boy, age 8 ~ Flaring centrals & open bite ~ Two fingers - pulling hair
Background: I received a phone call from a panic stricken mom. She was talking so fast I had to practically decipher what she was saying. She proceeds to tell me her son has been referred to me by their Pediatrician for help. I ask what seems to be the problem. He sucks two fingers on the left hand while pulling his hair out by the roots with his right hand. I’m afraid where he is pulling his hair out by its roots will not grow back and he will eventually be bald in that area. We made the appointment for Saturday morning.
Consultation: Josh and his mom arrived at 9:00 a.m. on a bright sunny yet crisp October morning. Josh appears to be a very nervous eight year old boy. While sitting in the waiting room I observe him arguing with mom and then the two fingers on the left hand went for the mouth and the right hand starts pulling on his hair. Josh while sucking his fingers seems to become so relaxed as if he is in a trance. I ask Josh what he is doing, in an inquisitive manner. He says, “Oh, I guess I’m sucking my fingers and pulling my hair.” The initial visit with Josh and his mom will be approximately one half hour long. I like to guide the conversation toward the client, not only to make him feel included, but to find out what he is thinking and how he feels.
We continue the conversation in my office. I ask Josh would you like to stop sucking your fingers. And if so why? His reply to me was as follows, “Yes, I want to stop sucking my fingers but don’t know how to.” I then asked him about pulling his hair. “I don’t realize I am pulling my hair. I then ask , “ Do you know you are not only sucking your fingers , you are pulling your hair out by its roots, which eventually can become a problem. Josh told me his mom and his Dr. have both told him he needs to stop soon. Josh continued talking and said he does want to stop sucking the fingers because of his age and he does not want his friends to find out he sucks his fingers. He was not as concerned about the pulling of the hair. “When do you suck your fingers Josh?” I only suck my fingers during the day, never at school. I like to suck my fingers in front of the TV. I feel comfortable and relaxed. I tell Josh and mom I would be glad to help him stop sucking and we can start a program next week.
Results: Josh is a little nervous when we sit down to begin the finger program. I tell him we are going to work on this as a team and have fun and even some laughs while on the program. Josh says, “I’m ready to get started!” I give him and his mom a sheet that lists the motivational tools they will need to begin the program. I also explain the trigger times (times that need most attention for those are the times he sucks the most, example in front of the TV.) That is where the Spoon Person is very helpful. I suggest that Josh make two Spoon People due to the fact he needs to keep both hands occupied. One spoon will help occupy the sucking hand, and the other to help the hair pulling hand. I tell Josh be as creative as you want to be. Have fun making your spoon people. Josh tells me he is going to make Skywalker and Chubaka from Star Wars. I tell him I can’t wait to see the spoons on our next visit.
Josh calls me the next day. He is so excited, he finished Skywalker and Chubaka and he watched TV with them. The spoons helped him remember to keep his hands away from his mouth. I praised him for his great work and told him to remember to mark his finger chart. (The chart is explained in the book template). Josh continues the program for a month doing extremely well-no slips of the fingers or pulling the hair. His hair is growing back nicely. Mom is very pleased. It is almost Halloween. I need to give Josh and mom some further preventive instructions. In my experience I have learned that holidays need special attention. During holidays one’s routine changes. Kids stay up later, foods change during some holidays no school-more free time. Halloween is a very exciting time for kids. Picking out a costume, trick or treating, and dressing up in that favorite costume can be very exciting. I’m sure you can guess what Josh is going trick or treating as! You’re right Skywalker. He tells me his mom even bought him a Light Saber. If a thumb or finger program coincides with a holiday I always extend the time frame of the program. I like to ease the client slowly off the program increasing control and confidence as we move toward concluding the program. Holidays change the regular routine so I like to extend the program through holidays to help maintain their successful routine. Josh got through Halloween with no problem. He had a great time trick or treating and even brought me my favorite candy as my reward for helping him. By the way he gave me a tootsie roll. YUM! He was placed on a program and stopped in 10 days. I however had the client continue to hold his spoon boy in the right hand for the next month to curb the hand from moving up to the hair subconsciously. His hair looks great now.
Case Study #2 Girl, age 15 ~ Open bite - sucked on pacifier
Background: I thought I had heard everything until today. The conversation I just had with a local Orthodontist was very unique. Dr. Owens called me this morning to tell me about a teenage girl he had a consultation with yesterday. She has a severe open bite because she still sucks a pacifier. The Orthodontist explained to Tiffany and her mom that before he could put braces on her teeth she has to stop sucking the pacifier. Tiffany emphatically denied pacifier sucking. Mrs. Russell interrupted her daughter and proceeded to tell Dr. Owens that Tiffany not only sucks the pacifier she would have a tantrum every time she or dad tried to take the pacifier away from her. Dr. Owens said Tiffany looked embarrassed. He then told Tiffany and her mother that he could not help her with the pacifier problem but he was going to call someone who might, and then called me. Dr. Owens proceeded to tell me he had a very unique case he wanted my opinion on. He asked me if I thought I could help Tiffany.
When I spoke with Mrs. Russell I explained I would be happy to have a consultation with her and Tiffany, and then make a decision as to whether I would accept Tiffany as a client.
During our initial consultation Tiffany appeared to be a very outgoing teenager,. While talking with her Tiffany told me she is very active at school, on the debate team, volleyball team, and a cheerleader. This surprised me for many individuals that have a sucking problem tend to be more introverted, less active, keeping to themselves. After some more general conversation I asked Tiffany why she came to see me. Her response was she didn't know. I already knew that was untrue after discussing the case with Dr. Owens. I let it go for now because it is very important within the therapy regime that the client admit what the problem is or therapy will not be successful. I thought I would give it more time, so she would feel comfortable due to the fact this was truly a unique case. I decided to set up a second appointment. Once an individual is comfortable with the surroundings and with me they usually open up and then we could begin a program.
Upon the second visit Tiffany was more open and comfortable however she continued to say she did not know why she was at my office. We talked for approximately a half hour and before we ended our visit I expressed to Tiffany that I was there to help her if she wanted my help but she had to tell me why she was at my office first. I also explained to Mrs. Russell and Tiffany that I would be willing to set up one more appointment. However, if we did not communicate then I would not be able to help Tiffany and they would have to seek help elsewhere, possibly a Psychiatrist or Psychologist.
Upon the third visit I asked Mrs. Russell and Tiffany to discuss if they wanted to meet me together or if Tiffany wanted to meet with me first by herself. Both felt it would be beneficial if I talked to Tiffany alone. By this time Tiffany was comfortable and proceeded to tell me how her Volleyball team was doing. She then said she wanted my help to stop sucking her pacifier. I told her that was half the battle to admit there was a problem that she wanted to stop and that we could work together. I invited Mrs. Russell back in and proceeded to formulate a plan. First we discussed when and where she sucked her pacifier and how she felt when she sucked it. It was also agreed that if she wanted to have beautiful teeth and for Orthodontics to be successful she had to give up the pacifier. She agreed yet was a little hesitant that she could accomplish such a feat. I promised her that she, her family and I would work together as a team just like she does at school working together with her teammates to accomplish their goals. That made her feel better.
I told her she had to first give up the pacifier cold turkey. Have a ritual, say good-bye and throw it away. She also needs to keep a chart to plot each successful day she completes without the pacifier. I also discussed with Mrs. Russell a reward system we would set up, where Tiffany would receive little items to express how proud the family is that Tiffany was brave enough to give up an item that is doing so much damage to her teeth. I also told Tiffany after she completed twenty days without the pacifier I would reward her with getting a manicure. She loved that idea. I suggested Tiffany check in with me at the end of every day to give me an update on her progress. She said I was her crisis line and she liked the idea that she could reach me any time if needed, as well as, to tell me how well she did each day.
I saw Tiffany a week later and she was beaming with delight. She had called me throughout the week so I knew she was doing well. However, when we had our visit she went into great detail regarding the exit of the pacifier. She went all out-she took a small box, made a paper heart and glued it to the lid of the box. Tiffany then placed the pacifier in it and secured the box with tape. She and mom had a little ritual in her room where Tiffany said good-bye to the pacifier and placed it in the garbage for pick up the next morning.
On our last visit Tiffany had completed a month with no pacifier and mom said Tiffany was happy and continued to be very active. Before mom left my office she wanted to speak with me alone. She reiterated how happy Tiffany was and how grateful the family was that Tiffany stopped this pattern. Mrs. Russell said she knew Tiffany was happy with what she accomplished due to the fact that prior to beginning the program every time her parents tried to take the pacifier away she would have a tantrum. This pattern ceased the day she threw the pacifier away.
Case Study #3 25 year old male ~ Overjet - thumb sucker
Background: Most people are very surprised when they ask me about the oldest individual that has come to me for help to stop a thumb or digit pattern. When I say the oldest person I have seen in my career to stop a thumb pattern was fifty-six I immediately see wide eyes and a jaw drop. After thirty five years in private practice I am not surprised by much anymore. So when I received a call from a 25 year old male who was referred to my clinic by his Orthodontist it seemed like a typical day. The Orthodontist explained to Mr. Cooper that Orthodontics could not begin until the thumb sucking stopped. He was very open regarding the purpose of his consultation with me. I thought that is always a good sign and the consultation was booked. During our consultation Mr. Cooper gave me some background. He then told me he had sucked on a pacifier while an infant until age 5 when the pacifier was taken away by his parents. He immediately started sucking his thumb. He sucked during the day, at school and to get to sleep. He continued by telling me he was so severely teased at school he gave up sucking his thumb there. However, he continued to suck in the privacy of his home and at night. As he got older he hid it from his parents. As an adult, “I was too embarrassed, as well as, I did not know where to seek help.”
Dan Cooper knew something had to be done before he could get braces. He felt his thumb sucking was just a habit that developed at an early age and he wanted to stop.
Results: Dan was placed on a thumb program. He stopped thumb sucking within 10 days and was very pleased with his progress and looked forward to beginning his braces. I continued to see him once a week for a month until he felt confident he could continue on his own.
Post therapy: I received a very nice phone call from Dan two years later. He said he wanted to thank me for my help. He was out of braces and into wearing a retainer. His teeth looked great; he got a new job, and was now engaged. All in all a very happy young man with what sounds like a very bright future.
Case study #4 Boy, age 6 ~ Open bite - thumb sucker
I received a referral from a previous client's mother. Mrs. Holiday called and asked if I would be willing to see one of her neighbors. She said she had told her neighbor Carolyn about her son's visits with me and how I helped him stop his thumb sucking pattern in ten days. The neighbor immediately wanted my number for she had been trying to get Tim to stop his thumb sucking .
When Tim and Mrs. Street arrived I immediately took a liking to Tim. He is a very vivacious energetic little blond boy. However, when he smiles I can see he has a severe open bite. Tim is comfortable in my office. He is such an outgoing kid I am sure he would be comfortable anywhere, he appeared to be that type of kid.
When Tim sat down in front of me I noticed he had his hands up on his face, then on his head, then pulling his ears, then back on his face. I knew this was going to be a problem. I thought I would ask Carolyn for some background while I continued to observe Tim.
Background: Carolyn proceeded to tell me that Tim prefers to suck his left thumb it is his favorite; however, he will switch from the left thumb to the right thumb. If neither are available he will then move on to whatever finger is available on either hand. (Very unusual) Sucking since birth, he has two favorite blankets, as well as, soft stuffed animals he likes to hold when sucking. He likes to suck during the day-at school-when going to bed- and while asleep.
Consultation: While mom is talking I am watching Tim who has had his hands up near his face and on his face nonstop. I definitely see a pattern emerging. Mom continues by saying she is concerned because of the malocclusion and the severity of the sucking pattern. During the consultation I observed pros and cons to beginning a program with this child. The pros are as follows: He is a very outgoing, pleasant, happy little boy. He acknowledged he wants to stop sucking and understands the physical damage that is occurring. The cons to beginning the program are as follows: During the consultation I observed that he could not keep his hands away from his face. This can be a real obstacle to a successful program due to the fact when the hands are constantly near the mouth the thumb or fingers can sneak in without being noticed until too late. After talking with Tim for a while I decided we would begin a thumb program on his next visit. I think what impressed me the most and swayed my decision to begin was the fact he is so enthusiastic about wanting to stop sucking his thumb and fingers and willing to cooperate. The desire, awareness and education is what lays the ground work for a successful program.
