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Straight, No Chaser: Understanding and Appropriately Stopping Thumbsucking

By Jeffrey Sterling, MD November 21, 2018

pacifiers
At first glance, you may be wondering what’s so significant about thumb sucking that we need to discuss it. And then, I show you these two pictures.
thumbsxthumb-sucking
In most instances, thumb sucking is a benign activity. It appears to stem from the sucking reflexes babies have, which are useful in breastfeeding. It is understandable how babies can transfer the level of comfort and security they find in their maternal attachment. You would think that at some point that wouldn’t be necessary, and indeed that is the case in the overwhelming majority. In those instances when that is not the case, you need to have tools at your disposal to address the situation.
As a frame of reference, thumb sucking tends to end during the toddler years for most. For most of the rest it ends when they are exposed to other children who may exert peer pressure.
As noted in the above picture, thumb sucking becomes a physical problem when a child’s permanent teeth start to come in. Thumb sucking then can affect how teeth develop and how the roof of the mouth forms.
Regarding mental considerations, children (and adults) may revert to thumb sucking behaviors when confronted with stress. In these instances the thumb sucking can take them back to a more comforting time.
The two most common questions are “When should I do something about it?” and “What can I do about it?”
In general, the time to start working with your children to move past thumb sucking is at about age four to five, if you notice dental problems or if you suspect that thumb sucking is related to anxiety and stress.
Various strategies are used to facilitate cessation of thumb sucking:

  • It appears that parental displays of anxiety are counterproductive. Children tend to respond more to positive reinforcement (rewarding good behaviors) than negative reinforcement (criticizing negative behaviors). Along those lines, experts generally recommend avoiding strategies such as placing bitter substances on the thumb.
  • Avoid rewarding the use of thumb sucking as a means to obtain attention.
  • It’s easier and more productive to address any triggers (e.g., anxiety, stressors) that promote thumb sucking than the activity itself. Substitution of the thumb with another release (e.g., a stuffed animal) may be effective.
  • If other efforts have been unsuccessful and the thumb sucking is interfering with normal development of the teeth, your dentist might recommend a dental appliance (such as a mouth guard) or a thumb guard to prohibit sucking.

thumbguardmouthguard
It is important to realize that in most instances thumb sucking will go away. It is also important for you not to display so much stress that it adds to the child’s stress or reinforces any attention-seeking behavior.
Feel free to contact your SMA expert consultant with any questions you have on this topic.
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