Clinical Reference Systems: Pediatric Advisor 10.0
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DESCRIPTION

• A child sucks on the thumb when not hungry.
• A child may suck a finger(s) or fist.
• A security object, such as a blanket, may become part of the ritual.
• Thumbsucking occurs mainly when a child is tired, bored, sick, or upset or when a child is not using the hands to play.
• 80 percent of infants suck their thumbs.
• Thumbsucking begins before birth or by 3 months of age at the latest.

CAUSES

An infant's desire to suck on the breast or bottle is a drive that is essential for survival. More than 80 percent of babies also do some extra sucking when they are not hungry (nonnutritive sucking). With ultrasound many fetuses can be seen sucking in the uterus. Thumbsucking also appears to help a child comfort herself and often increases when breast or bottle feedings decrease. It does not mean that a child is insecure or has emotional problems.

EXPECTED COURSE

The sucking need is strongest during the first 6 months of a child's life. In a study by Dr. T. Berry Brazelton, only 6 percent of thumbsucking babies continued the habit past 1 year of age and only 3 percent continued beyond the age of 2 years. A more recent study, however, found that 15 percent of 4-year-olds sucked their thumbs. Those children who continue sucking their thumbs after the age of 4 often have been involved in a power struggle in their early years with a parent who tried to stop their thumbsucking. Occasionally the thumbsucking simply persists as a bad habit.

The American Dental Association advises that a child can probably suck his thumb until he is 4 or 5 years old without damaging his teeth or jawline. However, thumbsucking must be stopped before a child's permanent teeth erupt (at age 6 or 7) because it can lead to an overbite (buck teeth). Another reason to encourage children to give up the habit before they enter school is to prevent the teasing they would otherwise receive.

By adolescence, all normal children abandon thumbsucking because of peer pressure.

HOW TO OVERCOME THUMBSUCKING

1. If your child is less than 4 years old, distract your child or ignore the thumbsucking.

   Thumbsucking should be considered normal before the age of 4 years and usually ignored, especially when your child is tired or sick. In fact, during the first 6 months of life it can be encouraged as a means of self-comfort. However, if the thumbsucking occurs when your child is bored and he is over 1 year old, try to distract him. Give him something to do with his hands without mentioning your concern about the thumbsucking. Occasionally praise your child for not thumbsucking. Until your child is old enough for you to reason with him, any pressure you apply to stop thumbsucking will only lead to resistance and lack of cooperation.

2. After 4 years of age, help your child give up thumbsucking during the day.

   First get your child's commitment to giving up thumbsucking by showing her what thumbsucking is doing to her body. Show her the gap between her upper and lower teeth with a mirror. Have her look at the wrinkled rough skin (callus) on her thumb. Appeal to her sense of pride. At this point most children will agree that they would like to stop thumbsucking.

   Ask your child if it will be all right if you remind her when she forgets. Do this gently with comments such as "Guess what?" and put an arm around your child as she remembers that she has been sucking on her thumb again. Encourage your child to remind herself by painting a star on her thumb with a Magic Marker, putting a Band-Aid on the thumb, or applying fingernail polish. Your child should put these reminders on herself. If your child finds herself sucking on her thumb, she can try doing something else with her thumb, such as holding her thumb inside a closed fist for 10 seconds or twirling her thumbs. Praise your child whenever you notice she is not sucking her thumb in situations where she previously did. Also, give her a star on her chart and a reward (such as a dime, a snack, or an extra story) at the end of any day during which she did not suck her thumb at all.

3. After daytime control is established, help your child give up thumbsucking during sleep.

   Thumbsucking during naps and nighttime is usually an involuntary process. Your child can be told that although the nighttime thumbsucking is not his fault, he can learn not to suck his thumb during sleep by putting something on his thumb to remind him. A glove, sock, splint (thumb guard), or piece of adhesive tape that runs up one side and down the other can be used.

   Another technique is to wrap an elastic bandage (not too tight) around the arm from a few inches below to a few inches above the elbow. Apply it while the elbow is straight. Then whenever your child starts to bring his thumb toward his mouth, the pressure at his elbow will increase and remind him to return his arm to the straight position.

   It should be your child's responsibility to put on whatever material is used to prevent thumbsucking or to ask you for assistance. Help your child look upon this method as a clever idea rather than any kind of penalty.

4. Consider using bitter-tasting medicines if your child is over age 4.

   A recent study by Dr. P.C. Friman demonstrated a high success rate in one to three nights using a bitter-tasting solution called Stop-zit (no prescription necessary) in combination with a reward system. Use Stop-zit only if your child is over 4 years of age and agrees to use it and after other methods have failed. Don't use it as a punishment. Present it as a reminder that "other kids like to use it also." Help your child apply Stop-zit only to the thumbnail at the following times:

   • before breakfast
   • before bedtime
   • whenever thumbsucking is observed day or night.

   Look to see whether your child is thumbsucking every 30 minutes after her bedtime until you retire. After five nights without thumbsucking, discontinue the morning Stop-zit. After five more nights without any thumbsucking, stop using Stop-zit at bedtime. If the thumbsucking recurs, repeat this use of Stop-zit.

5. Bring thumbsucking to the attention of your child's dentist at least by the time your child is 6 years old.

   When the permanent teeth come in, thumbsucking carries the danger of causing an overbite. Dentists have a variety of approaches to thumbsucking. By the time a child is 7 or 8 years old, dentists can place a reminder bar in the upper part of the mouth that interferes with the ability to suck. This helpful appliance does not cause any pain to your child but can spare you the future economic pain of $2500 orthodontic treatment.

PREVENTION OF PROLONGED THUMBSUCKING

If your baby has increased sucking needs, try to interest him in a pacifier instead of the thumb. Unlike thumbsucking, pacifier use can be controlled as your child grows older because you can take away the pacifier. Children who use pacifiers do not switch to sucking their thumbs when they give up the pacifier. Children are always able to give up their pacifiers by age 4 or 5 years. See Pacifiers.

Thumbsucking lasting beyond a child's fourth year can usually be prevented if you avoid pulling your child's thumb out of his mouth at any age. Also, don't comment in your child's presence about your dissatisfaction with the habit. Scolding, slapping the hand, or other punishments will only make your child dig in his heels about thumbsucking. If you can wait, your child will usually give up the thumbsucking naturally. If you turn the issue into a showdown, you will lose, since the thumb belongs to your child.

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:

• Your child is over 4 years old and sucks her thumb constantly.
• Your child is over 5 years old and doesn't stop when peers tease her.
• Your child is over 6 years old and sucks her thumb at any time.
• Your child also has emotional problems.
• The thumbsucking does not improve after trying this approach.
• You have other concerns or questions.