Thumb Sucking

Thumb sucking or soother sucking can cause considerable stress for parents. Despite its age, the magazine article below does a great job of explaining the importance of sucking for young children and babies. Please keep in mind that the techniques for thumb sucking cessation have changed considerably over the years, and newer more effective approaches have been used with success. Please speak to Dr. Wrinch or Dr. Onno if you would like some guidance on how to stop thumb sucking – when the times comes for your child.

Thumbs Up Thumbs Down

An Article By Eugenie Allen, Published in Parenting Magazine 1995

Lauren Wakefield’s parents first saw her sucking her thumb in a hazy black-and-white image on an ultrasound screen. At 20 weeks, Lauren had already mastered the art of bringing her thumb to mouth – a task made easier by the almost weightless aquatic environment. It took exactly three months for her to rediscover that pastime after she was born, and her parents were thrilled. “Lauren wouldn’t take a pacifier, and she wasn’t a real cuddly baby, so we knew that if she could get that thumb into her mouth, she would be able to calm herself,” says her mother Aleida, of Kent, Washington. “Sure enough, she quieted right down.”

Like all healthy newborns, Lauren had started life – indeed, sustained it – with an urge to suck. And as with most babies, that overwhelming instinct wasn’t satisfied by feedings alone. This quest for non-nutritive sucking is so basic that, at one time or another, virtually all babies occupy their mouth with fist, fingers, pacifier, or thumb; according to one estimate, about 50 percent choose the thumb. Most thumb suckers quit by the time they reach preschool, but some 20 percent – including Lauren – are still going strong at age five. And parents who, like the Wakefields, were once entranced by the sight of a tiny thumb in a rosebud mouth find themselves less and less accepting as time goes one.

Even as parents of thumb suckers worry about buck teeth and classroom cruelty, they dread the inevitable power struggle over halting the habit. And worst of all, they sometimes fear that thumb sucking may be a sign of immaturity or insecurity, for which they tend to blame themselves. Says Aleida Wakefield: “We shouldn’t think it’s our fault, but somehow we do.”

Thumb sucking has a long history of upsetting parents. When today’s grandparents were children, thumb sucking was considered a vile habit, even worse than nail-biting and nose-picking. Childcare experts thought it a sign of maladjustment and prescribed harsh measures – including mustard or “bitter aloes”” on the thumb, restrictive clothing to keep hands under wraps, and the dreaded “rake,” a prolonged mouth appliance – to prevent it.

Today, professionals are much less concerned about the habit’s far-reaching effects. “A number of studies have found no relationship between thumb sucking and neurosis,” say Susan Heitler, a clinical psychologist at Rose Medical Center in Denver. In fact, since the early forties, Dr. Benjamin Spock has held to the view that thumb sucking represents an important developmental stage for some babies and shouldn’t be turned into a battle. “From my own experience seeing young patients, I came to the conclusion that a behavior as common and usually limited in age as thumb sucking must be harmless,” say Spock, author of Baby and Child Care. “But I have felt I had to move slowly until I found a few others who agreed with me.” Other experts also came to that conclusion: “Over the years, I have become more and more confident that thumb sucking is a valuable form of self-soothing and nurturing that reinforces the child’s autonomy,” says Penelope Leach, author of Your Baby and Child. In other words, kids keep sucking their thumb for a very simple reason – it feels good.

Like all good things, though, thumb sucking must come to an end, and most experts agree that this should happen around the age of five. For most children, the fifth birthday coincides with two important milestones, both of which can be complicated by an active thumb habit: the advent of permanent teeth and the start of elementary school. Although experts can’t say what percentage of chronic thumb suckers will develop dental or social problems, the risk is great enough, they insist, that virtually all five-year olds – and some younger children whose teeth already show signs of damage – should be encouraged to stop.

But before that magic cutoff point, says Dr. Dennis McTigue, academic dean of the College of Dentistry at Ohio State University in Columbus, “there isn’t much use in trying to get a child who doesn’t want to quit to stop. And unless she is already developing dental problems, there isn’t much reason to either.” In fact, thumb sucking in the first year of life has a number of physical benefits: The behavior is so soothing that babies’ heartbeats and respiration rates actually slow while they’re doing it. Nurses at the University of Texas Health Science Center in Houston have even developed a thumb-shaped pacifier to comfort preemies who are too weak to get the real thing into their mouth.

Some weary parents actually give their infant a friendly push – or shove – toward their thumb. (Of course, other parents prefer the pacifier; see article “Thumb or Pacifier” at end.) When twins Cara and Caryn Lawson of Chicago were two months old, their mother Luann, was still nursing them almost around the clock, for their comfort as well as nutrition. After consulting with the girls’ pediatrician, she began guiding the twins’ thumbs into their mouth every chance she got. Within two weeks, the babies were able to calm themselves in the middle of the night, and Lawson got some much needed rest. “Their thumb sucking probably saved me from being institutionalized,” she says with a laugh.

