Ep 334: Bye-Bye Thumb! Myo & Airway Strategies to Break the Habit - for Good

Because it's not just about removing the thumb. It's about giving the body a better, like, functional substitute. Older kids, though, often have, like, more entrenched habits like, and they have more obvious structural signs.

Welcome to the Untethered podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner, and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy and airway tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest.

Posture. Tongue up, lips closed, teeth apart, breathe through your nose.

Let's get started.

Hello, my friends, and welcome to episode 334 of the Untethered podcast. We are going to be tackling a big question. I feel like this comes up a lot, so this definitely deserves to have its own episode on the podcast. And that is, how do we help children stop sucking their thumb? Especially when it's more than just a habit. Okay, so like I said, we hear this all the time, so let's jump in. Okay, friends, so like I said, this is a question we hear all the time from parents, from therapists, from pediatricians. Right? And here's the thing. Thumb sucking isn't just a behavior. It is often a compensation for something deeper, like airway obstruction or poor oral function. Okay, so in this episode, I'm going to break this down for you and we're going to talk about why thumb sucking happens, why it's so hard to stop, how airway and oral dysfunction play a role, what we can do with certain tools and therapy, and how we go even deeper inside of Feed the peds, the course that I teach. Right. To assess and address these cases holistically. Holistically. Okay, so let's jump in. Thumb sucking, my friends, is not just random. It is a. It's a red flag. And I. I don't love that word red flag, but I do feel like it's a red flag. And it's. It's a red flag that we all need to be, like, majorly paying attention to. So I'm just gonna let that term live on here. Okay? I want to reframe it for you, because it's not just A bad habit. It's often a compensatory behavior from an underdeveloped or a dysfunctional oral system. Okay, an oral system. What do I mean by that? Like your mouth. What's happening inside the mouth? Why is there dysfunction in there? Is the mouth underdeveloped? When I say underdeveloped, I'm usually talking about the jaws, the bones, right? Your, your maxilla is your upper jaw, your mandible is your lower jaw. Are we compensating for that, being underdeveloped or dysfunction occurring, which. This can all be interrelated. There could be dysfunction occurring because we're underdeveloped, right? So here, here's what happens. We learn to follow the path of least resistance and figure out a way to self regulate which our tongue should be doing for us. If our tongue is able to live in the roof of our mouth and it's up there, it creates endorphins. It feels good. Now, a child can't tell you this, right? We can't even really voice this as adults. But when the tongue is not up there in the roof of the mouth for whatever reason, maybe there's not enough space, maybe there's a tongue tie, maybe there's some other oral dysfunction going on. Whatever the case may be, we have our bodies just find ways to self regulate and in goes the thumb for a lot of kids, right? And this happens due to poor airway or tongue posturing like I was mentioning, right? So this is a major red flag for sleep disorder, breathing, sensory dysregulation, or even muscle imbalance, right? So if a child is dependent on thumb sucking, especially beyond like the younger years, like beyond age 2 or 3, which honestly, we should never need to suck our thumbs up. But this is often the times beyond two to three when we tend to get parents who are like, hey, how do we break this habit? And oh, this is a problem. Like how do we, how do we help the child get the thumb out of the mouth? Right. Um, regardless of age, though, we need to ask a few questions. Number one, why, why do they need to do this? Number two, what is it doing for their body or their brain or both? And number three, could this be a sign of airway obstruction? The airway is blocked. The airway air is not flowing the way that it should. Maybe it's not completely obstructed, but there's reduced airflow or, and, or oral dysfunction, like what's going on in the mouth. Right? So I really want you to focus on those questions because again, the thumb is in there for a reason. And we have to become airway detectives, if you will, and figure out why the thumb is in there. And so inside, like, feed the peds inside my, my 12 week feeding course, my pediatric feeding course, we, we help SLPs and OTs actually assess this, figure out like a whole body approach that doesn't just target feeding, but also targets underlying airway and oral motor issues that show up through things like thumb sucking. And we really hone in on, like, how do we address this? Because listen, there are thumb sucking elimination programs, but oftentimes they only work for a short period of time or they don't work at all. And there's reasons for that. And so what I, what I realized by working with older patients, patients, like older children and adults and like, I think there's some crazy number, like a third of adults, like, suck their thumbs behind, like closed doors. Don't quote me on the exact number. Go look it up yourself. But I'm telling you, it's high. It just made me kind of go like, wait, wait, wait, what? Like, why are adults doing this? Why are kids doing this? Let's figure out, like, what the issue is. And so if we can just kind of remember, thumb sucking is not random. It's actually telling us a story and it's serving a purpose. We have to then figure out what that purpose is. Okay, So I am going to give you some tools though, and some things you can do for kids who are under the age of four. I don't. Here's the thing, like, you can use something like a myo munchy, okay? Because that really helps with chewing skills and development of oral, the orofacial complex. And it can replace the thumb and it's a healthier habit. But I don't want you to skip the airway. Okay? So stay with me here while we talk about this. For toddlers and preschoolers who are still sucking their thumb, this is a really prime time for early intervention. And so a tool that can be very helpful on its own. But in conjunction with therapy and in conjunction with teaching the oral structures, like where they're supposed to live and how they're supposed to function, and all these fun things we can use, like a myo munchie mini or baby. It gives them the oral input, input they're craving. It is a way to start developing tongue, jaw, lip coordination, which many of our kids are lacking. And it's a replacement for the thumb that encourages nasal breathing. Okay? So here's the catch though. If that thumb is being used because the child can't breathe properly through their nose. We cannot be number one. We shouldn't be plugging them on the mouth because they need the mouth to breathe right now. But you're not going to eliminate the habit until you address the root cause. Okay, so again like that's why I have an entire course where I teach this inside of that course. But in feed the peds, you know, I, I train on like how to recognize, you know, things like nasal collapse, how to screen for tonsils and adenoids, you know, concerns with, you know, and mouth breathing, how to refer to. And actually I'm doing a free training that's going to go over a lot of this actually, especially the screening part of it. How to refer to ENTs, airway dentists, sleep doctors when appropriate, if necessary, building an interdisciplinary, you know, treatment plan that works and interdisciplinary treatment team as well when needed. Because it's not just about removing the thumb, it's about giving the body a better, like functional substitute. And I do want to stop for a second and plug my free training. Actually it's coming up the week of September 8, 2025. So if you're listening, go to FeedThePedes.com backslash training. Join us because I am doing a free three day training. Totally forgot about that, where we talk about how to screen for all of these things. And like literally we're going to screen the 50 most common symptoms that we see in pediatric cases. I'm going to teach you exactly how, how to use a milestone chart, how to use it with your families, how to screen for all these things, how to figure out what you need to assess for and even what referrals you might need to make. Like we're going to go over all of that in our three day training together. So like I said, go to feedthepedes.com backslash training. This was not actually meant to plug that, but here we are. So I'm going to, so yes, please join me. Okay. And that's completely free. Okay, so now I want to talk about like our kiddos that are not birth to four, but four plus because these kids kind of move into more of that myo motivation, you know, airway awareness age cohort if you will. And so older kids though often have like more entrenched habits like and they have more obvious structural signs. We are seeing more and more at younger ages though. I do want to say that, but because we're everything I'm mentioning, we do see under the age of four, but especially over the age of four. Like, they could become a myo case. And I even talk about how to figure out whether to refer for, like, feeding or myo in my free training. So there's that. But we're talking about things like open bites, narrow palates, mouth breathing while they're sleeping, dark circles under the eyes, forward head, neck, posture. Right. That thumb. And this is true of young kids, too. So I don't, you know, I don't want to say four plus myo age, because really, it's all. All pediatrics, all infant toddler. You know, as soon as they're sitting up and like, you can see if they have a forward head posture, dark circles, circles under the eyes, mouth breathing. The open bites or narrow palates. You know, the narrow palates you can see from birth. The open bites you'll see once those teeth start coming in. And that's more of a symptom of the tongue being in there, having an open bite. But that thumb is often their airway crutch. Okay. It's a way to get their tongue out of the way and prop the mouth open so that they can breathe. So we can't take the thumb out until we replace that need or until we kind of fix what's going on. Right. And open up their airway. So here's what we got to do. Number one, we need to assess the airway first. Airway is always first in everything I do and everything I teach. Number two, we then need to educate the child, like, if they're old enough, basically. This is how your body's been trying to help you breathe, right? We explain to them what's going on. Then we can use things like pediatric feeding or even myofunctional therapy, depending on the age, to work on elevating the tongue, getting that tongue up and breathing through our nose. Nasal breathing, right? Sealing the lips, keeping the lips closed when we're not eating or speaking. And then also, like, where everything should be at during the day and at night. Hint. When you're not eating or speaking, everything should be in the same place. Like I just said, you know, tongue up, teeth together, lips closed, breathe through your nose. Like, we need to be using our myo superpowers regardless of what our age is literally should be happening from birth. Once that nasal airway clears from all of the stuff, you know, coming out of the. The birth canal and out of the womb. And, you know, yes, babies do take time to clear like that. Those lips should be together. We should have the tongue on the palate. We should be nasal Breathing literally from birth. So just like let that sink in. Okay. Anyways. All right, so what else can we do then? We can replace the thumb potentially with the munchie. Like a myo munchie. The baby, the. The mini. The baby, the junior appropriate chewing tools. Right. We can also use things like chewy tubes and other types of chew, you know, objects and everything that are meant for this because we're giving them like a purpose behind the function. Like this. This is purposeful chewing, right? This is purposeful function. We're building muscles, we're helping support the orofacial complex with doing this. And it also will help set up a positive. You know, if you want to set up like a type of a behavior plan, which some people get really, really hung up on, I don't love them. But if you want to do that, like if you've tried everything else and nothing else is giving, then maybe that's where this comes in. But like, you know, a sticker chart, something like that. Yeah. Can only do something like that after airway is addressed. We have to address airway first. And I will tell you that the thumb sucking programs that I use in the beginning of my MYO career and that I still see out there, and this is not just like. And this is multiple, they don't address airway first. If we're actually addressing airway first high, like you could do feeding therapy, you could do myofunctional therapy and address airway. And oftentimes the thumb will fall by the wayside. They won't need it anymore. So why are we putting kids through these programs that are stressful for them and trying to reduce the stress load to basically say bye bye to the thumb to then have them get sick, get stuffy, and the thumb go back in again.

Right.

We're not actually solving the problem. We're solving the problem like temporarily, but not permanently. Like not long term. It's more short term than long term. And so how can we short, how can we solve it long term? We address the airway and hope the thumb falls by the wayside. And if it doesn't and the child's over the age of four, then maybe we do one of these, these plans, right? These behavior type focused plans to then get the thumb out and have the child, you know, replace it with something else. But again, they need to be like, at least cognitively at a level of like a 4 year old to do that. Okay. You know, and in Feed the Pizza, I also talk about like how we collaborate and all of us Taught instructors talk about how we collaborate with other providers, like aunties, pediatric dentists to build like a full circle care plan. Like in these cases, like, I focus on this in the, in module 7 and 8, the TOTs and MYO modules. But anywho. Okay, so let's talk a little bit about sleep and breathing and why, you know, we need to dive deeper into these things. Because, let's be honest, no one is fixing thumb sucking if the child is mouth breathing at night, if they're snoring or restless, if they're chronically congested, if they're waking up sleep super tired and cranky. I don't know about you, but, like, I. I'm not sure how you're gonna fix the thumb, get the thumb out and keep it out when the child still has all this going on. Okay. Because this is sleep disorder breathing. And this, my friends, is. This is what I've been trying to tell you. Like, this is the driver of the thumb sucking. So that's why in Feed the peas. There we go, plugging it again. But inside Feed the Peas, I do teach you, like, ask the right sleep and breathing questions during your evals. Like, use the checklist for symptoms. Right. Understand how airway and feeding and myo connect and airway and feeding. You know, especially with our little, little, little ones. Right? Because myo, yes, is all like, airway dependent too. But, like, there is a connection between all these and high. That's why the Untethered podcast talks about airway, myo, tether, oral tissues and pediatric feeding. Because I was like, nobody else is doing this. And now I feel like now more people are. That's great. But, like, nobody was talking about this, like, back in 2019, and they especially were not integrating pediatric feeding into it. And I was like, hello? Like, we need to educate the public. Here we go. Let's create this podcast. And we have not missed a week since, which is absolutely wild because we're at over. We're over 330 episodes now. So crazy. But I love this. Okay, so, and then I also, you know, we teach, like, how to confidently refer and advocate and educate families on, like, what's next and all that. So, like, whether you're an SLP or ot, like, this is one of the most powerful skills you can have because you stop treating symptoms as a feeding therapist and you start treating the whole child. And the same goes for you if you're an slp, ot, pt, rdh, or dentist. Like, again, you're not going to just be treating the symptoms in Myo cases and airway cases, you're going to start treating the whole child or if it's an adult, the whole, you know, adult. The whole patient.

Right.

Which is so important. So some final tips and tools. Okay, so using things like I mentioned the munchie Mini baby junior based on the age could be great. Maybe you do move into using like visual trackers and sticker charts if you're going the behavioral route. But like airway has to be addressed first. Okay. There are books out there that talk about like thumb sucking and stuff. So like David decides about thumb sucking is one of them. And I know there's other things out there. I know things have been coming out recently too. So definitely, you know, go on Amazon and see, see what you can find and see if there's anything. Because just I think the awareness, especially in young children to thumb sucking and, you know, not thumb sucking, I think are really important topics to just bring to their awareness of nothing else. And then having a supportive referral network. Like you want to build out that referral network of like ents, away dentists, OTs, sleep doctors, you know, SLPs, lactation, et cetera, et cetera, et cetera. What I want to caution you on before we start to wrap up is I want you to avoid shaming or punishing the child for thumb sucking because, hi, they need to do it. It's actually sustaining their life sometimes it's keeping their airway open and we need to breathe to live. So no shaming, no punishing. Okay, thanks. We also want to avoid forcing thumb elimination when the airway issues haven't been resolved. Hopefully. I've like really honed that one today and you were like, okay, Hallie, I heard you say that five times. Fantastic. That was my goal. Right? And then giving generic advice without like function focused strategies. Like a lot of people are like, oh, you could try this, or oh, have you tried that? Or put this on their finger, this, that. There are so many things out there that honestly are not helpful because airway is going to trump everything else. So if there is an airway issue at play and that's the root cause of the thumb sucking, let's go back to function. Let's go back to function and not just give like random strategies to appease a parent. But like, we need to do better education and we need to have conversations around, you know what, this is why I, I suspect your child is doing this. So let's address this and then we'll see if the thumb sucking kind of goes by the Wayside, we'll give them a tool to replace it as well in part of that process. And if it doesn't, then we can address it in a different way. However, first we need to make sure all the structural and functional issues are addressed. Okay, so that's, that's my little, my little PSA there. Okay, so if a child is thumb sucking past toddlerhood or at all, chances are their body is telling us something. The goal isn't just, it's, it's not just to stop the habit, it's to uncover the why and give them a better, healthier way to self regulate and breathe. And again, I know we mentioned under two or like if they're over two, but really in infancy also, like once they're old enough to like be putting that baby, the, the mini munchie in their mouth like that, my friends, might be a good idea, but we want to uncover the why. We want to give them a better, healthier way to self regulate. A healthier way to breathe through their nose. Right? And so if this is like something that you've been looking for or you've been wondering about, like please, please, please, like, please, airway first, always. Okay, because if you want the step by. But here's the thing. If you want step by step, like systems for like airway feeding, myodevelopment and all that, especially, you know, whether it's in the little ones or the older ones, we've got something for you. For the kids who are under five years of age, like we deep dive inside, feed the peeds. So definitely come join us inside that course when we open doors in the middle of September. Get like, you'll get lifetime access to all the content. You'll start making connections confidently with every child that you serve. But until next time, come and join our free training@feedthepedes.com backslash training the week of September 8, 2025, doors will open early to those of you who are our VIPs that participate.

Surprise.

But then we'll open doors to the general public the week of September 15th to feed the peds as well. So until next time, like I said, join us, but also keep observing, keep asking why, and keep leading with function first. All right everybody, I will talk to you on next week's episode. Until then, this is Hallie signing off. Bye. Quick disclaimer.

All information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer at hallebulkin. Com or pop over to at Holly Balkan on Instagram to get all the latest updates.