The thumb sucker sleep shirt was developed by a therapist, teacher and mother of a thumb sucker who recognized a need to develop an early intervention to prevent thumb sucking. This product is reasonably priced and provides no discomfort to the child. Other thumb sucking preventative devices include aversive stimuli such as bad tasting nail polishes, metal mouth guards, uncomfortable plastic thumb cases that render the thumb useless and thumb gloves that have textured pads to create a painful thumb sucking experience. While these devices maybe necessary for some children the concept behind this product is to stop the thumb sucking behavior before it requires more intense interventions. This product provides the child with an alternative self soothing behavior to thumb sucking while making the thumb unavailable to be sucked, with little discomfort and use of the hands to hold things like bottles and stuffed animals.
Unborn babies suck their thumbs as a way to self sooth and will continue to utilize sucking behaviors through infancy into the toddler years. Most babies suck their thumbs significantly less or have stopped by 9 months. For most children it is not necessarily seen as something that needs to be prevented until later on in their development when it causes problems with the teeth or is being done in public settings leading to teasing. This product is designed to be used by children 9 months and older as a way to prevent future thumb sucking therefore eliminating the previous concerns and the need for more intense interventions later. It has been advised by Dr. Barton D. Schmitt author of “My Child Is Sick,” American Academy of Pediatrics Books:
"That most children depend heavily on the sucking activity to relax and fall asleep at naptime and bedtime. The sleeping habit is the strongest part of the behavior and it takes the longest to eliminate. It will be important to address the sleep time sucking at the same time you are working on the daytime habit to minimize frustration and enhance success." (2015)
The thumb sucker sleep shirt has a snug design with a sleeve that opens up around the wrist to allow movement of the hand of the child without allowing the child access to the thumb and fingers. The sleeves of the shirt are extended and enclosed at the end with a satin seam on the inside of the shirt. The satin seam is designed to simulate the silky edging of a baby blanket which allows the child to self sooth by rubbing the satin between their fingers. This is a behavior that children tend to develop naturally by rubbing the silky trim of their baby blanket prior to falling a sleep. This behavior is the alternative behavior to thumb sucking that this shirt can provide early on.
This shirt should be used nightly and during nap time as a way to prevent thumb sucking. Use during long car rides can extend the benefits of the shirt for stopping thumb sucking faster. The shirt should be put on prior to starting the bed time routine such as reading, rocking or swinging. The parents should be enthusiastic about the shirt and try to make wearing it as fun as possible. With my daughter I pretended she has monster puppets on her hands and she will say, 'roar' while I would talk excitedly pretending that they were real. This made the sleep shirt fun for her and the fact that she got her nightly milk and story book time immediately following her putting the shirt on made it reinforcing to her.
This night shirt with regular use prior to and during sleep will help prevent the life long habit of and long-term physical effects of thumb sucking. Like any thing in your child's life early intervention and prevention is the best thing you can do for them. Don't wait until their behaviors require costly and painful medical interventions to stop!
Research
"Prevention and Intervention for thumb and finger sucking should begin prior to age 2, due to changes in the oral palette by age 2 from this behavior in order to avoid the need for more intensive and invasive interventions for those who do not stop before then."
The damage that is caused by prolonged intensive thumb sucking was clearly outlined in the article by, Mills, 2010, "What about thumb sucking?" the author writes:
"Progressive pediatricians understand that chronic thumb/finger sucking needs to be addressed in most children. Many dentists are satisfied to wait until the child is ready to see the orthodontist. Those dentists interested in prevention may want thumb sucking to cease early so that the normal processes of orofacial growth and development are not disrupted. If a thumb or finger exerts a force for hours per day against the anterior teeth, positional changes, usually tipping, of the teeth can occur. The most common changes to the dentition include the development of posterior crossbites, anterior excessive overjet, and anterior open bite. The direction of jaw growth may also be negatively affected. The constant pressure of the thumb or finger against the roof of the mouth can also contribute to the development of a narrow, high arched palate. Thumb sucking can lead to abnormal tongue rest and functional patterns, altered respiration, and an open rest posture of the lips. The thumb or finger can anchor the tongue down and forward instead of allowing the tongue to rest in the proper position on the roof of the mouth. Chronic thumb/finger sucking can cause skin or cuticle infections and/or calluses on the thumb/finger from the pressure being exerted. The facial muscles utilized in chewing, swallowing, and speech constitute an important part of the foundation upon which speech is constructed. When the thumb anchors the tongue down and forward and serves to reinforce an incorrect rest posture of the tongue, an inaccurate and inappropriate spring-off point for speech sound production occurs. Some sounds may be produced incorrectly. When the tongue is resting low and forward, the production of a frontal /t/d/n/l/, or interdental /s/ lisp may occur" (Mills, 2010).
