Thumb-Sucking

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Is thumb-sucking normal?

Thumb-sucking is normal in babies and young children. A natural sucking instinct leads some babies to suck their thumbs during their first few months of life, or even before birth. Babies may also suck on their fingers, hands, or items such as pacifiers.

Why do babies suck their thumbs?

Babies have a natural urge to suck, which usually decreases after the age of 6 months. However, many babies continue to suck their thumbs to soothe themselves. Eventually, thumb-sucking can become a habit in babies and young children who use it to comfort themselves when they feel hungry, afraid, restless, quiet, sleepy, or bored.

About 70% to 90% of infants suck their thumbs.¹ Most of these children gradually stop on their own between ages 3 and 6.

Does thumb-sucking cause any problems?

Prolonged thumb-sucking may cause a child to develop dental problems. Thumb-sucking can cause a child's teeth to become improperly aligned (malocclusion) or push the teeth outward, sometimes malforming the roof (upper palate) of the mouth. Malocclusion usually corrects itself when the child stops thumb-sucking. However, the longer thumb-sucking continues, the more likely it is that orthodontic treatment will be needed to correct any resulting dental problems.

A child may also develop speech problems, including mispronouncing Ts and Ds, lisping, and thrusting out the tongue when talking.

At what point does thumb-sucking become a problem?

Thumb-sucking in children younger than 4 is usually not a problem. Children who suck their thumbs frequently or with great intensity after the age of 4 or 5 or those who continue to suck their thumbs after age 5 are at risk for dental or speech problems.

In rare cases, thumb-sucking after age 5 is in response to an emotional problem or other disorder, such as anxiety. A child with this type of problem needs to be evaluated by a health professional. Most other children stop sucking their thumbs after simple treatment measures are introduced.

How is problem thumb-sucking treated?

Many experts recommend ignoring thumb-sucking in a child who is preschool age or younger. Most young children stop sucking their thumbs on their own.

Children who suck their thumbs may need treatment when they:

• Also pull their hair, especially when they are between 12 and 24 months of age.
• Continue to suck a thumb often or with great intensity after the age of 4 or 5.
• Ask for help to stop the behavior.
• Develop dental or speech problems as a result of the behavior.
• Feel embarrassed or are teased or shamed by other people because of the behavior.

Usually, treatment can be done at home and includes parents setting rules and providing distractions. It may be helpful to limit the times and places that your child is allowed to suck his or her thumb and to put away blankets or other items your child associates with thumb-sucking. Offering praise and rewards for not thumb-sucking may also help your child break the habit. As your child matures, usually around age 5, he or she may be able to take a more active role in treatment.

• Talk to your child openly about the effects of thumb-sucking.
• Put gloves on your child's hands or wrap the thumb with an adhesive bandage or a cloth. Explain that the glove, bandage, or cloth is not a punishment but is only there to remind him or her not to thumb-suck.
• Develop a reward system, such as putting stickers on a calendar or otherwise recording each day that your child does not suck his or her thumb. After an agreed-upon number of days, have a celebration for your child.
• Use a special nontoxic, bitter-tasting nail coating, such as Thum. Apply it like fingernail polish to the thumbnail each morning, before bed, and whenever you see your child sucking his or her thumb. This treatment is most successful when it is combined with a reward system.

If these treatments aren't successful, other methods—including behavioral therapy, thumb devices, or oral devices—may be used.

Frequently Asked Questions

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	Thumb-sucking: Helping your child stop

A thumb-sucking child usually places the thumb in the mouth above the tongue, pressing forward against the upper front teeth or gums and backward against the lower front teeth or gums. A child may develop a callus on the thumb if he or she sucks often and very hard.

• Some children suck their fingers instead of their thumbs. They may have found their fingers more easily than their thumbs when they first started sucking.
• Some children finger a piece of cloth, pull on their ears, or twist their hair while sucking.

Thumb-sucking in children younger than 4 is not usually a problem behavior. Children who suck their thumbs frequently or with great intensity after the age of 4 or 5 may develop:

• Emotional difficulties. Some preschoolers who suck their thumbs may feel ashamed if they are teased by other children. Parents can cause low self-esteem by ridiculing or punishing their child for this behavior.
• Dental problems. Thumb-sucking can cause many serious future dental problems, such as improperly aligned teeth (malocclusion). Malocclusion usually corrects itself when the child stops thumb-sucking. However, the longer thumb-sucking continues, the more likely it is that orthodontic treatment will be needed to correct any resulting dental problems.
• Speech problems. The most common speech problems that develop because of thumb-sucking include mispronouncing Ts and Ds, lisping, and thrusting out the tongue when talking.

Thumb-sucking behavior before age 3 or 4 is normal and does not require medical tests or evaluation. Children who continue to suck their thumbs after age 4 or 5 may need a:

• Dental exam, to identify any irregularities of the teeth, bite, or jaw.
• Speech evaluation, if word pronunciations are affected or other irregularities develop.

If the habit is severe and appears to be related to other behavioral disorders, such as anxiety, or a reaction from a traumatic event, a psychological evaluation may be needed.

Most children stop sucking their thumbs on their own sometime between ages 3 and 6. They usually do not need treatment.

Children who suck their thumbs may need treatment when they:

• Also pull their hair, especially when they are between 12 months and 24 months of age.
• Continue to suck a thumb often or with great intensity after the age of 4 or 5.
• Ask for help to stop the behavior.
• Develop dental or speech problems as a result of the behavior.
• Feel embarrassed or are ridiculed by other people because of the behavior.

Treatment to stop thumb-sucking works best if the child is involved in the process and wants to quit. Preferred treatments vary among experts. Some believe that any treatment that does not have the child's cooperation is not likely to work and may even make the habit last longer. Others believe that it is sometimes necessary to try to stop thumb-sucking even when the child objects. For more information, see:

Thumb-sucking: Helping your child stop.

It is important to delay treatment for thumb-sucking if a child is facing a stressful time, such as after an injury, loss of a pet, moving, or when the family is having difficulties.

Some parents of thumb-sucking children are unable or unwilling to ignore the behavior even in a child younger than 4. In this case, parents may choose to talk to a health professional about their concerns, rather than focus on treating the thumb-sucking.

Caregivers disagree about whether it is best for infants to suck their thumbs or use pacifiers. One advantage is being able to control when your child uses the pacifier. However, pacifiers may be linked to an increase in ear infections in some children. Prolonged thumb-sucking may cause serious dental problems, although most children stop on their own before entering school. This is largely an issue of preference.

Problem thumb-sucking is most often resolved with home treatment such as offering rewards and praise when the child is not thumb-sucking. When home treatments have not worked, other treatments may be necessary. These include:

• Behavioral therapy. Behavioral therapy helps a child avoid thumb-sucking through various techniques, such as substituting tapping fingers together quietly. Behavioral therapy works best if all people involved in the child's care follow the treatment plan.
• Thumb devices. Thumb devices, such as a thumb post, can be used for children with severe thumb-sucking problems. A thumb device is usually made of nontoxic plastic and is worn over the child's thumb. It is held in place with straps that go around the wrist. A thumb device prevents a child from being able to suck his or her thumb and is worn all day. It is removed after the child has gone 24 hours without trying to suck a thumb. The device is put back if the child starts to suck his or her thumb again. Thumb devices need to be fitted by a health professional.
• Oral devices. Oral devices (such as a palatal arch or crib that fits into the roof of the mouth) interfere with the pleasure a child gets from thumb-sucking. It may take several months for the child to stop sucking the thumb (or fingers) when these devices are used. Once the child stops sucking, parents may choose to continue using the device for several months. This may prevent the child from starting the habit again. Oral devices need to be fitted by a dentist.

Many experts recommend ignoring thumb-sucking in a child who is preschool age or younger. Most children stop sucking their thumbs on their own sometime between ages 3 and 6.

Home treatment to help a child stop sucking the thumb is not usually attempted until age 4 and then only if the behavior is frequent or intense. Beginning at age 4, dental and speech problems can develop as a result of thumb-sucking.

Home treatment for thumb-sucking is usually successful. Parents can set rules and help distract a young child from thumb-sucking. The child can take a more active role in controlling thumb-sucking as he or she matures and is able to understand cause-and-effect relationships, concepts of time, values (such as right and wrong, or sense of pride), and has some self-control.²

The following are suggestions to help your child stop sucking his or her thumb:³

Parent-directed measures for a young child (around age 4)

• Give your child more attention and distract him or her with engaging activities.
• Limit the places and times for thumb-sucking. For example, ask your child to do it only while in his or her bedroom.
• Put away items (such as blankets) that your child associates with thumb-sucking. At first, put the items away for short periods of time throughout the day. As your child learns other ways of self-comfort, gradually increase the amount of time these items are not available.

Measures where the child takes an active role (beginning around age 5)

• Talk to your child openly about the effects of thumb-sucking.
• Put gloves on your child's hands or wrap the thumb with an adhesive bandage or a cloth. Explain that the glove, bandage, or cloth is not a punishment, but is only there to remind him or her not to thumb-suck.
• Develop a reward system, such as putting stickers on a calendar to record each day that your child does not suck his or her thumb. After an agreed-upon number of days, have a celebration for your child.
• Use a special nontoxic, bitter-tasting nail coating, such as Thum. Apply it like fingernail polish to the thumbnail (or fingernail) each morning, before bed, and whenever you see your child sucking his or her thumb. This treatment is most successful when it is combined with a reward system.

Before you start any home treatment for thumb-sucking, make sure you feel comfortable and confident with your plan. In addition, make sure your methods will be consistently used by other people who care for your child. For more information, see:

Thumb-sucking: Helping your child stop.

When attempting to get your child to stop thumb-sucking:

• You should not remove the thumb from the child's mouth while he or she is awake. You can remove it after the child is asleep.
• Do not punish or shame your child for thumb-sucking. Stay neutral, calm, and nonjudgmental when talking about your child's thumb-sucking habit.
• Do not allow other people to make fun of your child.

If home treatment methods have not worked and you are concerned or feel frustrated about your child's thumb-sucking, talk with a health professional.

Organizations

• Anxiety
• Growth and Development, Ages 1 to 12 Months
• Growth and Development, Ages 12 to 24 Months
• Growth and Development, Ages 2 to 5 Years
• Growth and Development, Ages 6 to 10 Years
• Malocclusion and Orthodontics

Citations

1. Nowak AJ, Warren JJ (2000). Infant oral health and oral habits. Pediatric Clinics of North America, 47(5): 1043–1066.

2. Van Norman RA (2001). Why we can't afford to ignore prolonged digit sucking. Contemporary Pediatrics, 18(6): 61–81.

3. Christophersen ER, Mortweet SL (2001). Diagnosis and management of habit disorders. In Treatments That Work With Children, chap. 3, pp. 79–97. Washington, DC: American Psychological Association.

Other Works Consulted

• American Academy of Pediatrics (accessed 6/20/06). Quitting thumb sucking and pacifiers. Available online: http://www.aap.org/pubed/ZZZBQKBWQ7C.htm?&sub_cat=1.

• Boris NW, Dalton R (2004). Habit disorders. In RE Behrman et al., eds. Nelson Textbook of Pediatrics, 17th ed., chap. 21, p. 80. Philadelphia: Saunders.

• Gabby T (2003). Compulsive behaviors: Habits to tics. In CD Rudolph et al., eds. Rudolph's Pediatrics, 21st ed., pp. 459–463. New York: McGraw-Hill Medical.