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Thumbs naturally find their way into the mouths of babes and often stay there for years. Thumbsucking is a boon to babies but bothers onlookers and dentists. So what's a poor thumbsucker to do? Can a baby and her thumb find happiness together without public censure?

Some babies are born thumbsuckers. Ultrasound pictures show babies sucking their thumbs in the privacy of the womb. In many babies, the need to suck is not satisfied by bottle-feeding or breastfeeding alone, and they learn to suck on the ever- present thumb for comfort. In the early months, even tiny infants discover that one of life's little pleasures is right in their hands and under their noses. We consider the ability of babies' to use their own body parts for comfort as a sign of emotional health, not psychological disturbance. In fact, some veteran baby comforters even help their babies find their thumbs to self-quiet. What's all the fuss about? Whose thumb is it anyway?

Some babies seem unsatisfied after bottle-feeding. They've had enough milk, but not enough sucking. One advantage of the breast is that it can still be sucked on even after the feeding is over, so baby can get the sucking he needs without over-filling his tummy. But there are times when the breasts' owner has had enough and a few babies still need pacifying. If you don't feel you can handle letting baby pacify on your breast, let him suck on your finger, and eventually, if he doesn't discover them on his own, you can direct his thumb or fingers into his mouth. The seemingly insatiable desire to suck is there for a reason.
Sucking mellows the fussy baby, helping to organize the otherwise disorganized bio-rhythms of a newborn. Some babies need more mellowing than others. Our high-need baby was the only one of ours to suck her thumb. We thought it was sweet to see her snuggled up with her thumb while she slept. She started at three months and quit on her own at five months; a very uneventful thumb weaning. Martha was careful to breastfeed her frequently so that the thumb did not become a substitute for the breast. Sucking at the breast is more than eating to a baby or toddler. They learn that the comforting they get helps them relax. A child who has gotten attached to her thumb will tell you she needs it to help her relax.

While most mothers, for practical reasons, give infant thumbsucking their thumbs-up approval, some dentists vote thumbs down. While this harmless habit subsides without concern or intervention in most infants by the age of two, some children increase their thumbsucking to such frequency and intensity that it becomes a social and dental problem.
Thumbs in push teeth out. In the first two to four years, don't worry about thumb and teeth not getting along. Seldom does thumbsucking harm teeth in the child under four, and it usually subsides by this age anyway. But habitual thumbsucking at age three or four or older is a reason to start putting money aside for the orthodontist, especially if the child already has a hereditary overbite or protruding upper gum. Or, you can start thinking of ways to get that offending thumb out of the child's mouth and into his pocket. Because of the way the thumb is forced against the inside of the upper front teeth, thumbsucking can cause overbite (buck teeth) and other dental malocclusions. If neither your child's doctor nor his dentist are worried about the thumbsucking, you shouldn't worry either.

Oversucked thumbs get sore. Habitual sucking is hard on the skin of the thumb. Spending too much time between the moisture of the tongue and the pressure of the teeth causes oversucked thumbs to look like one long callus; others crack and bleed. Some get infected (there is a red, swollen tender area where the thumb nail joins the skin).
Sucking becomes socially unacceptable. Toddlers don't ridicule their thumbsucking peers because thumbsucking is standard operating procedure for children under two. But the older the sucker the more likely she'll get teased about her thumb-in-mouth "disease." In most children, the fact is that thumbsucking, like bedwetting, doesn't reflect a psychological disorder. It's just a habit -- though unsightly to some older children and adults. Don't fret about a happy thumbsucker who is gregarious and has a good self-image -- this thumb will soon leave the mouth. But some suckers never show an unobstructed view of their smile; it's as if their nose has grown a fist. They prefer sucking their thumbs to relating to peers. This scene is socially unacceptable and the thumb and its owner may be teased continually about being a "baby."

Like most normal but bothersome behaviors, if you did nothing but accept and ignore it the thumb would eventually find its way into other occupations. But if the habit persists and is harming the child's teeth, try these tips:

1. Satiate sucking needs. Sucking satisfies the need for attachment. A need that is filled goes away; a need that is not filled stays as a habit. If you have a "sucky baby," let her suck to her heart's content during early infancy. Breastfeed on cue as long as possible. Let your baby suck your fingers. Allow non-nutritive sucking (sucking on an "empty" breast, finger or pacifier, collapsible bottle nipple) after the baby's hunger is satisfied. An interesting study confirmed that babies who get their sucking needs met seldom become habitual thumbsuckers. In 1977 researchers studied fifty children between ages one and seven who were habitual thumbsuckers, and compared these with children who did not suck their thumb. The studies showed that thumbsuckers tended to be bottle- fed rather than breastfed. The later the child was weaned, the less likely he was to suck his thumb. The thumbsucking children tended to have been fed on schedule rather than on cue. And 96 percent of the thumbsuckers had been left to fall asleep alone after being fed. But not one of the non-thumbsuckers was left alone to fall asleep. Researchers theorize that during sleep persons return to primitive reflexes, such as sucking and hand-to-mouth actions. In our own pediatric practice we have noticed that babies who are nursed down to sleep and not weaned until they are ready are much less likely to become habitual thumbsuckers. Consider breastfeeding as a suck of prevention for habitual thumbsucking.

