thumb sucking

The good news is that while thumb sucking is common in toddlers and younger children (about half of all children do it at some time or another), it tends to disappear by age two or three, except in those few children who become fixated. Nelson's Textbook of Pediatrics gives the incidence by age 5 of 10% of children. If the habit persists beyond age six, the outlook gets worse for spontaneous cure, and the dentists start getting worried about malocclusion problems (tooth misalignment) and facial changes.

Various therapies have been used, with mixed results (mixed results is the term doctors use for "nothing works really great..." ). Bitter substances painted on the fingers or dental appliances are generally tried (see below on a method said to work). As with all such behavioral fixations, excessive nagging leads to more rather than less thumb sucking. (See masturbation, nail biting)

But the situation may not be as dismal as it might seem at first blush. A series of studies on thumb sucking by Dr. Patrick Friman reviewed in Contemporary Pediatrics by Dr. Edward Christopherson described a procedure to stop the thumb sucking habit in most children 5 and older.

  • Parents begin by giving the child a lot of brief, non-verbal physical contact, such as pats on the back, roughing up the hair, hugs or whatever. The type of contact is unimportant as long as it is frequent, warm and loving.
  • After about two weeks of this attention, the parents start painting the thumb with one of the commercial thumb-sucking or nail-biting deterrents. This is done first thing in the morning and throughout the day every time he touches his face near the mouth.
  • Positive reinforcement and praise for progress are naturally helpful. The child will usually give up the habit within two weeks of starting the second step of the procedure.

This was a new procedure to me, and I intend to try it out the next time this issue comes up as a parent question. Problem thumb sucking doesn't come to the doctors attention nearly as often as it occurs, I suspect, because parents have heard "He'll grow out of it," so often they are resigned to it.

I used to think that thumb sucking was probably the best argument for early judicious use of an orthodontic pacifier (the only sensible type to use). "Better a binky than a pinky." A pacifier can be discarded after the first few months, a finger can't. However, since pacifier use has been associated with increased ear infections in young children, and in light of the problems parents report to me in my Internet sleep counselling I have changed my attitudes. If the pacifier can be avoided in the newborn period, it probably should be. I do not consider this a major issue, but one parents should think over before starting out with the pacifier.

The economist John Maynard Keynes was once asked about a statement he made which contradicted an earlier view he had expressed. He replied, "Sir, when the facts change, I change my mind. What do you do?"

There is a device called the ThumbGuard which is FDA listed for the treatment of thumb sucking. It is a plastic sleeve that covers the thumbs and physically interferes with the behavior. I have not personally used this device and cannot give any recommendation one way or the other. The last price I saw for the kit was $64.95 plus shipping.

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