Thumb sucking

Between 75% and 95% of all infants suck their thumb, making thumb-sucking the most prevalent kind of nonnutritive oral activity in infants and young children. Thumb-sucking continues in approximately 45% of American pre-school children, but in only 30% of Swedish children of the same age. In a significant percentage of American 7-11-year-olds, thumb-sucking persists. Among Inuit, American Indian, and African children thumb-sucking is rare.

Thumb-sucking may begin before birth. The thumb has been observed in the mouths of fetuses as young as 18 weeks of gestational age, and true sucking movements and protrusion of the lips may occur by 24 weeks. New-borns often have blisters on their hands and arms, indicating the probable occurrence of sucking before birth. After birth, infants have a strong rooting reflex: they turn their head toward an object touching the cheek. This reflex allows them to find the nipple. Around the age of 3 months, an infant may accidentally discover its thumb or another digit and suck on it. Thumb-sucking is usually established before the first birthday.

A number of theories have been advanced concerning the origins and import of thumb-sucking. Freud believed that thumb-sucking is an instinctual activity. Following S. Lindner's 1879 argument that thumb-sucking is sexual in nature, Freud found that it fulfilled all the criteria to be considered the model of infantile sexuality. It relies on a physical function — the need for nourishment and the pleasure derived from it; it is autoerotic, or directed toward self-gratification; and it is controlled by an erogenous zone, the lips, which first experience the pleasure of sucking. Freud believed that thumb-sucking (or sucking another part of the body) arises when the gratification of the erogenous zone becomes separated from the desire to take nourishment. During thumb-sucking an infant desires to grasp something, such as its own or another's ear, and pull it rhythmically. Since this activity is very pleasurable and may become associated also with rubbing sensitive parts of the body, such as the breast or genitals, Freud believed that thumb-sucking led to masturbation.

The behaviourist John B. Watson rejected instinct as an explanation for human behaviour. In The Psychological Care of the Infant and Child (1928), he promoted child-rearing practices based on his belief that children are made, not born, and that almost all behaviours result from conditioning. An implication of this view was that thumb-sucking, a bad habit, resulted from a conditioned response associated with eating, and must be cured within the first few days after birth. Charles Anderson Aldrich and Mary Aldrich, the authors of Babies are Human Beings (1938), by contrast, viewed thumb-sucking as a prenatal sport designed to exercise the facial muscles, and assured their readers that a child would stop it as soon as he developed other interests.

Other explanations for the origin and significance of thumb-sucking abound. Some consider it a natural stage of development that usually ceases by the end of the third year, though it may become a habit. Still others characterize it as a means by which infants comfort themselves. In contrast to these explanations, one study finds that thumb-sucking seems to improve respiratory function in babies with an immobile tongue (ankyloglossia) and a deviated epiglottis and larynx. Another group of theories links the development of thumb-sucking with inadequate sucking during breast-feeding or with bottle feeding, which takes less time. Some children suck their thumb only while falling asleep or sleeping. In older children thumb-sucking occurs in stressful situations, such as fatigue, boredom, hunger, insecurity, parental deprivation, or frustration.

Thumb-sucking may entail certain risks to physical health. It pushes the upper incisors out and the lower incisors in. Such malocclusions resolve spontaneously if thumb-sucking stops before the permanent teeth erupt. Other undesirable effects can include problems with jaw movements, narrowing of the cheek bones due to the contractions of the cheek muscles, ulcerations beneath the tongue, and root resorption. More commonly, the thumb may develop calluses or an irritant eczema, and the digit itself may become deformed.

Parental and expert responses to thumb-sucking underwent significant changes during the twentieth century. Before the end of the nineteenth century, little was said or written about it. In the final decades of the century, however, it became a cause for concern. Freud noted disapprovingly that, in the nursery, thumb-sucking was treated like any other ‘sexual naughtiness’. It was recognized that thumb-sucking could also lead to a misshapen mouth. Luther Holt recommended mittens or a splint to the elbow to prevent it. In 1922 Charis Barlow warned that thumb-sucking introduced dirt and germs into the mouth, caused adenoid inflammation, weakened the digestion, and spoiled the mouth and thumb shape. To prevent thumb-sucking, she recommended pinning the sleeves shut or wrapping the baby in a shawl to sleep, while Watson advised sewing mitts onto pajama sleeves. In the first edition of the Common Sense Book of Baby and Child Care (1945), Dr Benjamin Spock recommended increasing the time taken in breast- or bottle-feeding in young infants to discourage thumb-sucking, but cautioned parents against using restraints such as aluminum mittens for older children, as such devices frustrate the child.