Results: Upon the next visit I asked Tim to make two spoon people to help him stop his thumb sucking pattern. I want him to have his spoon people help him keep his hands away from his face. I explained that keeping his hands away from him face was top priority to a successful program. I also asked to send his blankets on vacation during the thumb program. Tim was placed on a thumb-finger program. He has not sucked his thumb-fingers at school; he has not sucked his thumb-fingers falling asleep or while asleep. However, he has slipped twice at home during the day within the first seven days on the program. On the positive side he is trying very hard, is cooperative, and with the severity of this thumb-finger pattern has done extremely well in a short time for his age. His parents and I have praised him for his partial success and have expressed he has concurred half of the problem.
It was made clear he needs to work on keeping his hands away from his face. This was going to be his biggest obstacle to stop.
It has now been two months of no sucking, no fingers, no thumbs, none at all. Both parents are thrilled and so is Tim. In fact he told me he doesn't think about his thumb or fingers any more. Mom told me she never sees him with his hands anywhere near his face. This is a very big change in his behavior.
Remember, no two thumb or finger suckers are alike. You need to treat every single case as special. And after thirty-nine years of treating thumb and finger sucking there are still cases that challenge me. That is what keeps life interesting don't you think?
Case Study #5 28 year old woman ~ Open bite - thumb sucker
Background: Well it is late November we have had our first snow fall and the anticipation of the holidays is in the air. I am talking at an Orthodontic study club meeting tonight. I always enjoy this kind of meeting. Usually there are approximately twelve to fifteen Orthodontists at the meeting making it informal. At this kind of meeting there is more give and take, down to earth straight talk and tonight’s topic is open mouth rest posture and thumb sucking. Many of the Orthodontists I have known for years so it is always a pleasure to talk to this group.
When I arrive we get right to it. After discussing different causes of open rest posture of the mouth we move right into the topic of thumb sucking. Dr. Jones asks “If I have worked with adult thumb suckers?” I answer by telling the group about the fifty-six year old thumb sucker that was referred to me by a periodontist. She had sucked her thumb since birth and now if she did not stop she would lose her teeth. It is always amazing to me how surprised people in the dental field are when I discuss the ages of adult thumb/digit suckers. Dr. Jones then said he is going to refer a twenty eight year old woman with an open bite that continues to suck her thumb. I tell him I look forward to helping her. We continue the evening discussion.
Miss Casey called bright and early the next morning. She said Dr. Jones referred her to me. I was pleased she called so soon. We set up a consultation for the next morning; she said she did not want to wait.
Miss Casey was a very tall, confident, and straight forward to the point lady. She came right to the point regarding her thumb sucking problem. I need Orthodontia and Dr. Jones cannot begin until I stop sucking my thumb. I have tried everything. I have put that nasty tasting stuff on my thumb that is suppose to taste so awful you quit. I didn’t. I have tried gloves, an appliance to keep my thumb out of my mouth and have even tried hypnosis. I’m sure some of those remedies work for some people but haven’t helped me quit. I then ask Miss Casey some background on the thumb pattern.
She tells me she was born with the thumb in her mouth. Her parents tried to coax, then tried bribery, and later punishment to get her to stop. She continued to suck her thumb then and as an adult. She said she would come home to her apartment after work and sit in front of the T.V. and suck all evening. Miss Casey said she did not go out with friends often for the urge to get home and suck her thumb was too strong. I was definitely an introvert. Fortunately, my desire for straight teeth was stronger than the urge to suck my thumb and I am ready to do whatever I need to do to stop. Do you think you can help me?
I tell Miss Casey we already have with her being open, and honest regarding sucking her thumb and having the desire to want to quit.
Results: This young lady was placed on a thumb program and stopped sucking her thumb immediately. Evelyn Casey said she surprised herself at how quickly she stopped and was very pleased with herself in making the decision to stop and get braces. I also told Evelyn that she had the desire, determination, and drive to ask for help, do what needed to be done and that she did all the work and should be very proud of herself in conquering this problem. She was well on her way to a beautiful smile.
Suburban Myofunctional Therapy Clinic
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International Association of Orofacial Myology
The IAOM certified orofacial myologist is specifically trained to diagnose and treat orofacial myofunctional disorders. These abnormal tongue patterns can contribute to changes in natural growth and development which may lead to a malocclusion and complicate speech problems. The orofacial myologist is also trained to eliminate thumb-finger (digit) sucking habits which can contribute to multiple problems.