Two Thumbs Up

Interview with Christine Stevens Mills

Christine Stevens Mills Picture

Christine Stevens Mills is one of the leading experts when it comes to thumb sucking and how to treat thumb sucking. She has a very impressive track record and more than 45 years of experience. Furthermore, she has written a very insightful book, Two Thumbs Up, about thumb sucking and its complications and treatment. We are convinced that it is one of the best books on this subject and therefore recommend it to professionals and parents alike.

More details on her impressive track record can be found here.

We were very grateful for her sharing her knowledge with us in this interview.

Thumb-Heroes: You wrote a very compelling book on thumb sucking covering risks, treatment, and lots of insight into the topic. What brought you to the point of writing a book about thumb sucking?

Christine Stevens Mills:  Many reasons. I repeatedly heard from the general public, “It’s just a simple habit; the child will outgrow it when ready, no problem.” Assessing and addressing sucking habits for over 40 years, I have treated many professionals’ children with sucking habits. During many conversations, I kept hearing the same thing: “I didn’t know thumb sucking could cause these problems, and I didn’t know there was anyone [or any other ways] to treat this pattern, other than using an HBA (habit-breaking approach).”

As a therapist and educator, I decided I had to write this book. I wanted to provide pertinent information to parents, patients, and professionals. A phrase I use when teaching may explain why I wrote it: “if you do not know it, you will not see it; if you cannot see it, you cannot treat it.” Once the parents and professionals have this information, they can make an educated decision regarding if, why, and how to treat this multifaceted complex pattern that can affect [both] mind and body.

Thumb-Heroes: What would you consider the biggest risk of continuing thumb sucking?

Christine Stevens Mills: Complications that can arise include:

  1. Changes in the growth and development of the face, jaw, [and] teeth.
  2. Abnormal eating, drinking, and swallowing patterns.
  3. Speech disorders.
  4. Disordered breathing.

Thumb-Heroes: How can parents determine if the thumb sucking of their child is a problem?

Christine Stevens Mills: I like to explain it with this formula:  Frequency + Intensity + Duration = the amount of damage caused by thumb sucking.

Thumb-Heroes: In your practice and the book, you present a positive behavior modification approach. What are the main pillars of that program?

Christine Stevens Mills: Awareness training, generalization, and habit reversal. It’s important to know all the facets of the individual’s pattern, including their triggers. Once these are identified, then you work to deescalate the strength of that pattern and establish a new, acceptable pattern.

Thumb-Heroes: You point out that it’s very important not to start a program until the child is ready. Why is that so?

Christine Stevens Mills: If the child is not ready, you will not get the necessary cooperation.  I feel [that] the individual needs to want to help themselves if [they] are to succeed.  I am here to help guide them to that success. There are many components that will determine if they are ready to begin a program, more than just the individual wanting to stop, which is only one component.

Thumb-Heroes: Do you think the parents should wait until the child is ready, or should the parents guide the child in order to get it ready?

Christine Stevens Mills: Discussion and communication is very important. During a consultation, I always ask, “Do you want to stop sucking your thumb?” and the answer, many times, is “NO!” However, I then need to determine why they said ‘no.’ They may be anxious about the unknown program, and this can make them anxious. Or, they are afraid they cannot stop and do not want to disappoint their parents, or they really do not want to stop.

Thumb-Heroes: How important is the involvement of the whole family and other caregivers?

Christine Stevens Mills:  Extremely important. I always involve the entire family; everyone participates, motivates, encourages, and praises the child. This involvement encourages the child to want to achieve success.

Parents who are divorced both need to be on board, especially if the child alternates between two households, to follow through with the step-by-step procedures.

Thumb-Heroes: What would you consider the best age to stop thumb sucking?

Christine Stevens Mills: Both the American Academy of Pediatrics and the American Dental Association both agree that after age 3, chronic sucking can contribute to changes in growth and development as well as [issues with] tooth alignment. Previously, concern began at age 6, but with research, we now say age 3 and beyond is the critical age for concern.

However, every child is different in maturity no matter what [their] chronological age [may be], and we need to take that into consideration as well.

Thumb-Heroes: What is your opinion about pacifiers?

Christine Stevens Mills: There are pros and cons to the use of pacifiers. Pacifiers for the first year of life are okay. [They] promote sucking and can reduce the risk of SIDs when given at bedtime, just to name a few [positives].

Thumb-Heroes: Based on your experience, did all kids manage to stop thumb sucking with your program?

Christine Stevens Mills:  If you look through my book, you then understand [that] every child is unique, and each program needs to adapt to their sucking pattern, personality, etc. Awareness of all facets of the pattern, understanding how to treat this operant conditioning (learned behavior), and understanding how to terminate this learned behavior is key. The individuals that returned to sucking usually did so due to an event that triggered the introduction of sucking. [In these cases,] I then would have to figure out what the trigger was and then address that trigger; then, successful termination of the pattern became stable. You have to look for the cause and address it.

Thumb-Heroes: What are the pros and cons of your modification approach vs. HBA (the habit-breaking approach)?