Children who continue to suck their thumb beyond babyhood sometimes develop amusing rituals around the habit. For instance, Katie Honig, a four-year-old New Yorker, always holds her stuffed dog Bow-Wow in her left hand while sucking her right thumb, and sometimes uses the other four fingers of her right hand to stroke Bow-Wow’s ear. And Joseph Kennedy, a six-year-old former thumb sucker in Oakland, California, used to enjoy twirling his mother’s long hair and sucking his thumb while she held him.

What seems so cute a bedtime may be less appealing in the preschool classroom, however, and parents begin to feel pressure to halt the habit. “The thumb is right out there,” say Dr. Martin Stein, a professor of pediatrics at the University of California, San Diego School of Medicine. “Parents, teachers, grandmothers – everyone sees it, and some of them get anxious about it.”

What to do about unwelcome comments? One approach is to tell concerned individuals that the child’s doctor or dentist has examined the child and has given the habit the green light. If meddling relatives can’t drop the topic, suggest that they speak with the doctor or dentist themselves. Experts also recommend that parents inform a child’s preschool teach of their chosen approach so she can tailor her policy to theirs. And Pamela Rubin of New York City has a ready response for nosy strangers who ask when Jake, now four years old, is going to quit sucking his thumb: “When he’s ready,” she says firmly.

If Jake isn’t ready by the time he’s five, though, a strategy session may be in order. According to dental expert McTigue, a strong thumb habit beyond that age can alter the jawline and cause malocclusion, or misalignment of the upper and lower teeth. This can take the form of what’s commonly known as buck teeth. Or it may result in an open bite (top and bottom front teeth protrude so far that they don’t meet even when the jaw is clenched) or a cross bite (back upper teeth migrate inward as constant sucking narrows the palate).

But the trouble doesn’t stop the teeth. Linda Bejoian, a speech pathologist in New York City, has treated about 200 school-age thumb suckers, many of whom lisped until she helped them give up the thumb. As Bejoian explains, thumb sucking lead to tongue-thrusting, which in turn makes it hard for children to pronounce consonants like s, t, d, n, z, l and r. If the habit is caught before the permanent teeth come in, speech and dental problems can usually be reversed.

The physical repercussions notwithstanding, the emotional consequences are what parents feel most anxious about. Patrick Friman, a child psychologist for Boys Tows, near Omaha, Nebraska, who has conducted numerous studies of thumb sucking over the past decade, found that schoolchildren can be merciless toward the thumb suckers in their midst. Parents can reassure a child by explaining that it’s the habit itself, not the child’s personality, that is inspiring the teasing, so that the peer pressure becomes a motivating factor, says Friman.

Still, parents may worry that the short-term trauma of quitting will be worse than the consequences of continuing the habit. “The idea of taking away the one thing that soothes her seems so cruel,” says Sallly Schwab Honig, Katie’s mother.

Although professionals understand that concern, they feel it’s unfounded. If late thumb sucking were filling a deep emotional need, say Friman, then children who quit would simply compensate by clinging to their “sucking prop” – a blanket or stuffed animal – even more fiercely. But his research shows the opposite: Kids who stop sucking their thumb often drop their teddy bear or blanket, too. “With the exception of children who’ve experiences a trauma,” say Friman, “late thumb sucking is typically an empty habit, devoid of meaning.”

With a little care, experts agree, quitting doesn’t have to be traumatic. “As with any kind of behavior you’re trying to change,” say Bejoian, “if you make the child feel like she’s leading and give her lots of positive feedback, she’s not going to think she’s losing anything.”

Parents should take action if a child is older than five, shows dental wear and tear, or is being teased, says Dr. Arthur Nowak, a pediatric dentist at the University of Iowa College of Dentistry and Medicine in Iowa City. But instead of forbidding the behavior, which will only provoke stubborn rebellion, parents need to let a thumb sucker know they’re on her side. Then it’s time to give her the facts about what the habit can do to her teeth and social standing. Such an explanation might include reading Susan Heitler’s book David Decides: No More Thumbsucking or watching Linda Bejoian’s video, Mr. Wizard’s Thumbs Out.

For children who require more motivation than a book or video can provide, strategies range from dental consultations to at-home reward systems. Depending on a child’s age and the severity of the habit, parents may have to try more than one approach. In some cases, a dentist can persuade a child to quit just be talking to him gently, without the parents present. McTigue uses a standard talk, which he occasionally illustrates with pictures or models of thumb-damaged mouths: “I tell a child, ‘This is your mouth and not anybody else’s, and I know how good that thumb feels because I used to suck my thumb when I was a kid. But here’s what can happen to your teeth, so let’s try to prevent that.’ Many times that’s all it takes.”

But Stein, the professor of pediatrics, warns that many kids under the age of six aren’t capable of the cause-and-effect thinking required by such a direct approach. For them, a mild physical deterrent might be in order, such a wrapping an adhesive bandage around the thumb during the day to transform an unconscious behavior into a conscious one. “Sometime kids don’t even know they’re doing it,” says Dr. Heber Simmons, Jr., a pediatric dentist in Jackson, Mississippi. “That thumb just sort of finds its way into their mouth.”

Verbal reminders can also be useful but require some subtlety. Dr. Ellen Schumann, a pediatrician in Wausau, Wisconsin, recommends using a silly code word like “jelly bean” or “dinosaur” to avoid embarrassing a young child in public. Schumann also suggests restricting access to a child’s thumb-sucking props. That strategy worked for kindergartner Christopher Battista of suburban Minneapolis whose “kiki,” his blanket from infancy, is now safely stowed in his bottom drawer. “Once he could get to sleep without the blanket,” say his mother, Mary, “he could fall asleep without his thumb, too.”

Anne Kennedy, mother of Joseph, the former thumb sucker and hair twirler, had great success with the stickers-and-calendar strategy prescribed by Joseph’s dentist. “The dentist said, ‘Everyday that you don’t suck your thumb, you get to put a star on your calendar, and when you have a whole month of stars, we’ll send you a box of toys.’” Sure enough, Joseph stopped at once and later got his windfall of prizes. “That was it,” says Kennedy. “There was no trauma and no anxiety.” (While Joseph showed remarkable willpower, most experts recommend more frequent rewards.)

A reminder and a reward both figure in a controversial treatment plan developed by Friman, the Boys Town psychologist. He uses the same sort of bitter-tasting fluid (available in drugstores) that once was used punitively, but gives it a positive spin by calling it “reminder fluid” and allowing kids to paint it on their thumbs themselves. Friman also draws a dot-to-dot picture of a toy of the child’s own choosing, and everyday that she manages not to suck her thumb (aided by the fluid, which she applies twice a day) the child gets to connect two dots. When the picture is complete, her parents buy her the toy.

Some experts question the use of the reminder fluid, however: “I personally don’t recommend that, because it tastes bad and the child is going to feel unhappy,” says McTigue. But Friman has tested the treatment, which usually take about a month, on some 500 chronic thumb suckers in Omaha, Baltimore, and Philadelphia and says that it has been so successful that he’s never had to refer a child to a dentist for another possible solution, the palatal crib.

The crib is an acrylic or metal appliance that functions much like a retainer, blocking access to the roof of the mouth. It doesn’t hurt the child, but because it is intrusive and expensive, it usually reserved for serious thumb suckers ae six and older, after other strategies have failed. “I try to make it clear to the child that this is just a practical reminder,” says Simmons. Other experts agree with this approach. “I would consider it if thumb sucking was persisting beyond age five and was itself causing a malocclusion or significant psycho-social problems,” says pediatrician Stein. But the crib doesn’t always work as it’s supposed to, either. Simmons’ grown daughter wore one for a year when she was seven. The day Simmons removed it, he discovered her sitting on her bed, thumb in mouth. After sucking thumb for a week, she quit for good, later explaining: “I wanted to show you I could quit by myself.”

Indeed, professionals emphasize that since school-age thumb suckers are very much in control of their habit, none of these strategies is likely to succeed until a child want to quit. Lauren Wakefield hasn’t reach that stage yet. Her parents broached the subject with her when she was about four, but she was so upset that they dropped the issue. After all, their pediatrician assured them that the first time Lauren sucked her thumb in kindergarten would probably be her last. Instead, the day Lauren first worked up enough courage to put her thumb in her mouth at school, she came home and announced delightedly, “Guess what? I sucked my thumb and nobody said anything!” Her parents are saving up for braces.

Thumb or Pacifier

When it comes to satisfying a baby’s need for extra sucking, both the thumb and pacifier do the trick just fine. There’s one crucial difference, however: who’s in control. One advantage of the pacifier is that it can be suddenly, inexplicably, lost one day, while the thumb gives a child more independence and doesn’t fall out of the crib at night.

Although many parents think the pacifier is for better for the teeth, it can actually cause some of the same dental problems as the thumb, especially if it’s used upside down, all day long, or well past toddlerhood. Still, almost without exception, pediatric dentists prefer the pacifier to the thumb, and its use can often be ended earlier, lessening damage to the teeth.

Most pediatricians, on the other hand, generally don’t care which comfort tool a child uses, as long as the pacifier is given up by age two or three and the thumb by age five. But since daytime pacifier use can discourage a child’s speech efforts, toddlers should rely on pacifiers primarily at naptime and bedtime, says Dr. Marilyn Bull, a professor of pediatrics at Indiana University in Indianapolis.

Bulls’ own children, Beth and Julie, now teenagers, had free access to their pacifiers until they were about a year old, after which time the pacifiers were kept in the crib. “We call them ‘night-nights’ and the kids knew they were for bedtime,” Bull recalls. “After a while, they didn’t even suck on them: they just held one in each hand, and when the nipples wore out, they would carry the plastic shields to bed.”