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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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Hepatitis is inflammation of the liver, usually an infection caused by one of three viruses.

Type A hepatitis is what we previously called infectious hepatitis. This virus is shed in the faeces and spreads from person to person by contamination from faecal matter. It has an incubation period of about 30 days.

The virus has recently been identified and can now be grown in culture and a vaccine to protect against this form of hepatitis may be available soon.

To protect immediate contacts of those with this type of hepatitis, an injection of gamma globulin may be given. This is prepared from human serum collected by the Blood Bank and, in Australia, extracted at the Commonwealth Serum Laboratories. It contains antibodies to the virus and can give short-term protection over two to three months.

Type  hepatitis, formerly called serum hepatitis, is due to a different virus and has a much longer incubation period, around 90 days. It is usually spread by contact with the blood.

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Persistent indigestion may be due to an ulcer, to irritation of the stomach or to the presence of what is called an hiatus hernia.

We now realise that it is not the presence of the hernia itself, but of the associated reflux of acid into the gullet which causes the trouble.

The gullet or oesophagus runs through the chest, then passes through a gap or hiatus in the diaphragm, the sheet of muscle which separates the chest from the abdominal cavity. Once through this hiatus, it widens out to become the stomach.

In hiatus hernia, this gap is widened and allows a portion of the stomach to push up or herniate through the diaphragm into the chest.

Hiatus hernia becomes increasingly common as we age. Symptoms do not seem to correlate with the size of the hernia.

Associated with the hernia is gastro-oesophageal reflux. The distortion in the anatomy allows the acid contents of the stomach to regurgitate into the lower part of the gullet and this irritates the lining and is responsible for the symptoms.

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The Rh antibodies should also be checked at 28 and 34 weeks of the pregnancy. Following delivery, the antibodies are again checked and so is the blood group of the child.

Should Rhesus antibodies be found in the mother’s blood, the doctor will consider inducing labor earlier than the due date. This is because the risk of the baby being affected increases as the birth date is approached.

However, if the child is delivered too soon, it has to face the risks of prematurity.

Amniocentesis is a procedure where a needle is inserted through the womb into the amniotic sac that surrounds the baby, and fluid is removed for examination to determine if the child is affected and how severely.

Those women who are already sensitised have to rely on the skill of their obstetrician and the paediatrician to save their babies.

Those other women who are Rhesus negative and conceive an Rh positive child should have anti-D globulin after each pregnancy and particularly after spontaneous or induced abortion. In this way, the frequency if not the severity of this disorder can be greatly reduced.

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Once the mother has formed these antibodies, they readily cross the placenta to enter the baby’s circulation and can destroy the baby’s red cells.

If the baby is severely affected, this can lead to death in the womb or soon after birth. Destruction of the red cells can also cause anaemia and jaundice due to an excess of bile pigment from the broken-down cells.

Destruction of the baby’s red cells, with a rapid onset of severe jaundice, is more likely in the first few hours after birth. If the jaundice is severe, it can lead to brain damage.

If Rhesus iso-immunisation occurs and the baby is severely affected, it is possible to treat by the technique of exchange transfusion.

In this, most of the baby’s blood is withdrawn and replaced by Rh negative blood. In this way, the Rh antibodies from the mother which are circulating in the child’s blood are washed out and those which remain are destroyed by the baby’s own immune system. While this is happening, the transfused Rh negative cells do the work of transporting oxygen and are not affected by the antibodies.

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