"Thumb sucking is a common habit in the pediatric age group and is frequent at bedtime, during illness, and in times of emotional tension" (Shital Kiran et al, 2015). "It is usually related with oral pleasure and self-comforting behavior, persisting approximately into the 5th year" (Shital Kiran et al, 2015). According to the research thumb sucking is a common behavior that occurs in approximately 23-46% of children aged 1-4 (Ellingson, 2000). "The prevalence of finger sucking is 42% in 2-, 46% in 3- and 37% in 4-year old children" (Eslamian, 1999). Fetal scans that looked at thumb sucking during gestation noted thumb sucking as a potential indicator of how prepared babies are for feeding as seen in a study on 60 scans of 15 healthy fetuses at monthly intervals with thumb sucking increasing with time (Community Practitioner, 2013). Intermittent thumb sucking in infants and young children is not seen as abnormal as it is a comforting device (Babbush, 2013) especially when tired, lonely, unhappy or hungry, however, prolonged and intensive thumb sucking past the time of the first eruption of the permanent teeth at 5-6 years of age can lead to a misshapen mouth and displaced teeth (Venes, 2013). Although new research is stating the damage has already been done to the oral palette by age 2. Further research is currently being to try and change the recommendation to treat thumb and finger sucking later in life to provide patients with more current information and provide interventions for thumb sucking earlier, prior to age 2 and perhaps even during the second 6 months of life just as you would a pacifier.
Treatments for thumb sucking should include combined "dental intra-oral, extra-oral methods" (Eslamiam, 1999) and psychological therapies (Venes, 2013). Marcovitch, 2010, states that "it is cruel to use threats or punishment to try and stop the habit." Treatment for thumb sucking is intensive and requires a treatment duration ranging from 2-5 months with fading procedures lasting weeks-months beyond the 5 month time frame for children over age 4 (Stricker, et al, 2001). There is limited research and information about the cause of thumb sucking, however one study in 1968 assessed 52 thumb suckers and 53 non thumb suckers using the CMAS, Children's Manifest Anxiety Scale. The results of the study showed that the two groups had no difference and therefore there was no relationship between anxiety and thumb sucking (Tryon, 1968). Though one might hypothesis that the lack of difference just shows that non-thumb suckers have developed different coping mechanisms and therefore the scale would not find a difference between the two. The thumb sucker sleep shirt provides an alternative device for self soothing in an effort to help teach an alternative replacement behavior to thumb and finger sucking for self soothing. Inside the sleeve there is a soft padded area to rub between the fingers as a replacement behavior for thumb sucking.
