Cochrane · intervention · CD008694
Interventions for the cessation of non‐nutritive sucking habits in children
Borrie, FRP, Bearn, DR, Innes, NPT, et al. · Cochrane Database of Systematic Reviews · 2015 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
21
current version
GRADE rated
4
No studies
4
Included studies
6
as reported
No studies 4 · 19%Ungraded 13 · 61.9%Very low 2 · 9.5%Low 2 · 9.5%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children (up to 18 years of age) who have a digit sucking habit or any other non-nutritive sucking habit, including a pacifier habit (dummy) | 252 enrolled participants in six trials; age range 2.5 to 18 years. All included studies assessed digit sucking; none reported on pacifier use |
| Intervention | Orthodontic appliances; barrier techniques (gloves/plasters); chemical techniques (topical substances applied to pacifier or digit); behaviour modification techniques; non-treated control; any combination of the above | Orthodontic appliances - palatal crib/palatal arch (n=3); psychological interventions - positive/negative reinforcement, habit reversal, DRO (n=4); aversive tasting substance applied to digit (n=1); combination treatment (n=2) |
| Comparison | Any combination of the above or pacifier withdrawal | No treatment (n=5); waiting list control (n=2) |
| Outcomes | Primary: cessation of the habit. Secondary: time taken for intervention to be effective; child and parent- or carer-centred outcomes (discomfort, psychological effects of teasing, distress from removal of comfort/habit); reduction in malocclusion (anterior open bite (mm); overjet (mm); correction of posterior crossbite); costs of interventions | Sucking cessation, short and long term (n=5); occlusion - overbite/anterior open bite, mandibular and maxillary arch length, overjet (n=1); child and parent-/carer-centred outcomes (n=2); adverse outcomes - upset, speech and eating difficulty, mannerisms reported by Haryett 1967 (n=1) |
| Study designs | Randomised controlled clinical trials (RCTs) and quasi-randomised controlled clinical trials | Randomised and quasi-randomised controlled clinical trials, all at high risk of bias (n=6) |
| Timing | Data planned to be analysed at 6 months and 12 months after commencement of intervention | Short term (less than 12 months) and long term (12 months or more) follow-up |
Search date: 2014-10. Databases: MEDLINE via OVID; Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE via OVID; PsychINFO via OVID; CINAHL via EBSCO
Questions and results
Current version onlyOrthodontic appliances (palatal crib) vs No treatment
Population: Children with a non-nutritive sucking habit (digit or pacifier)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Occlusion (change in maxillary arch length, short term) Short term (3 months) | Table 1 (reduction in malocclusion), Villa 1997 (n=24), palatal crib vs no treatment: change in maxillary arch length (mm) - no treatment 0.01 (SD 0.33); palatal crib -1.4 (SD 1.4); reported as statistically… | 1 study · 24 participants | Ungraded |
Sucking cessation (long term) Long term (12 months or more) | RR 5.81 [1.49, 22.66] | 1 study · 37 participants | Ungraded |
Sucking cessation (short term) Short term (less than 12 months) | RR 6.53 [1.67, 25.53] 7 per 100 vs 46 per 100 | 2 studies · 70 participants | Low Downgraded: risk of bias, indirectness |
Occlusion (net change in overjet, short term) Short term (3 months) | Table 1 (reduction in malocclusion), Villa 1997 (n=24), palatal crib vs no treatment: net change in overjet (mm) - no treatment 0.02; palatal crib -0.2; no statistically significant net change in overjet between… | 1 study · 24 participants | Ungraded |
Occlusion (change in mandibular arch length, short term) Short term (3 months) | Table 1 (reduction in malocclusion), Villa 1997 (n=24), palatal crib vs no treatment: change in mandibular arch length (mm) - no treatment 0.03 (SD 0.19); palatal crib -1.2 (SD 0.8); reported as statistically… | 1 study · 24 participants | Ungraded |
Adverse events | SoF (orthodontic appliances vs no treatment): Adverse events - insufficient information reported. Table 3 (adverse outcomes after one month; Haryett 1967), orthodontic treatment group: reported upset 6/22 (27%); speech… | 1 study | Ungraded |
Correction of posterior crossbite | Correction of posterior crossbite was not measured in this study despite being a well recognised feature in the malocclusion of a child with a thumb-sucking habit. | 0 studies | No studies |
Occlusion (change in overbite, short term) Short term (3 months) | MD 4.10 [2.93, 5.27] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Psychological interventions vs No treatment
Population: Children with a non-nutritive sucking habit (digit or pacifier)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | SoF (psychological interventions vs no treatment): Adverse events - insufficient information reported. Table 3 (adverse outcomes after one month; Haryett 1967), psychological treatment group: reported upset 1/11 (9%);… | 1 study | Ungraded |
Sucking cessation (short term) Short term (less than 12 months) | RR 6.16 [1.18, 32.10] 3 per 100 vs 19 per 100 | 2 studies · 87 participants | Low Downgraded: risk of bias, indirectness |
Sucking cessation (long term) Long term (12 months or more) | RR 6.25 [1.65, 23.65] | 1 study · 57 participants | Ungraded |
Occlusion | Occlusion: Not reported. | 0 studies | No studies |
Barrier techniques (gloves/plasters) vs No treatment
Population: Children with a non-nutritive sucking habit (digit or pacifier)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | There were no studies that looked at barrier techniques or pacifier withdrawal. | 0 studies | No studies |
