What is thumbsucking?

Babies have a natural desire to suck. Thumbsucking is a common way babies seem to comfort themselves. Thumbsucking usually begins by 3 months of age.

A child usually sucks his thumb when he is tired, bored, sick, or upset or when he is not using his hands to play. A child may suck a finger(s) or fist instead of a thumb. Sometimes a security object, such as a blanket, may become part of the thumbsucking habit.

What is the cause?

An infant's desire to suck on the breast or bottle is a drive that is essential for survival. More than 80% of babies do some extra sucking when they are not hungry. With ultrasound many babies even 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.

How long does it last?

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% of thumbsucking babies continued the habit past 1 year of age and only 3% continued beyond the age of 2 years. A more recent study, however, found that 15% of 4-year-olds still sucked their thumbs. Those children who continue sucking their thumbs after the age of 4 often have become 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 come in (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, most normal children abandon thumbsucking because of peer pressure.

How can I help my child overcome thumbsucking?

1. If your child is less than 5 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, sick, or stressed. Help your child overcome any stressful situations. 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, any pressure you apply to stop thumbsucking will only lead to resistance and lack of cooperation.

2. After 5 years of age, help your child give up thumbsucking during the day.

   Most 5-year-olds have reached the age of reasoning and are developmentally ready to cooperate with their parents and work on a bad habit. They must have an understanding of cause and effect relationships, the ability to discriminate between right and wrong, and the capacity to practice some degree of self-control and self-denial.

   First get your child's commitment to giving up thumbsucking by showing her what thumbsucking is doing to her teeth and 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. Discuss the unhealthy aspects of placing the thumb in the mouth when there are germs or dirt on it. Appeal to her sense of pride. At this point most children will agree that they would like to stop thumbsucking.

   If your child expresses the desire to stop, the next step is careful planning. Young children may become frustrated easily and want to stop trying. To help succeed, parents will want to be available for the first difficult days and focus on keeping the child distracted from the sucking behavior by planning some activities to occupy the child's hands such as drawing, craft projects, puzzles, and games. If the hands are busy they won't be going in the mouth.

   Because most children with sucking habits are unaware of the activity, it will be important to use some sort of reminder on the thumb. Character Band-Aids work well for daytime, but children generally need assistance placing the bandage comfortably on the top part of the thumb. However, it is important that it is the child's choice to wear the reminder and not to be enforced by parents. Introduce the reminder as a special helper to let the child know when the thumb is trying to sneak in the mouth. Limit television watching for the first couple of weeks and avoid other situations that stimulate the sucking habit.

   Older children may also want an outlet for dealing with the urge to suck their thumb. You can suggest doing something else with her thumb, such as holding her thumb inside a closed fist for 10 seconds or twirling her thumbs. Although self-reminders are the most effective, parent reminders may occasionally be helpful if the child approves. 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.

3. At the same time, help your child give up thumbsucking during sleep.

   Most children depend heavily on the sucking activity to relax and fall asleep at naptime and bedtime. The sleeping habit is the strongest part of the behavior and it takes the longest to eliminate. It will be important to address the sleeptime sucking at the same time you are working on the daytime habit to minimize frustration and enhance success.

   Parents will also want to plan to be available at bedtime for the first week to help the child adjust to falling asleep without sucking. Your child can be told that the sleeptime thumbsucking is not his fault, because "that old thumb just sneaks in and he doesn't even know it because he is sleeping." He will need a powerful reminder, one that covers the entire hand. A long cotton tube sock is the most effective reminder. A glove or puppet sock are other options. Help your child look upon this method as a clever and a fun idea rather than any kind of penalty. Again, parents should assist with putting on the bedtime reminders but not enforce cooperation. It is important to remember that parents cannot eliminate the habit for their child. The habit belongs to the child and the child must willingly cooperate and accept responsibility if the habit is to be eliminated.

4. Incentives

   Praise your child whenever you notice she is not sucking her thumb in situations where she previously did. This will build her self confidence. 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).

5. Consult with a thumbsucking expert if these techniques are not successful.

   When the permanent teeth come in, thumbsucking carries the danger of causing an overbite. Eventually an overbite will require orthodontic braces, which are expensive.

   An expert on thumbsucking is called a certified oral myologist (CMO). They are trained to help children stop their sucking habits quickly using motivational programs. Ask your doctor about CMOs or call The International Association of Orofacial Myology at 303-765-4395.

6. What to avoid

   The following techniques are generally not helpful and may prolong the thumbsucking habit because the child looks upon them as punishment:

   • Dental appliances: This is usually a reminder bar that is placed in the upper part of the mouth.
   • Elastic wrap or splints: Placing these around the elbow to keep it from bending often causes some discomfort. It can also cause temporary blueness, swelling, and numbness of the arm in the morning.
   • Bitter-tasting medicines applied to the thumbnail: If the parent applies this medicine without the child's permission, the child will usually just wash it off or switch to another finger. Only if your child wants to use it as a reminder it may be helpful.

How can I prevent thumbsucking?

If your baby needs to suck a lot, try to interest him in a pacifier instead of his thumb when he needs to be comforted, but is not hungry. However, avoid overusing it. Unlike thumbsucking, pacifier use can be controlled as your child grows older because you can take away the pacifier. If they are older than 1 year, 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.

Thumbsucking lasting beyond age 5 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.

When should I call my child's health care provider?

Call 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's teacher has expressed concern about thumbsucking in class.
• Your child also has emotional problems.
• The permanent teeth appear to be crooked.
• The thumbsucking does not improve after trying this approach.
• You have other concerns or questions.