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Thumbsucking
The reflex to suck on a nipple, thumb, fingers or pacifier is natural and healthy for babies, since this is how they get their nutrition and comfort. Many babies even suck their thumbs before they’re born—you might have seen your daughter sucking her thumb on an ultrasound during pregnancy. The sucking reflex is usually strongest in the first year of life, and most children give it up on their own by 2 to 6 years of age. When children continue to suck their thumbs, they often do it at naptime or bedtime, while watching TV or riding in the car. This is usually for comfort, to relieve stress or boredom or simply from habit.

Do you need to do anything about thumbsucking? Some experts say “Yes” and others “No.” I review each position below.

No, don’t do anything about it. Many child development experts and parents say that children suck their thumbs because they need the comfort, and if you try to stop the thumbsucking your child’s anxiety will come out in other ways. They also say that almost all children will give up thumbsucking when they are ready, most by 6 or 7 years of age, when they want to act like big kids at school. If parents push their child too hard to give up the thumb before she’s ready, it can make her feel ashamed and hold onto the habit even longer.

Yes, help your child stop sucking her thumb. Dental experts say that thumbsucking beyond 4 to 5 years of age can affect the shape of the roof of the child’s mouth (the palate), push her permanent teeth forward as they are coming in and disrupt her speech (cause a lisp). Stopping thumbsucking by 4 or 5 years of age can help prevent the need for orthodontia and speech therapy. In addition, older children who suck their thumbs may get teased by other children and adults, and giving up the thumb could help prevent shame and embarrassment.

Consult your pediatrician and dentist about your daughter’s thumbsucking. If you decide to encourage your child to give up her thumb, here are some strategies:

1. Explain why it’s best for her to stop sucking her thumb.
Tell her that she’ll be a big girl and that it will help her teeth be strong. Have the doctor and dentist give her these same messages.

2. Use positive reinforcement.
Tell her that you understand that it might be hard to give up the thumb, but you’re confident that she can be a big girl and do it. Get a book to read with her about a child who successfully stops sucking her thumb. Provide comfort when she needs it, and praise her for not sucking her thumb. Offer rewards such as stickers on a calendar for each day she doesn’t suck her thumb, which she can trade in for something she really wants. Don’t scold her for sucking.

3. Try distraction.
At the times when she usually sucks her thumb, try engaging her in other activities, particularly those that use her hands, suck as drawing or doing puzzles.

4. Make rules about where she is allowed to suck her thumb.
For example, you may say that she is only allowed to suck her thumb in her bedroom.

5. Use “reminders” on her thumb that tell her not to suck.
Consider putting a bandage on her thumb during the daytime, and gloves, socks or a plastic thumbguard on her hand at bedtime to remind her not to suck her thumb. It is also safe to use an over-the-counter, non-toxic, bitter-tasting nail coating. Apply it to her thumb every morning and evening. You could even tell her that this is nail polish to help her be a big girl.

6. If the above strategies don’t work, talk with your dentist about using a mouthguard.
A pediatric dentist or orthodontist can make a special metal device to protect your child’s palate, which also makes it uncomfortable to suck her thumb.

Above all, try to be encouraging and patient. These strategies usually work if you’re consistent and give them time. If none of them does, or if your daughter is showing extreme anxiety or distress, talk with your doctor about consulting a mental health professional.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician