It’s not uncommon to see a toddler walking around with her thumb in her mouth. However, once a child reaches school age, it is expected that she no longer sucks her thumb. When this isn’t the case, social consequences and dental problems become concerns. For the child who continues to suck her thumb, the habit has become a crutch. Her thumbsucking is no longer a mere reflex. At this point in a child’s development, breaking the habit will take patience, understanding and a joint effort by both the child and her parents to eliminate the prolonged habit.

Why do children suck their thumbs?
Thumbsucking in infants is quite common and very natural. According to the American Dental Association (ADA), “Children suck on things because sucking is one of baby’s natural reflexes. It may make them feel secure and happy and helps them learn about their world to suck on their thumbs, fingers, pacifiers or other objects.”

However, for the older child, thumbsucking is not a simple reflex. The older child might still suck her thumb to relieve boredom or tension. She also might suck her thumb because she is insecure. In some cases, an older child might only suck her thumb in order to soothe herself to sleep or when she is not feeling well. According to the American Academy of Pediatrics, school-age children who continue thumbsucking “might still use sucking as a way of going to sleep or calming themselves when they are upset. This is usually done in private.”

When does thumbsucking become problematic?
The American Dental Association reports, “Usually children stop between the ages of two and four years.” When thumbsucking continues into the school years, sucking may cause problems with the proper growth of the mouth and alignment of the teeth. The ADA specifies: “When permanent teeth start to come in, thumbsucking could prevent proper spacing and tooth alignment. In severe cases, it can even change the formation of the roof of the mouth.”

Although most school-age children who suck their thumbs do so in private (because older children become aware that thumbsucking is not an accepted practice), there is a small percentage of children who continue thumbsucking during the day. For the school-age child, the social ramifications of this can be devastating. The ADA warns, “Chronic thumbsucking in school-age children may reduce peer social acceptance, an important contributor to social development.”

How to help your older child kick the habit
If she sucks her thumb because she feels insecure, focus on eliminating the cause of the anxiety. If she tends to suck her thumb because of boredom, offer an alternative activity to distract her. If the habit only occurs during sleep (when she is unaware), you might want to consider a “thumb guard” (an adjustable plastic cap that is secured to the thumb and not easily removed). Ask your pediatric dentist if there is a particular guard that he recommends.

In their book, Good Behavior, Stephen Garber, Ph.D., Marianne Garber, Ph.D. and Robyn Spizman suggest that parents chart their child’s behavior and offer rewards for success. “A reward chart increases the chances that a child will practice a new behavior. Tell her she may print her thumb on a thumbprint chart every time she is successful.” The authors note that you should use a nontoxic vegetable dye for this purpose.

Most importantly, the older child must be part of the process. She must be ready and willing to quit. In other words, the older child must take ownership of the plan. Habits are not broken by parents. They are broken because the child is convinced that she no longer wants to continue the habit.

The American Academy of Pediatrics explains, “Your child should be directly involved with the treatment chosen. Before using any method, be sure to explain it to your child.” Most experts agree on the following tips to help an older child break the habit:

—Don't use harsh words or teasing — this will reinforce the habit
—Praise her for not sucking her thumb
—Involve her in choosing the method of stopping
—Set up an incentive system to reward progress
—Don't get frustrated — this tends to make the habit worse
—Use a device (such as a thumb guard) — especially if the problem occurs at night while she sleeps
—Ask your dentist (or pediatrician) to explain to your child the effects of thumbsucking
—Find age-appropriate literature on the subject

When to see a specialist
Most children will stop sucking their thumbs when they are ready. If, however, after many attempts at trying to kick the habit, your child continues to suck her thumb, you may need to seek outside help. Your child’s pediatric dentist or pediatrician might suggest an appliance that will help facilitate the quitting process. You can also talk to your child’s pediatrician about recommending a therapist if you think your child’s thumbsucking is related to an emotional or psychological problem.

Barton D. Schmitt, M.D., author of Your Child’s Health, offers the following general guidelines for seeking advice from a health care provider:
• Your child is over 4 and sucks her thumb constantly
• Your child is over 5 and doesn’t stop when peers tease her
• Your child’s teacher has expressed concern about thumbsucking in class
• Your child also has emotional problems
• Your child’s permanent teeth are affected

Reading Material for Both Parent and Child:
For children ages 5 and up (or for reading together):
—David Decides About Thumbsucking, by Susan Heitler, Ph.D. (Reading Matters)
—My Thumb and I, Carol A. Mayer, Barbara E. Brown & Ashley C. Brown (Chicago Spectrum Press)

For Parents:
—Helping the Thumbsucking Child, by Rosemary Van Norman (Avery Publishing Group)
—It Worked for Me! Parents Magazine (St. Martin’s Press)

More Information on Thumb Guards:
The following website contains information about ThumbGuard™, a popular appliance developed in 1995. This guard has FDA-approved material. Consult your dentist before purchasing any thumb guard. www.thumbguard.com

Oh the thumb-sucker’s thumb
May look wrinkled and wet
And withered, and white as the snow,
But the taste of a thumb
Is the sweetest taste yet
(As only we thumb-suckers know).
—Shel Silverstein,
Where the Sidewalk Ends