Pacifier withdrawal vs No treatment
Population: Children with a non-nutritive sucking habit (digit or pacifier)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | There were no studies that looked at barrier techniques or pacifier withdrawal. | 0 studies | No studies |
Psychological intervention + orthodontic treatment (palatal crib or palatal arch) vs No treatment
Population: Children with a non-nutritive sucking habit (digit or pacifier)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | Table 3 (adverse outcomes after one month; Haryett 1967), combined psychological plus orthodontic treatment group: reported upset 4/22 (18%); speech difficulty 6/22 (27%); eating difficulty 6/22 (27%); developing… | 1 study | Ungraded |
Sucking cessation (short term) Short term (less than 12 months) | RR 6.36 [0.97, 41.96] | 1 study · 32 participants | Ungraded |
Aversive tasting substance applied to digit vs Psychological intervention (habit reversal)
Population: Children with a non-nutritive sucking habit (digit or pacifier)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sucking cessation (short term) Short term (less than 12 months) | RR 0.18 [0.03, 1.24] | 1 study · 29 participants | Ungraded |
Palatal arch vs Palatal crib (alternative orthodontic appliance)
Population: Children with a non-nutritive sucking habit (digit or pacifier)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sucking cessation (short term) Short term (less than 12 months) | RR 0.13 [0.03, 0.59] | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Psychological intervention (habit reversal / positive reinforcement) vs Alternative psychological intervention (DRO / negative reinforcement)
Population: Children with a non-nutritive sucking habit (digit or pacifier)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sucking cessation (short term) Short term (less than 12 months) | Christensen 1987 (20 participants) compared habit reversal (HR) with differential reinforcement of other behaviour (DRO): no statistically significant difference. Larsson 1972 (38 participants) compared positive with… | 2 studies · 58 participants | Ungraded |
Sucking cessation (long term) Long term (12 months or more) | Larsson 1972, comparing positive reinforcement with negative reinforcement, also provided long-term data. Again, no statistically significant between-group differences were shown (Analysis 6.2). | 1 study | Ungraded |
Psychological intervention + palatal arch vs Psychological intervention + palatal crib
Population: Children with a non-nutritive sucking habit (digit or pacifier)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sucking cessation (short term) Short term (less than 12 months) | RR 0.30 [0.13, 0.74] | 1 study · 22 participants | Ungraded |
Orthodontic appliances vs Non-treated control
Population: Individuals with a digit sucking habit or any other non-nutritive sucking habit, including a pacifier habit (dummy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR 6 and 12 months (planned) | Protocol only (no search conducted, no studies included). Planned comparison: Orthodontic appliances versus non-treated control. Planned primary outcome: cessation of the habit. | 0 studies | No studies |
Behaviour modification techniques vs Non-treated control
Population: Individuals with a digit sucking habit or any other non-nutritive sucking habit, including a pacifier habit (dummy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR 6 and 12 months (planned) | Protocol only (no search conducted, no studies included). Planned comparison: Behaviour modification techniques versus non-treated control. Planned primary outcome: cessation of the habit. | 0 studies | No studies |
Barrier techniques (gloves/plasters) vs Non-treated control
Population: Individuals with a digit sucking habit or any other non-nutritive sucking habit, including a pacifier habit (dummy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR 6 and 12 months (planned) | Protocol only (no search conducted, no studies included). Planned comparison: Barrier techniques versus non-treated control. Planned primary outcome: cessation of the habit. | 0 studies | No studies |
Chemical techniques (topical substances applied to digit or pacifier) vs Non-treated control
Population: Individuals with a digit sucking habit or any other non-nutritive sucking habit, including a pacifier habit (dummy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR 6 and 12 months (planned) | Protocol only (no search conducted, no studies included). Planned comparison: Chemical techniques versus non-treated control. Planned primary outcome: cessation of the habit. | 0 studies | No studies |
Pacifier withdrawal vs Non-treated control
Population: Individuals with a digit sucking habit or any other non-nutritive sucking habit, including a pacifier habit (dummy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR 6 and 12 months (planned) | Protocol only (no search conducted, no studies included). Planned comparison: Pacifier withdrawal versus non-treated control. Planned primary outcome: cessation of the habit. | 0 studies | No studies |
Any combination of the above interventions vs Non-treated control
Population: Individuals with a digit sucking habit or any other non-nutritive sucking habit, including a pacifier habit (dummy)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR 6 and 12 months (planned) | Protocol only (no search conducted, no studies included). Planned comparison: Combination of interventions versus non-treated control. Planned primary outcome: cessation of the habit. | 0 studies | No studies |