Thumb Sucking
Stephanie Blenner
I. Description of the problem. Most infants engage in nonnutritive sucking. They may use fingers, toes, a pacifier, or other object as a means of self-soothing. In some children, this behavior persists into early or middle childhood.
A. Epidemiology.
Seen in the fetus on ultrasound as early as 16 to 18 weeks.
Infants commonly suck their fingers or toes.
Thirty percent to forty-five percent of preschool children and 5% to 15% of children over age 5 continue to engage in thumb sucking.
Thirty percent to fifty-five percent of children who suck their thumb or fingers also use an attachment object, blanket, or twirl or caress their own hair when thumb sucking.
B. Etiology. Historically, psychoanalysts conceptualized thumb sucking as an expression of infantile drives and felt it could reflect emotional disturbance if it persisted beyond infancy. Some believe thumb sucking is a learned habit. Most view thumb sucking as a means of self-comforting. It may help relieve stress and calm a child in the face of environmental challenges. Thumb sucking is often seen when a child is falling asleep, tired, bored, hungry, or anxious. It is not associated with emotional disturbance in most cases.
C. Negative sequelae.
1. Dental. The most common consequences of thumb sucking are dental, in particular, malocclusion of both primary and permanent dentition. It may also lead to temporomandibular problems, anterior overbite, posterior cross bite, atypical root resorption, mucosal trauma, narrowing of the maxillary arch, and abnormal facial growth. The risk is highest among children who suck continuously and persist beyond age 4.
2. Digit abnormalities. With chronic thumb sucking, a digital hyperextension deformity can occur that may require surgical correction. Callous formation, paronychia, irritant eczema, and herpetic whitlow are also seen.
3. Psychological effects. Thumb sucking can contribute to impaired parental and peer relationships. It is often viewed as immature and socially undesirable. Parents and peers may criticize, tease, or punish the child for engaging in thumb sucking. These reactions may, in turn, adversely affect a child’s self-esteem.
4. Accidental poisoning. Children who thumb suck are at increased risk of accidental poisoning (e.g., lead poisoning).
II. Making the diagnosis. Thumb sucking becomes a problem at any age when it interferes with normal developmental achievements, physical health, social interactions, or self-esteem.
Physical examination. Examination may reveal a wrinkled, red digit with or without callous formation. Oral examination should be performed looking for malocclusion or other dental complications.
III. Management.
A. Primary goals. The goals of treating thumb sucking are to prevent dental complications and potential adverse effects on the child’s social interactions and self-esteem. In general, targeted intervention is not necessary until after age 4, when adverse sequelae become more common. Most children will spontaneously stop thumb sucking as they develop other self-regulatory strategies.
B. Treatment strategies.
1. Identify triggers and reinforcers. Emotional and situational triggers should be identified. Thumb sucking often occurs at particular times of day, during certain activities, or accompanying specific emotional states. Some children only thumb suck while twirling their hair or holding a blanket. As a child gets older, thumb sucking may provide secondary gain through attention paid to the behavior. Intervention should not be considered during a time of unusual stress for the child. For example, it would not be ideal to begin an intervention program at the start of school or during a family move.
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