Pediatricians now recommend that no action against thumb-sucking be initiated during the first two or three years. In the older child, an environmental cause for thumb-sucking should be sought and eliminated; for cases where thumb-sucking is an empty habit, parents are urged to remind the child gently only if the child wants to quit. Other cures involve bitter tasting liquids applied to the thumb, and palatal bars. In all cases children require emotional support.

— Kristen L. Zacharias

Bibliography

• Hardyment, C. (1983). Dream babies. Three centuries of good advice on child care. Harper and Row, New York.
• Leung, A. K. C. and Robson, W. L. M. (1991). Thumb sucking. American Family Physician, 44, 1724-8

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Definition

Thumb sucking is the childhood habit of putting the thumb in the mouth for comfort or to relieve stress.

Description

About half of all children suck their thumbs during infancy, with most starting in the first weeks of life. Ultrasound pictures of intrauterine life have even shown fetuses sucking their thumbs. One way that infants explore their world is by putting objects in their mouths and sucking on them. Thumb sucking appears to be a natural habit of children in all parts of the world. Sucking the thumb is soothing for a small child, and many children continue this habit for comfort and security into the early school years. Thumb sucking is most prevalent in children under two, and most children give up the habit on their own by age four.

Thumb sucking by itself is not a cause or symptom of physical or psychological problems. It is not known why some children suck their thumbs longer than others. More girls than boys suck their thumbs beyond age two. Researchers speculate that boys receive stronger negative messages from parents and peers that thumb sucking is infantile and not acceptable. Thumb sucking offers security to a child, but this behavior does not imply that the child is insecure. Most children have some sort of self-comforting ritual that may involve sucking the thumb, fingers, or a pacifier, pulling or twisting their hair, or stroking or sucking a soft toy or blanket. These are all normal habits of infancy that are eventually outgrown.

Some nineteenth-century physicians feared a variety of consequences from thumb sucking, such as weak moral character, and earlier generations of parents were advised to break this habit forcibly. Parents were sometimes told to place mechanical constraints on their children's hands to keep their thumbs out of their mouths. Children's thumbs were sometimes coated with a bitter substance, taped, or covered with gloves. It was also considered necessary to shame and humiliate the thumb sucker.

Modern doctors find few negative health effects of thumb sucking, even if prolonged, and parents are urged to let their children outgrow the habit on their own. Thumb sucking may be more of a problem for the parent than the child, if the parent is unsettled by the behavior. Weaning a young child from the habit before he or she is ready is usually difficult and may only prolong the thumb sucking.

Infancy

Some children suck their thumbs before they are even born, and others begin sucking their thumbs soon after birth. All or nearly all infants suck on their fingers, thumbs, or a pacifier. This is completely normal and very common.

Toddlerhood

Thumb sucking is most common in children who are younger than two years old. Many children stop sucking their thumbs by age three or four without any intervention.

Preschool

Preschool children may begin to become embarrassed by their thumb sucking if the children with whom they interact do not suck their thumbs and make fun of them. Most children in this age group who still suck their thumbs will stop on their own, and intervening may stress the child and make the problem worse. Even when they have stopped thumb sucking during the day, children may continue it as part of a nighttime falling sleep ritual.

School Age

Most children have stopped sucking their thumbs before they begin school, or else stop sucking shortly thereafter, usually in response to peer pressure. If a school age child seems distressed about his or her thumb sucking, the parent may want to suggest ways in which they can work together to wean the child from the thumb. If the child does not want to give up thumb sucking, the dentist should be consulted to ensure that it is not doing any damage to the alignment of the teeth.

Common Problems

There are a few cases where thumb sucking may become a problem. If a school-age child sucks his or her thumb and is teased by classmates, the child may wish to quit and need help either from parents or a counselor. Some dentists warn of misalignment of permanent teeth if a child of five or six sucks the thumb with a lot of pressure on the teeth. Not all dentists agree, however, that thumb sucking is harmful to tooth development. If a child's dentist sees evidence that thumb sucking is causing a particular problem, the child may need to be urged to quit. If the child is having trouble quitting the habit, parents may be able to help with positive reinforcement. The child can be given a sticker or small reward for a day spent without thumb sucking. Parents can also help the child find something else to do with his or her hands when the child has the urge to suck the thumb. Parents should avoid negative pressure on children to stop sucking their thumbs; this habit is eventually outgrown by all children. In extreme cases, some dentists can prescribe an oral device to alter the shape of the roof of the child's mouth, so that it is unpleasant for the child to continue sucking. If a child has recently undergone any sort of trauma such as witnessing divorce, a pet's death, or family problems, treatment for thumb sucking should not be undertaken right away.

Parental Concerns

Parents tend to be more concerned with thumb sucking than is actually warranted. Until the child is five or six, or there starts to be a problem with speech formation or teeth alignment, thumb sucking is not a problem.

