A 6 year old female child reported with a chief complaint of proclined upper anteriors. Parents give a history of prolonged bottle-feeding and a persistent thumb sucking habit. Clinical examination reveals anterior open bite with proclined upper anterior and retroclined lower anterior teeth and associated tongue thrusting.
The foremost line of treatment in this patient is:
Approach to Thumb-sucking treatment
During treatment, the child should be given an opportunity to stop the habit spontaneously before the permanent teeth erupt. Delay until the early school-age years, allows spontaneous discontinuation of the habit due to peer pressure. If it is not discontinued, the treatment should generally be undertaken from 4 to 6 years. The treatment includes the following approaches.
Phase 1 (normal and sub-clinically significant sucking):

This phase extends from birth to 3 years of age.
Children develop thumb sucking at this stage and resolve at the end of this phase.
In case of malocclusion signs, prophylactic approaches, like pacifiers or medicaments, can be used.

Phase 2 (clinically significant sucking):

This phase extends from 3 to 7 years of age.
A firm and definite treatment plan of correction that includes psychological counseling and appliance therapy is required.

Phase 3 (intractable sucking):

Thumb sucking present after 4th year poses problem for the children.
Two-fold treatment including both psychotherapy and appliances is essential.
No treatment. Wait and watch
Extraction of first premolars followed by Hawley's appliance
Psychiatric consultation prior to any therapy
Extraction of second premolars followed by Hawley's appliance