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The Informed Parent

Thumb Sucking

by Peter W. Welty, M.D., F.A.A.P.
Published on Jul. 29, 2002

Thumb sucking is a common occurrence in most babies. It is estimated that a fetus begins thumb sucking by the twenty-ninth week of development and is one of the earliest complex behaviors the newborn baby develops. Research has determined that thumb sucking occurs in approximately 24% of children and is also generally considered a normal behavior in children up to about five years of age. Thumb sucking seems to be associated with hunger, shyness, teething, tiredness, and sleep. If left unchecked, however, it can also affect face and mouth development.

Twice as many breast-fed babies as bottle-fed babies suck their thumbs, although for shorter periods of time. Once thumb suckers get past their fourth birthday, however, there is no difference whether they were breast-fed or bottle-fed. Experts seem to agree that thumb sucking past four years of age is abnormal.

Researchers have discovered some interesting characteristics common to thumb suckers. Various stress factors seem to be associated with this habit, such as parental over-protectiveness and strictness. Bedwetting and nail biting appear to be associated. Younger siblings tend to be thumb suckers. Those of the older children who suck their thumbs are girls, while a common characteristic among these children is shyness. It appears that the habit of thumb sucking serves as a relaxing purpose for children.

The severity of any problem associated with thumb sucking depends on the frequency, intensity, duration of the habit, as well as the position of the thumb in the mouth. Teeth changes can occur. This includes an anterior open bite along with decreased alveolar bone growth. Also teeth are placed at risk for traumatic injury. Pediatricians frequently note chronic inflammation of the distal thumb in thumb suckers. This leads to a separation of the skin from part of the fingernail, and a skin and nail infection. In extreme cases, thumb sucking can cause orthopedic problems, necessitating splints to correct a twisted thumb.

Treatment of thumb sucking is generally not indicated in an infant or young toddler. Most children discontinue the habit by ages three-and-a-half or four. However, treatment of thumb sucking in older children is necessary if the behavior is accompanied by tantrums, social withdrawal, low self-esteem, bedwetting, or tics. These may be signs of an emotional disturbance and will need follow-up by a child psychologist or psychiatrist.

Nagging and ridiculing your child to stop this habit is generally not a good idea. A bitter nail polish applied to the thumb is usually effective. Sometimes orthodontists have applied a dental device which is quite effective in eliminating the habit. A behavioral modification program geared for children ages three-to-fifteen years of age is usually also effective in stopping thumb sucking.

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