Most of the research on thumb sucking is about interventions and treatments of thumb sucking. Findings have been made that show children who suck their thumbs beyond age 2 are at a higher risk for conditions such as buckteeth and are more likely to need braces. The American Dental Association monitored 372 children's long-term dental care with "findings that countered the traditional concept that thumb sucking is more or less benign up until age 5" (Hefner, 2002). A survey done by the Division of Health Examinations Statistics, “An assessment of the Occlusion of Children Ages 6 to 11 Years Old,” concluded that an estimated 2.4 million children suck a thumb/finger (Tanaka, 2016). Regarding the frequency of sucking, it was estimated that 60% suck “almost every day or night and 40% “just once in awhile” (Tanaka, 2016). They estimated that of these thumb suckers, 79.4% produced an open bite and 56.6% produced an overjet dental malocclusion (Tanaka, 2016). The results of the Iowa Study were published in the journal, Pediatrics for parents, 2002, and showed that "sucking past age two increases the risks of developing protruding front teeth or an improper bite with narrowing of the upper jaw relative to the lower jaw (crossbite)." The report further showed that increases in age while thumb sucking increased the "incidence of crossbite from 5.8% in children who stopped the habit by one year of age to 13% for children who stopped between two and three years of age, and 20% for those who stopped after they were four years old." The study found changes in the bites of children who sucked their thumb after age 4 and found other problems before that age, suggesting dentists should alter the current advice to parents about ignoring sucking behavior until children are in school (Hefner, 2002). The recent literature shows that sucking habits have detrimental effects on occlusion, and these effects extend well beyond habit elimination (Suwwan, 2008). The recommendation is now to stop the habit by the age of 3 years (Suwwan, 2008). The conclusions of this study provide further support for a more preventative then intervention based treatment for thumb sucking. If the habit is prevented through treatment during the 6-18 month range then increased stress on the child and parent to stop the habit as well negative feelings about thumb sucking could be prevented.
Studies that have assessed the social acceptance of children who suck their thumb during school have resulted in peers rating them with reduced social acceptance. In one study they used pictures of peers sucking their thumb and they were rated by their peers as being less intelligent, happy, attractive, likeable, fun, less desirable as friends, playmates, seatmates, classmates and neighbors (Friman et al, 1993). The same peers was in of them not sucking their thumb (Friman et al, 1993). This study is even more concerning as in recent times it is more common for children to attend pre-school at age 3-4 with students who potentially could be in their kindergarten and future elementary classes. The impression of these students made during the pediatric and dental acceptability ages of up to age 5 may no longer be applicable as social factors currently come into play much earlier in children's development then in previous years.
Case studies involving treatment of thumb sucking suggest that in siblings thumb sucking could be a learned behavior and that the treatment of one sibling can lead to similar results on the other sibling (Watson et al, 2002). Transitional objects are seen to influence thumb sucking behaviors, "individuals who exhibit habits may also simultaneously engage in other behaviors, creating a covariation, where changes in one response has a function of creating changes in another response" (Watson et al, 2002 ). "Modeling, from the social learning model, is seen as another powerful behavior change technique" that would explain the reason that the treatment of one sibling would effect the other sibling without any intervention being applied to them (Watson et al, 2002).
Other research articles that examined the concept of TOs, Transition Objects, on the behavior of thumb sucking find that the thumb sucking behavior occurred only in the presence of the transitional object (Friman, 2000). The research suggests that the TO could be an EO, Establishing Operation, for thumb sucking (Friman, 2000). The treatment implications are that when treating thumb sucking in children who also has a TO, therapeutic control may be obtained through limiting access to the TO (Friman, 2000). Suggesting that attachment behavior literature can be a valuable source for future research and data on TOs and their function in thumb sucking behavior (Friman, 2000).
Research on thumb sucking and pacifiers found that pacifiers stunted the emotional development of children due to "their limited ability to participate in facial expression mimicry as their mouths were hidden and occupied by a pacifier, their emotional growth and eventual competence were compromised" (Seckman, 2013). The article concluded that parents should begin to wean the pacifier habit in the second 6 months of life, between 6-12 months of age (Seckman, 2013). The implications of this study also suggest that a similar time frame for weaning the thumb sucking behavior should begin in that same range however, it is difficult to keep an infant from sucking their thumb whereas a pacifier can simply be taken away. The prevention and intervention methods for infants this young should be assessed in future research.
