Dr. Bob: I am concerned that my three-year-old still sucks her thumb at night and when stressed. Occasionally she will do it in public. Will it continue too long if I don’t do something now? Will it harm her teeth, and will she need braces because of it?
Answer: You are describing behavior that is self-soothing. Early on, parents often give an infant a pacifier when they seem fussy. While I don’t necessarily encourage this behavior, it causes no great harm. So many infants and young children seem to benefit from the sucking behavior that occurs with a pacifier.
Infancy and early childhood are certainly filled with numerous challenges – feeding, sleeping, fatigue, learning, walking, and so many more. When things go slightly awry, children often look for ways to soothe themselves. Sucking on a pacifier can provide that comfort. When they subsequently move on or reject the pacifier, they often substitute their thumb.
Thumb sucking is very similar to using a pacifier except that usually children tend to be older. These older children, 2 to 3 years of age, obviously still feel the need for some soothing behaviors. I don’t think we really know why other than there is an internal drive to calm down from the stress that the child feels is present. It is very important to let children engage in such behavior if at all possible. Learning to regulate one’s emotions is so vital to the maturation process of young children. I would stress the following –
- Make sure that your child feels comfortable being comforted by you and doesn’t just use thumb sucking as a substitute for parental embrace.
- Do not make her feel guilty for thumb sucking. Shaming her (in public or even in front of their sibs) is inappropriate. We all need ways to calm ourselves, and we should be encouraged to do so.
- Children will usually stop thumb sucking in public due to peer pressure. You can help encourage this by using a reward system (chart with stars) that will lead to a special treat.
- If thumb sucking continues excessively at home, try keeping the child engaged in activities that require hand activity. You cannot suck your thumb if you have to use it.
- Do monitor the skin on the thumb that is used. I have seen infections develop from skin breakdown. If you have concerns, discuss this with your pediatrician.
- By and large, thumb sucking does not affect the development of the teeth leading to subsequent overbite. If you have concerns about the shape of the dental arches and the palate, you can discuss this with your pediatrician and dentist. By this age, children should be seeing a dentist. Lots of children receive orthodontic therapy and did not suck their thumbs.
- Gently ignoring the thumb sucking is again the most important intervention. The overwhelming majority of the children that I saw that sucked their thumbs outgrew it. It is fine to discuss it (encouraging them to stop) with your child so long as you do it in a non-accusatory and nurturing way.
Thumb sucking does not mean that your child has some deep-seated emotional problem. In fact, thumb sucking might be a great skill that they have acquired to help them at various times. However, it might signal that your child needs special attention – are they overreacting or underreacting to certain situations? You want to be sure to discuss this with your doctor. Early in life is the time to be particularly attuned to the emotional needs of our children.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions