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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INTELLIGENCE QUOTIENT (IQ) TESTS LUMBAR PUNCTURE

IQ tests are usually performed by trained psychologists as part of a total assessment of a child’s development and achievement. An IQ test is often performed when a child is suspected of having developmental delay or learning difficulties. The test itself compares the child’s performance in a wide range of cognitive/thinking skills and tasks with the scores of a large sample of children of the same age. An average score falls between 85 and 115. IQ test results should not be looked at in isolation as being truly representative of overall intelligence. They can only be used as a guide, because many other factors come into play with respect to learning, such as motivation, health and social circumstances.

LUMBAR PUNCTURE

The fluid surrounding the spinal cord and brain is called cerebrospinal fluid and protects the delicate nervous system. If there is any suspicion that your child has developed an infection in this fluid (as in meningitis), then a lumbar puncture (or spinal tap) is performed under sterile conditions, usually at the hospital. A fine needle is passed into the spinal canal, and a small amount of fluid is removed and sent to the laboratory for testing. In older children, local anaesthetic may be used to make the area numb; this is not done in younger children, as it requires two needle pricks instead of the one.

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ECHOCARDIOGRAM

This test uses ultrasound techniques to produce an image of the heart on a television screen, and can be an invaluable aid in showing up abnormalities in both heart structure and function.

ELECTROCARDIOGRAM (ECG)

An electrocardiogram is produced by a machine which monitors the electrical activity of the heart. Leads are attached to your child’s chest with stickers, and rubber straps attached to leads are placed around the ankles and wrists. Electrical impulses are recorded on a moving graph. Abnormalities of the heart’s rhythm, size and structure can be detected. It is a harmless and painless procedure. Young children may be afraid because they have to lie as still as possible during the recording, so it helps if you are nearby to reassure your child.

ELECTROENCEPHALOGRAM (EEG)

This is a painless procedure performed when there is any suspicion that your child has epilepsy, or when he has had convulsions for any reason. Electrodes are attached to your child’s head with a gluey material, and the electrical activity of the brain IS recorded on graph paper by an electroencephalograph. The patterns are then interpreted by a specialist doctor. The procedure is harmless. Young children are often given sedation before the procedure, and sometimes the doctor may want an EEG performed while the child is asleep in order to diagnose certain conditions.

ENDOSCOPIES

Endoscopies are performed using a tiny fibre-optic camera attached to the end of a long, flexible tube. With the child under sedation, this is passed either through the mouth into the oesophagus (oesopbagoscopy), into the stomach and upper bowel (gastroscopy), or into the rectum and lower bowel (colonoscopy). Younger children may require a light general anaesthetic. Gastroscopy is performed if there is any suspicion that the child has a problem such as a peptic ulcer. Colonoscopy may be performed if a diagnosis such as inflammatory bowel disease has been suggested.

EYE SWAB

If your child has a sore or itchy eye in which a discharge is present, your doctor will usually take an eye swab. This involves gently removing some of the material with a sterile cotton bud, and sending it to the laboratory for identification of the germ causing the infection. The appropriate antibiotic to fight the germ can also be determined.

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Question

A friend of mine has told me alternative therapies such as massage or acupuncture will help me. I’m not sure if I should try them.

Answer

Massage and acupuncture can help to release and balance bodily tensions. As with all other therapies, we need to learn to control and^fnanage the anxiety and attacks ourselves. While we are learning the management skills, massage and acupuncture can be useful in reducing anxiety and tension. In the long term they can help keep our bodies relaxed.

Question

lam not happy about taking prescribed medications and I am wondering if herbal medications and vitamin therapy would help me instead.

Answer

Herbal and vitamin preparations are used regularly by many people. They can be bought over the counter or prescribed by a herbalist or naturopath. They can be helpful in easing the condition, but again they do not teach us the necessary skills for the long-term management of the disorder.

There is, however, one note of caution regarding these and other medications. Some people have reactions to them which are put down to anxiety; yet when the medication is discontinued the reactions disappear. If we are using these preparations, we must be aware of how we feel after taking them. We should not assume any new sensation or symptom is part of the disorder. It may be a reaction to the medication.

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It was one of those beautiful autumn evenings. The light from the setting sun filtered through the trees and their leaves blazed with colour. Jane wondered how many other people were looking at this natural masterpiece as they hurried home after the day’s work. Jane knew that she had never taken much notice before. Now was different. Once or twice a day she would be struck by the beauty of her surroundings. A moment here, a moment there. But those moments were precious in their spontaneity. They added to the peace she felt within herself. She was amazed at the last few years of her life. It had not always been like this. The years of panic disorder/agoraphobia had appeared to take everything from her. They were desolate years. The fight back was long and hard but she knew now it had been worth it. Everything that had been taken away from her had been given back a thousand-fold. She was at peace with herself and she was free.

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Remember, any person, including one facing emergency surgery, still has a right to know beforehand what is likely to be found and how the surgeon will probably want to deal with it. Any person also has a right to set limits on what he or she will permit. We discussed this earlier in this chapter. For example, the emergency patient described above may not wish to have a colostomy (bowel emptying through an opening on the abdominal wall). He or she has the right to refuse a colostomy and also the right to know what could happen because of such a refusal. Refusal may not create a problem if the surgeon can relieve the obstruction by some other means, such as removing or bypassing the blocked section of bowel. However, if this is not possible, the person’s refusal to have a colostomy could mean his or her death within a few days of the operation. Knowing this, he or she is still entitled to refuse a colostomy. No surgeon has the right to override an adult patient’s refusal to agree to any procedure, even though that procedure could be temporarily life saving. You know what’s best for you. You know what you can and can’t handle. You may know that you would rather die than have some drastic temporarily life saving treatment. Hold on to what is right for you.

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There are some cases when all efforts to make a pre-operative diagnosis are either unsuccessful or prevented by the urgency of the situation. Here is an example of the first type of situation. A person has had persistent abdominal pain and weight loss, for which no cause can be found on clinical examination and extensive tests. Cancer is suspected but cannot be proved. An exploratory operation may be recommended. In this case the person must either be prepared to have two major abdominal operations within a few days of each other, or agree to the surgeon immediately performing whatever operation seems best once the diagnosis is made. Fortunately, it is rarely so difficult to make a diagnosis. If such an exploratory operation is recommended to you I suggest that you ask for a second opinion before agreeing to it. Another doctor may be able to think of a way of making the diagnosis without operating.

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