Q: A little boy (3 years 6 months) in my nursery is constantly sucking his thumb and we're unsure how best to respond, as his mother doesn't seem to mind him doing it. She's told us that her nine-year-old daughter still sucks her thumb. I get concerned about the possible long-term damage to the children's teeth, but the mother feels the effects of thumb-sucking are exaggerated. Which of us is right and what do you advise?
A: Most young children comfort themselves by sucking something. Older children continue with more or less visible habits of comforting themselves in times of stress, concentration or daydreaming. The same applies to adults. Look around at the adults you know and you will see hair twiddling, face stroking or touching, pen spinning, finger tapping and more. The urge for comfort seems to be a human need, but concern does arise over the possible negative consequences of a particular habit.
Sucking for comfort is normal. Ultrasound images show that some babies suck their thumb or fingers while they are still in the womb. Full, or close to full, term babies have an instinctive sucking reflex. This reaction helps establish breast or bottle feeding. This unlearned response fades by about four months of age, so continued sucking of anything is then a learned habit.
Some very young babies find their thumb or fingers in the first weeks of life. Some take a little longer, and no baby will be happy with a thumb when they are hungry or otherwise demanding personal attention.
Very flexible babies occasionally suck their toes. Some babies do not find their thumb or fingers a source of comfort. Parents may well offer a pacifier (dummy) to crying babies, who do not manage to comfort themselves. Some babies are given a pacifier from their earliest weeks, sometimes because parents judge this is preferable to thumb-sucking.
Very young children need to be able to comfort themselves in one way or another. No sensible parent or early years practitioner tries to stop this behaviour in the early years. The concerns come - as expressed in the question above - when the habit shows no signs of fading as the years roll by.
Most children seem to stop thumb-sucking at some time between two and five years of age. However, a sizable minority - maybe about one in ten children - continue into middle childhood or early adolescence. The little boy in this nursery is still young enough that his sucking habit may fade, but are his parents or his practitioners right in this case? The brief answer is a bit of both.
TEETH
The common concern about persistent thumb-sucking is that the pressure of a thumb in the mouth will push children's teeth out of alignment, and in some instances parents voice concern about damage to the child's jaw. However, in early childhood, dentists see this problem as minor compared to the serious, avoidable dental decay caused by the deeply unhealthy diets of some young children.
In this instance, the nursery should acknowledge to the boy's mother that the risks of thumb-sucking have sometimes been overstated. However, as she is unworried about her nine-year-old, staff should also explain that there is definitely a level of risk to the teeth when persistent thumb-sucking continues into middle childhood.
Nowadays, the most consistent advice from the dental profession is that potential problems arise when children's second set of teeth start to emerge, usually from about six years onwards. Before that time, the main physical consequence could be that a persistently sucked thumb becomes soggy. It may also become sore, because of the constant wetness and the effect of enzymes naturally present in saliva.
Keen thumb-suckers, especially those with an established style of pushing the thumb hard against the teeth, could well distort the alignment of the set of teeth which now have to last through adulthood. Fierce sucking may also affect the development of the upper palate, the roof of the mouth. Dentists say that children cannot, however, distort their jaw, and also point out that many problems needing orthodontic treatment have not been caused by thumb-sucking.
Children who are old enough to distort their second teeth have also reached an age when parents or practitioners can explain why it is a good idea to reduce thumb-sucking. These slightly older girls and boys may welcome help to restrict their sucking habit to a few times or places. It is at this time that they also become aware that some of their peers think it is a 'baby' thing to do.
COMMUNICATION SKILLS
What should be of more concern to both parents and practitioners when it comes to thumb-sucking or using pacifiers is babies' and toddlers' ability to communicate.
Young children cannot speak clearly if they have a thumb, several fingers or a pacifier in their mouths, so inhibiting their tongue, lips and mouth from moving in the subtle ways necessary to articulate different sounds.
Long before there is cause for concern about the healthy development of a child's teeth, adults should be encouraging a young child to take a thumb or pacifier out of their mouth for the sake of their language development. Supportive adults can take a positive approach when encouraging a child to co-operate, with comments like 'Now I understand what you're saying' and 'That is interesting, tell me more ...'
CHANGING HABITS
The little boy in the question is described as 'constantly' sucking his thumb. In this situation, it is wise to check carefully about how much, where and when, so I would suggest practitioners ask themselves:
- - Is the boy's thumb-sucking actually non-stop? If this is really the case, does it suggest that he's not really at ease in the nursery? Does he need company and help to make friends? Can you identify from your observations what does or could engage his interest?
- - Are there times when he does not suck his thumb? When and where and how can you build on these times? Are there kinds of play that he enjoys and for which he needs two hands? Can you invite his help for tasks or to join in play - again, when he will need to use both hands?
This boy is still very young and should not be made to feel that he is doing anything wrong. His thumb-sucking may now be a strong habit and it would be useful for him to have other options for personal comfort. If, for instance, he sucks his thumb while listening to a story, maybe offer him and everyone else a soft toy to cuddle and stroke at the same time.
Some websites still promote painting bitter-tasting substances on to a child's thumb. This is a pretty unpleasant thing for any adult to do to an older child, never mind starting with the very young, as some of these sites suggest. Avoid them, and their advice.
FURTHER INFORMATION
- - An internet search on 'thumb-sucking' brings up a range of sites. Some of these want to sell products to discourage thumb-sucking. The more informative sites often use information from the Wikipedia entry: http://en.wikipedia.org/wiki/Thumb_sucking
- - National Literacy Trust: www.literacytrust.org.uk/talk_to_your_baby/key_topics/1601_dummies#6
