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Early Childhood Concerns: Counseling on Sleep Issues, Thumb-Sucking, Picky Eating, School Readiness, and Oral Health

Carl Bryce, MD
Theron Liddell, PhD
Geoffrey Gideon, DO

American Family Physician. 2025;111(1):31-36.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Common early childhood concerns and behaviors include sleep issues, thumb-sucking, pacifier use, picky eating, school readiness, and oral health. Family physicians must recognize when these indicate an underlying disorder and offer constructive and evidence-based strategies to support healthy child development and family well-being. Behavioral interventions and education to address sleep issues can alleviate stress and decrease fatigue for the whole family. Thumb-sucking and pacifier use have dental and social consequences if they persist beyond 3 years of age. Eating problems in childhood are common; in most cases, reassurance and trying new foods can improve picky eating. Readiness to begin school depends on child, family, and societal factors, and needs an individualized approach that emphasizes inclusion while ensuring person-centered success. Reading and participation in early childhood educational programs improve literacy and classroom preparation. Oral health is an important part of childhood well-being; preventive care, including fluoridation, should begin when the first tooth has erupted.

During early childhood, challenges can involve a range of normal to problematic behaviors. Sleep issues, thumb-sucking, pacifier use, picky eating, and school readiness are common challenges and often resolve on their own. However, some of these issues can impact quality of life if not appropriately addressed. This article provides evidence-based interventions for family physicians to help them counsel families on common behavioral challenges and preventive care for oral health.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating Comments
Behavioral interventions and education for sleep problems in childhood and infancy are first-line interventions.9,14 B Systematic review of mixed quality of studies in children with neurologic disabilities and a consensus guideline
Pacifier use should be eliminated or decreased between 6 and 12 months of age to reduce the risk of otitis media, and nonnutritive sucking behaviors (eg, pacifier use, thumb-sucking) should be stopped by 3 years of age to reduce dental malocclusion.20,23,25 C Consensus guidelines
A structured, positive mealtime environment and offering of a variety of healthy foods should be promoted.35,37 C Expert opinion and observational studies
Encourage reading to children to increase literacy and participating in early childhood educational programs to improve school readiness.18 B Systematic review, meta-analysis of observational studies, and expert opinion
Apply fluoride varnish to primary teeth, beginning at first tooth eruption, and prescribe oral fluoride after 6 months of age to patients whose water supply is deficient.44,45 B Consensus statements from systematic reviews and meta-analyses including randomized clinical trials

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SLEEP ISSUES

Early childhood sleep behaviors are an important part of family life and foundational for healthy child development. Inadequate sleep can disrupt family dynamics and contribute to fatigue and daytime sleepiness in parents and children.

CARL BRYCE, MD, FAAFP, is program director at the Abrazo Family Medicine Residency, Phoenix, Arizona, and a clinical assistant professor in the Department of Family Medicine at Midwestern University Arizona College of Osteopathic Medicine in Glendale.

THERON LIDDELL, PhD, is director of behavioral sciences and a core faculty member at the Abrazo Family Medicine Residency, and a clinical assistant professor in the Department of Family Medicine at Midwestern University Arizona College of Osteopathic Medicine.

GEOFFREY GIDEON, DO, is a resident physician at the Abrazo Family Medicine Residency.

Address correspondence to Carl Bryce, MD, FAAFP, at carl.bryce@abrazohealth.com.

Author disclosure: No relevant financial relationships.

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