Insufficient evidence to recommend a treatment to stop non-nutritive sucking habits in children

Abstract

The electronic databases searched included The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (Central), MEDLINE via Ovid, PsycINFO via Ovid, CINAHL via EBSCO, the US National Institutes of Health Trials Register (Clinical Trials.gov) and the WHO International Clinical Trials Registry Platform. No restrictions regarding language and date of publication were used and reference lists from relevant articles were screened. Authors from eligible studies were contacted for further information. Randomised or quasi-randomised controlled trials in children with a non-nutritive sucking habit that compared one intervention with another intervention or a non-intervention control group. The primary outcome of interest explored was the cessation of the habit. Study selection, data extraction and risk bias assessment were carried out independently. Three reviewers screened the records, two performed data extraction, two assessed risk of bias and two assessed the overall quality of the evidence. Meta-analysis could not be done. Six trials involving 252 children (aged 2½ to 18 years). Data were available for only 246 children. Only digit sucking was assessed in the studies. The studies compared single or multiple interventions. All studies were considered high risk of bias due to limitations in the methodology and reporting. The studies had a very small number of participants. Follow up ranged from one to 36 months. The review found low quality evidence that orthodontic appliances and psychological interventions (including positive and negative reinforcement) are effective at improving sucking cessation in children. There is very low quality evidence that palatal crib is more effective than palatal arch. The orthodontic appliance was more likely to stop digit sucking than no treatment, whether it was used over the short term, risk ratio (RR)= 6.53, 95% confidence interval (CI) 1.67 to 25.53; or long term RR =5.81, (95% CI 1.49 to 22.66); or used in combination with a psychological intervention RR= 6.36, (95% CI 0.97 to 41.96).