How to end thumb-sucking

Q: I’m wondering how to get my 21-month-old to stop sucking her thumb, since I can see her front tooth getting worn down. She sucks it for comfort when she gets upset, when she is bored and to go to sleep at night.

A: You’ve certainly asked the right person — I had a thumb-sucker myself. (Notice the emphasis on “had.”)

Sucking is one of the most common ways babies and toddlers comfort and settle themselves. Many – like my daughter, Olivia, for instance – start in the womb. According to Cary lactation consultant Cindi Freeman, “Sucking is a normal and necessary biological activity for young children that can last well beyond their weaning from the breast and bottle.”

And sucking on a thumb has several advantages over a pacifier. For one, thumbs are always handy and are under the child’s own control. There’s no crawling around on the floor in the dark looking for a lost paci, no need for constant replugging during the night, and no concern about increased ear infections. (According to a study in Pediatrics, pacifiers may cause 40% more ear infections, or acute otitis media.)

There’s something so sweet and endearing about seeing a baby drifting of to sleep with thumb in mouth. But when they get to be preschoolers, it’s not so cute. Knowing a surplus of germs was going straight into my daughter’s mouth several times daily was, well, hard to swallow. When she turned four we decided to take action.

We consulted her older brother’s orthodontist in Raleigh, Dr. Herbert Land, who, it turned out, was quite accomplished at helping to end thumb sucking. “We love thumb-suckers,” said Allison Williams, Dr. Land’s patient coordinator. “We recommend that children stop sucking their thumbs between the ages of 4 and 6 years old, but they must stop before permanent teeth erupt.”

Thumb-sucking after permanent teeth erupt may result in protruding front teeth, an irregular bite or cross-bite, warping of the jaw, facial asymmetry, speech problems and mouth breathing, Williams said.

Together, Olivia and Dr. Land came up with a star chart and plan of attack that included wearing socks on her hands at night. (Like many children, Olivia’s weakness was when she was sleepy. Hence, the socks.)

Let me say for the record, I wish I had my daughter’s willpower. She was done with the thumb within days. She proudly marched into Dr. Land’s office when her chart was filled and got the reward she earned.

It might be challenging to bargain with a 21-month-old, though. I recommend an attempt at behavior modification using something like a star chart to motivate her. If, however, you believe there is damage happening to your daughter’s teeth, consult with a respected orthodontist or pediatric dentist who’s been successful in helping young children give up thumb-sucking. As with any behavior modification program, the key to success is consistency.

We tend to hear the horror stories about thumb-suckers who continue the habit well into their teen years or beyond. And though it’s true that you can’t take away a thumb the way you can a pacifier, many children stop on their own once they find new ways to calm and comfort themselves.