Q: Do you have any thoughts on thumb sucking as a way to move facial bones?  One of my four-year-old clients is a frequent thumb sucker. A professional on my team wants to encourage the habit to move this child’s facial bones as part of her craniosacral therapy. The therapist says that the child’s thumbsucking is “a pathological compensation for a structural anomaly.” Now the staff thinks that this child’s thumb sucking is okay. What do you have to say about all this?

I think the phrase “thumbsucking is a pathological compensation for a structural anomaly” is a very narrow view.  There are many reasons for a persistent thumb-sucking problem that have nothing to do with bones.  Here are a few examples:

• There are kids who suck the thumb because they are immature.
• There are kids who suck their thumbs because at their three-year checkup they overheard their pediatrician say that it was not a problem yet.
• There are kids who suck the thumb because they simply are imitating another sibling or friend.
• There are kids who suck the thumb because the only time their mom pays attention to them is when she is fretting over their thumb sucking.
• There are kids who simply like sucking their thumbs.
• There are kids who think of their thumb as their very best friend.
• There are kids who could stop sucking their thumbs easily but are enjoying the defiance it represents.
• There are kids who suck the thumb because they are insecure, or even traumatized.

I am always very wary of anyone who claims that “this is the answer” or “there is only one way to view this…”

I have had affiliation with, but no direct experience working with, a craniosacral therapist, and I have not encountered this situation.  However, we can think this through logically in a sequence like this:

• We know that pressure moves and re-shapes bones when applied over time.
• We know that orthodontia is prescribed pressure on bones to re-position the teeth and establish better occlusion.
• We know that habitual thumb sucking also can cause the facial bones and skull to re-position and to re-shape.
• But we also know that habitual thumb sucking is not prescribed.  Therefore, how do we know where and in what direction the skull will shift when a child sucks the thumb?  How do we know that the pressure he is applying will be of benefit to him?
• It is a given that any therapy designed to move bones should have a craniofacial expert or at least an orthodontist on the team to measure pre- and post-treatment with X-ray, cinefluorography, or MRI.
• If there were not a medical person like this involved in the team, I would caution against such an approach.

My opinion, based on logic and not on experience, is that therapists have no business moving bones without a professional on the team who can measure, prescribe, and monitor bone changes over time.  Thumb sucking is a very imprecise way to facilitate bone changes. It may or may not facilitate desired changes because it is not prescribed.