2. Offer early alternatives to sucking. If you are blessed with a baby with a strong sucking drive, instead of always automatically pacifying him by sucking, try alternatives: rocking, massage, playing animated games, and singing. The earlier baby learns that there are other ways to find comfort in addition to the breast, bottle, thumb, or pacifier, the more he will seek alternatives to oral gratification later.

3. Keep thumbs busy. Bored little thumbs often seek their friend, the mouth, when there is nothing better to do. Busy the bored child. When you see the thumb heading toward the mouth, distract and redirect the child into an activity that keeps both hands busy.

4. Keep life calm. As your toddler gets older he will use his thumb to help himself relax. This is good. You then do what you can to keep peaceful yourself, and that will flow over into a peaceful atmosphere in the home. Model relaxing ways and your child will learn from you; such as quiet times, long walks, music, and slow, deep breathing when you feel anxious.

5. Show and tell. If your child is old enough for thumbsucking to bother his teeth, he is old enough to understand why this habit harms his teeth. In front of a mirror let your child rub his index finger over the protruding upper teeth and put his fingertip into the gap between the upper and lower teeth during a bite. Imitate a buck teeth appearance (like Bugs Bunny), showing your child what can happen to thumbsucked teeth. Also, point out to your child that her sucked thumb does not look as nice as her other one.

6. Time your intervention. With thumbsucking, wait to intervene until your child is in a receptive mood. Trying to step between thumb and mouth when your child is not in a cooperative mood is likely to result in a power struggle. Your interference will be regarded as a threat to her independence.

7. Offer reminders. In the thumbsucker over four, try an adhesive bandage or tape on the thumb. A glove can remind and dissuade the nighttime thumbsucker. For the intensive night sucker who uses his thumb on his teeth like a crowbar, I've suggested a tongue-depressor taped to the thumb as a splint to keep the thumb from bending. If your child is older, talk with him about using a product that gets painted on the thumb and gives a stinging reminder when thumb meets lips. Encourage the child to paint it on himself; it's his thumb and his habit.

8. Suggest a competing habit. With the child over four you can use the principle of a competing habit. Show your child how to fold his arms, squeeze his thumb, or some other gesture that he enjoys instead of sucking his thumb. A trick that I've used successfully in my office is the game of hide the thumb: "As soon as you feel like sucking your thumb, wrap your fingers over your thumb into a fist." If it's a bedtime habit, suggest hiding the thumb under the pillow.

9. Negotiate a milestone. If your child seems to be eager to meet goals you could give her a target date -- "When you have your fourth birthday you can say goodbye to sucking your thumb!" Don't hold your breath, though. On the big day she may smile sweetly at you and say "I've changed my mind." Remember to smile sweetly back.

10. Consult your child's dentist. When your compulsive thumbsucker is four years of age, and her teeth are starting to reflect the harmful habit, a dentist can fit a palatal appliance that keeps the thumb from pushing on the teeth.

11. Relate with people instead of the thumb. If you see your child withdrawing from group play and interacting with his thumb instead of other children, consider the possibility that your child may need a social boost. Rather than attack the thumbsucking, delve into the underlying self-esteem problem that may hamper his social interaction. If you need some help in this department, consult a professional.

12. Chart-a-thumb. Once peer pressure begins, the child over ages six or seven may want to stop thumb-sucking for her own reasons. Offer to help her design a chart that she can use on her own to mark down the number of times she sucks every day. She'll be motivated to see the number get smaller and smaller. You do not have to watch her, or remind her, or check up on her charting.

Which are better, thumbs or pacifiers? Babies would vote for thumbs. They are always available, taste familiar, don't get lost in the night, and don't fall on the floor. Dentists would vote for pacifiers. Children don't use them like crowbars against their upper teeth, and they can be "lost"; permanently. Even for those who dislike the way "these things" obstruct the view of a baby's face, it's hard not to like the quieting effect of the silicone plug. All babies suck their thumbs at some time. Most outgrow it, and if their sucking needs are appropriately met in early infancy, they seldom carry the thumb-sucking habit into childhood.

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