When to Call the Doctor

If the child continues to suck his or her thumb after age five or six, or sucks it frequently or very hard after age three or four, the doctor may have helpful suggestions for the concerned parent. If the child's teeth are becoming misaligned because of thumb sucking the dentist should be consulted. If the thumb sucking is combined with other problems such as anxiety a doctor should be consulted.

Resources

Books

Dionne, Wanda. Little Thumb. Gretna, LA: Pelican Publishing Company, 2001.

Organizations

International Association of Orofacial Myology. 970 Elizabeth Street, Denver, CO 80209. Web site: www.iaom.com.

[Article by: Tish Davidson, A.M.]

For other uses, see Thumbsucker (disambiguation).

Infants may use pacifier or thumb or fingers to soothe themselves

Newborn baby thumb sucking

Thumb sucking is a behavior found in humans, chimpanzees, captive Ring-tailed Lemurs,^[1] and other primates.^[2] It usually involves placing the thumb into the mouth and rhythmically repeating sucking contact for a prolonged duration. It can also be accomplished with any piece of skin within reach (such as the big toe) and is considered to be soothing and therapeutic for the person. As a child develops the habit, it will usually develop a "favorite" finger to suck on.

At birth, a baby will reflexively suck any object placed in its mouth; this is the sucking reflex responsible for breastfeeding. This reflex disappears at about 4 months of age; thumb sucking is not purely an instinctive behavior and therefore can last much longer.^[3] Moreover, ultrasound scans have revealed that thumb sucking can start before birth, as early as 15 weeks from conception; whether this behavior is voluntary or due to random movements of the fetus in the womb is not conclusively known.

Thumb sucking generally stops by the age of 5 years. Some older children will retain the habit, which can cause severe dental problems.^{[citation needed]} Thumb sucking is sometimes retained into adulthood and may be due to stereotypic movement disorder, another psychiatric disorder, or simply habit continuation.

Contents 1 Dental problems and prevention 2 See also 3 References 4 External links

Dental problems and prevention

Alveolar prognathism, caused by thumb sucking and tongue thrusting in a 7-year-old girl.

Percentage of children who suck their thumbs (data from two researchers) Age Kantorowicz[3] Brückl[4] 0–1 1–2 92% 93% 66% 2–3 87% – 3–4 4–5 5–6 86% 85% 76% 25% Over 6 — 9%

Most children stop sucking on thumbs, pacifiers or other objects on their own between 2 and 4 years of age. No harm is done to their teeth or jaws until permanent teeth start to erupt. The only time it might cause concern is if it goes on beyond 6 to 8 years of age. At this time, it may affect the shape of the oral cavity or dentition.^[5]

To prevent their children from sucking their thumbs some parents use bitterants or piquant substances on their child's hands—although this is not a procedure encouraged by the American Dental Association^[5] or the Association of Pediatric Dentists. During the 1950s, parents could get a series of sharp prongs known as "hay-rakes" cemented to a child's teeth to discourage sucking.

The American Dental Association recommends:

• Praise children for not sucking, instead of scolding them when they do.
• If a child is sucking its thumb when feeling insecure or needing comfort, focus instead on correcting the cause of the anxiety and provide comfort to your child.
• If a child is sucking on its thumb because of boredom, try getting the child's attention with a fun activity.
• Involve older children in the selection of a means to cease thumb sucking.
• The pediatric dentist can offer encouragement to a child and explain what could happen to its teeth if it does not stop sucking.
• Only if these tips are ineffective, remind the child of its habit by bandaging the thumb or putting a sock/glove on the hand at night.

See also

• Stereotypic movement disorder
• Prognathism

References

1. ^ Jolly, A. (1966). Lemur Behavior. Chicago: University of Chicago Press. p. 65. ISBN 978-0226405520. 
2. ^ Benjamin, Lorna S.: "The Beginning of Thumbsucking." Child Development, Vol. 38, No. 4 (Dec., 1967), pp. 1065–1078.
3. ^ ^{a b} A. Kantorowicz: "Die Bedeutung des Lutschens für die Entstehung erworbener Fehlbildungen." In: Fortschritte der Kieferorthopädie. Bd. 16, Nr. 2, 1955, S. 109–121.
4. ^ Erwin Reichenbach, Hans Brückl: Kieferorthopädische Klinik und Therapie. J. A. Barth, Leipzig 1962
5. ^ ^{a b} http://www.ada.org/2977.aspx

External links

• American Dental Association: patient advice
• JADA study: Duration of pacifier use, thumb sucking may affect dental arches
• http://www.cda-adc.ca/en/oral_health/cfyt/dental_care_children/pacifiers.asp
• http://www.blurb.com/bookstore/detail/2268598 : "Latchment Before Attachment, The First Stage of Emotional Development, Oral Tactile Imprinting" Author Elsie Mobbs, GT.Crarf Publisher, Westmead, 2011.

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