Treatment

In the great majority of children, no treatment is needed for thumb-sucking. In any case, treatment should generally not be contemplated before the age of 4 years. Thumb-sucking should be regarded as a normal behaviour up until this age, and treatment will be ineffective because the child does not yet have the cognitive capacity to co-operate.

Treatments that are sometimes advocated have not been shown to be effective. Some parents will use mittens, or hand restraints at night, or punish the child. These measures are harsh and unnecessary, and there is no evidence that they hasten the time when the child will stop the habit. Often the use of bitter-tasting nail polishes or similar solutions to paint on the child’s hands at night are advocated, but again with very little evidence that they do much good. These methods may work in the older child as a means of assisting him when he has already made a commitment with the parents to give up the habit.

All of these interventions may in fact have the opposite effect of what is intended.

By continuing to draw attention to the habit, parents may be unwittingly reinforcing it, and actually prolonging it.

In children of 4 years of age or older, where the continuation of thumb-sucking is embarrassing to the child, it may be worth considering a specific behaviour modification program for the child. This involves getting the child’s co-operation to stop the habit, and contracting with him to remind him when he does it. The child can help remind himself by drawing on his thumb, or putting a band-aid on it. Praise him when he does not suck his thumb, and reward him when he completes an agreed period of time (for example, a whole day) without sucking his thumb.

Prevention

There is no reliable way to prevent finger- and thumb-sucking, nor should you try to do so. It should be regarded as a developmentally normal part of childhood. To attempt interventions that are at best ineffective and at worse harsh and inappropriate for the child may actually prolong the habit. It may be helpful for you to consider providing other sources of comfort during periods of stress.

When to see your doctor

There are very few indications to seek medical help for this condition, because it is almost always transient and has no long lasting consequences. If the habit persists into the school years, the family dentist should be asked to review the child. Parents may want advice if they suspect that the habit is a manifestation of more serious underlying psychological problems, or if they are worried about other associated behaviours.

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Thumb-sucking and finger-sucking are very common in young children. It is estimated that around half of all children will be thumb-suckers for several months or more during their toddler or preschool years. It is therefore considered a normal part of development, and despite parental protestations, rarely needs any active intervention.

Sucking of the fingers or thumb often starts during infancy. A young baby may initially bring his hand to his mouth accidentally, in the course of general movements of the upper limbs. In many babies this then becomes purposeful, as the baby derives comfort and pleasure from it. Indeed, thumb-sucking may be seen as a positive behaviour in infancy, and is regarded as part of the baby’s ability for self-regulation and self-comforting. Babies who can suck on their fingers are often more easily able to settle themselves without relying on parental involvement. This is especially helpful when going to sleep, or at times of distress.

Some children simply continue this habit that they have acquired in infancy. Others begin to suck on their fingers or thumb at some stage during the toddler period. For most children this is a normal developmental behaviour and it will soon pass. By the age of 4-5 years, only a few children are still sucking their thumb, although many will still revert to it at times of stress, tiredness or when going to bed.

There are rarely any serious or long-term complications of thumb-sucking. Many children will develop calluses on their thumb or fingers, which will often become misshapen. These effects are not long lasting and will return to normal soon after the child ceases the activity.

Infrequently there are more significant concerns. The main one appears to be a concern that the persistence of finger- or thumb-sucking beyond 4 or 5 years may interfere with the normal development of a child’s teeth, so that the teeth will grow unevenly. It is worthwhile asking the child’s dentist to check on this after the child prolonged thumb- or finger-sucking may interfere with normal speech development but it is likely that factors other than thumb-sucking are responsible for this.

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