Christine Stevens Mills: Most patients introduced to the behavior modification approach felt it was a positive approach, fun, [and] easy. The elimination program was a pleasant experience and [was] completed in one month. The HBA is prescribed by most professionals in the dental field because they are not aware [that] there are alternatives to the HBA. That is the approach most dental professionals learn in school. Most of the patients that came to me after the HBA did not work told me they considered the HBA a negative experience, [that] it hurt, made eating and speaking difficult, and while in their mouth, they would open the mouth wider put their thumb in and suck [anyway]. “Where there is a will there is a way.”

We need to address the problem, not put an appliance in and think [that] it will do everything needed to eliminate the pattern and stabilize a new pattern. Full details about complications and changes due to wearing an HBA are also in my book.  HBAs are usually worn for months, and the behavior modification program is completed in one month and nothing is placed in the mouth.

Thumb-Heroes: What do you think of products like T-Guard or Dr. Thumb?

Christine Stevens Mills: I have perused thumb-sucking devices on the internet, and I am sure each one has worked for some people. I look at them from the standpoint:

  1. Do they address the trigger or just place something on the thumb to deter the sucking pattern while it is being used?
  2. Is there a medical reason for that individual sucking, such as airway issues [that require sucking] to maintain an open airway so the child can breathe, psychological issues that need to be addressed first by a different type of professional, or is it a habit?

Please remember, I am giving short, general, answers. There is no quick fix. Many devices are just putting a band-aid on the problem, not addressing the long-term established components of the pattern [or] habit. My job is to get all of the facts [and] evaluate not only the physical components but determine if this individual is emotionally ready to eliminate a sucking pattern. Then, I map out a plan for that individual to guide them through the process. My book was written with the same premise: know the facts, evaluate, then set up a step-by-step program to help this child.

Thumb-Heroes: What is the typical duration of your program?

Christine Stevens Mills: One month. Many patients will stop their habit within a few days to a week. However, it takes at least 30 days to change a pattern and stabilize the new pattern.

Thumb-Heroes: Do you think parents can successfully execute the program after reading your book, or do you think a professional should be involved?

Christine Stevens Mills: A professional, such as an orofacial myologist, with the training and expertise to assess and address sucking habits, is preferred. However, many concerned parents live in areas that do not have a specialist readily available to help their child. Part of the reason I have written the book is for those parents. If the parent reads the entire book before initiating this program, they will have an understanding of the problems and the steps and guidelines [to follow] to help.

So, yes. I feel [that] concerned parents will be able to help their child eliminate the habit and establish a new acceptable pattern. I have a section that talks about pitfalls to avoid and how to determine if your child is ready to eliminate their sucking habit as well.

Thumb-Heroes: Is there an important aspect of treating thumb sucking that we haven’t covered?

Christine Stevens Mills: Prolonged sucking patterns can contribute to not only structural changes but also functional changes. Structural changes [may be conditions and changes] such as [developing a] high-arched palate, narrow nares, changes in growth and development of the orofacial structure, and misalignment of the teeth.  Functional changes [may include] disordered breathing, eating, drinking, swallowing, and speech dysfunctions.

When one body part dysfunctions, other parts of the body will adapt and compensate, causing symptoms and problems to develop. The thumb anchors the tongue down and forward, causing changes in the resting posture of the lips, tongue, jaw, and head. These changes in rest posture can cause [other] functions to adapt and compensate, leading to the thumb [anchoring] the tongue down and forward, the lips parting, the jaw dropping, [and] the tongue dropping, altering proper rest postures. And when rest postures change, so do the functions.

Thumb-Heroes: Thank you so much for your time and for sharing your knowledge and experience with us. We strongly recommend everybody who is interested in the subject to read your very insightful book, Two Thumbs Up.

Book: Two Thumbs Up

Understanding and Treatment of Thumb Sucking

This is a guide for parents and professionals that takes a deep look at thumb sucking and its complications and treatment.

Based on more than 40 years of experience, Christine Stevens Mills shares her very successful positive behavior modification approach to treat thumb sucking.

Our recommendation

Book Information

  • Title: Two Thumbs Up
  • Subtitle: Understanding and Treatment of Thumb Sucking
  • Author: Christine Stevens Mills
  • Paperback: 113 Pages
  • ISBN-13 : 978-1548924256
  • Publisher: Independently published
  • Language: English
  • Buy:,

Christine Stevens Mills

  • Speech Pathologist, IAOM Certified Orofacial Myologist
  • 45 years of experience in the field of Orofacial Myology (treating orofacial myofunctional disorders  and sucking habits)
  • Runs an established suburban myofunctional therapy clinic, a private practice exclusively treating orofacial myofunctional disorders and chronic sucking habits
  • Author of TWO THUMBS UP (Understanding and Treatment of Thumb Sucking)
  • Served on the Board of Directors of the IAOM
  • Assistant Professor at the University of Detroit Mercy Orthodontic Department for 19 years
  • Continues to mentor, consult, lecture, and teach classes. Presently teaches an IAOM-approved certification track course.

Interested dentists, physicians, speech pathologists, and dental hygienists can enroll to learn about how to treat orofacial myofunctional disorders and chronic sucking patterns (thumb, finger, and tongue sucking.) Detailed information regarding this training can be found at