Question:  I have a client (5-years) who sucks her thumb.  She has a lisp and produces most of her consonants while protruding her tongue.  I perfectly understand that unless we resolve the thumb sucking, the protrusion will not going to go away, but her parents are not on the same page as me.  What techniques would you recommend to decrease the thumb sucking?

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You're definitely right in that the tongue protrusion/thrust isn't going to go away until the thumb sucking goes away.  And the thumb sucking isn't going to go away until mom and dad get on board.  There are many potential side effects you can discuss with them to help them understand the situation:

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DENTAL 

Suggest that they make an appointment with their daughter's dentist and/or an orthodontist who knows about tongue thrusts.  They'll be able to show that the teeth are being pushed forward or if the palatal arch is high from thumb-sucking.  And even if there are no visible side effects yet, they can explain their likelihood and discuss potential dental/orthodontic bills later on.

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SPEECH 

Explain that similar to the effects of a spouted sippy cup, sucking her thumb has promoted a tongue thrust, which is not a normal tongue position except in young babies suckling from a bottle.  This is why she's producing certain consonants with her tongue protruding (or against the front teeth), and why she has a lisp.

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FEEDING 

Explain that in addition to the speech problems already present, tongue protrusion can cause feeding problems.  There are a couple ways you can demonstrate how a tongue thrust affects feeding/drinking:

•  Pull the lower lip down with your thumb and ask the child to swallow.  She may not be able to because she needs her lips to assist the swallow.

•  Ask the child to chew a cracker.  Have her open her mouth to show you the chewed food before she swallows.  You may see food particles scattered throughout the oral cavity without any bolus formation, as the tongue is not strong enough to manipulate the food into a ball.

•  Sometimes individuals with a tongue thrust are not able to drink from a water fountain without making some kind of adjustment to get the water into their mouth (like turning sideways).  So have her take a sip of water, lean over a garbage pail, and swallow without turning her head.  See if the water falls out of her mouth.

The tongue is the major factor in all of these situations and many more.  When you suck your thumb, the tongue often rests forward and low under the thumb, which can allow the tongue to become flaccid and unable to function properly.

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SOCIAL

Thumbing sucking is a habit, and many habits get harder to break the older you get.  That is not fair to the child because she is too young to understand the side effects and make the right choice.  As she gets older, it will become more inappropriate and could cause social problems.  Other children may make fun of her and call her names if she sucks her thumb at school.  Kids may also make fun of her lisp.  People may have a hard time understanding her, or may be too distracted by the lisp to focus on what she's saying.  This could even affect her career options, as some employers are judgmental, and some jobs require clarity of speech.

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HYGIENE 

From a hygienic perspective, she is also putting germs and bacteria in her mouth.  She herself may be good at washing her hands after going to the restroom, but some children aren't.  Say a non-hand washer opens a door and she opens the door after him, she's at risk if she sucks her thumb afterward.

Discussing these points with the parents might not be a comfortable conversation to have, but it sounds like it's a must.  They will have resistance and tough days ahead of them, but there will be even tougher ones if something isn't done now.

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As for methods for decreasing thumb sucking, there is no one right answer.  I'm afraid it can be a very tough habit to break sometimes, and there may be a lot of trial and error to see what works.  Some of these strategies may help though:

•  In simple terms, explain to the child why it's important to stop.  Kids can understand a lot more than we know.

•  Thumb guards are a possibility and come in a variety of different options.

•  There are also many different bad-tasting polishes on the market that can act as a deterrent to sucking one's thumb.

•  For younger children, redirecting the behavior towards a safer oral fidget may help.

•  If children are sucking their thumb in times of stress or to self-soothe, help them develop healthier coping mechanisms.

•  As a last resort, dentists can also put in a built-in device in the roof of the mouth (something they can discuss while at the dentist).  Some people may balk at this (and the nail polish) as cruel, but I doubt the same people have personally been in this situation as a parent who has tried everything else.  Or as a parent who understands the much bigger physical, emotional, and financial hardship that thumb sucking can lead to.

•  Pam Marshalla's wonderful book How to Stop Thumbsucking can offer further guidance.

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In the meantime, have the child use drink from straws - drinking from a straw encourages the tongue to retract and the cheeks to tighten and do some work, too.  To get the most mileage here, use the Lip Blok Hierarchy.  Start with the longest Lip Blok (¾").  Once she can drink comfortably at that length, progress to the ½" and eventually the ¼".  This hierarchy will teach her to put less and less of the straw into her mouth, and to tighten and retract the tongue.  You can also use one of the Flexible Lip Bloks instead (standard, Mustache or Lips).  The same concept of smaller and smaller lengths, except that you'll slowly trim these over time to achieve those smaller lengths.

Work on teaching the child where her tongue should be in resting position - tongue tip on the alveolar ridge.  If necessary, use a Probe to give her a tactile cue for where the tongue tip rests.

Tongue pops are a great oral motor exercise to strengthen the tongue, and using whistles therapeutically may help as well.

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I hope some of this information helps.  Good luck!

Debbie

Debra C. Lowsky, MS, CCC-SLP

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