In children who do not have a known transitional object to use as part of the intervention for thumb sucking an awareness enhancement device (AED) for thumb sucking in children over the age of 5 might be a treatment option (Stricker et al, 2001). A study assessed 2 children ages 14 and 7 as they utilized the AED to treat thumb sucking (Stricker et al, 2001). This device makes a noise when the wearer put their hands close to their head the noise acted as a deterrent and auditory reminder to prevent thumb and finger sucking (Stricker et al, 2001). The study found that thumb sucking was more likely to occur in the alone condition of the functional analysis and rarely occurred in the other conditions (attention, escape and control) (Stricker et al, 2001). These results suggest that thumb sucking occurs as the result of automatic reinforcement (Stricker et al, 2001). The end results of the study showed a clear functional relationship between contingent delivery of the tone from the AED and levels of thumb sucking (Stricker et al, 2001). The AED device can be worn while the participating in other activities and the study sees the possible affects of the AED device are that it increases awareness of thumb sucking which led to the reductions in the behavior (Stricker et al, 2001). This device does need to be faded out to ensure that the treatment was successful and that the thumb sucking has been fully eliminated this treatment averaged between 2-5 months of time with fading procedures extending that period per individual needs and could last for weeks to months.
More common treatments include bitter tasting polishes, that are not recommended for children under age 3, thumb guards, that range from manufactured plastic guards to home made sewn covers, and dental interventions such as metal mouth pieces, fixed appliances, used to break the habit like the palatal crib appliance that causes discomfort and the inability to suck one's thumb, emotional reactions and effects on speech and eating are evident for these procedures (Suwwan, 2008). Other interventions include counseling, positive reinforcement and a calendar with rewards (Suwwan, 2008). The prevalence of this behavior, the noted damage to the mouth and the number of interventions available to parents and their children demonstrate a need for a prevention or early intervention method as most treatments are not recommended for children under 3 that can be used prior to age two and perhaps even start in the 6-12 month age range as recommended by Seckman, 2013, for pacifier use termination. Research on successful interventions for infants and toddlers is an area of need. With early prevention and intervention the thumb sucking habit may never fully develop into a behavior that requires intervention. Like any habit the longer an individual engages in a behavior the harder it is to quit. This research and development is necessary to provide a valuable option for children and their parents before more intensive interventions are required later in life. This is why the thumb sucker sleep shirt is a valuable product to infants, toddlers and children. Research also shows that stopping night time thumb sucking is the first step in the treatment of thumb and finger sucking. The thumb sucker sleep shirt is soft comfortable and snug fitting making it a viable treatment for children under 3.
References
Foetus thumb sucking 'could indicate healthy development'. (2013). Community Practitioner, 86(12), 7. Retrieved from http://search.proquest.com.library.capella.edu/docview/1470062523?accountid=27965
Finger sucking. (2013). In C. Babbush (Ed.), Mosby's Dental Dictionary. Philadelphia, PA: Elsevier Health Sciences. Retrieved from http://library.capella.edu/login?url=http://search.credoreference.com/content/entry/ehsdent/finger_sucking/0
Ellingson, S. A., Miltenberger, R. G., Stricker, J. M., & Garlinghouse, M. A. (2000). Analysis and treatment of finger sucking. Journal of Applied Behavior Analysis, 33(1), 41.
Eslamian, L. (1999). Thumb sucking: Problems and management. Iranian Journal of Pediatrics, 9(4), 245-256.
Friman, P. C. (2000). "transitional objects" as establishing operations for thumb sucking: A case study. Journal of Applied Behavior Analysis, 33(4), 507-509. doi:10.1901/jaba.2000.33-507
Hefner, D. (2002). Thumb-sucking ill-advised after 2, study suggests. Journal of the National Medical Association, 94(4), A11-A11.
Isaacs, D., & Isaacs, S. (2014). Transitional objects and thumb sucking: Transitional objects. Journal of Paediatrics and Child Health, 50(11), 845-846. doi:10.1111/jpc.1274
Thumb-Sucking. (2010). In H. Marcovitch (Ed.), Black's medical dictionary, 42nd edition. London, United Kingdom: A&C Black. Retrieved from http://library.capella.edu/login?url=http://search.credoreference.com/content/entry/blackmed/thumb_sucking/0
Seckman, C. H. (2013). Pacifiers and thumb sucking. Tulsa: PennWell Corporation
D. P. Shital Kiran, Seema Bargale, Parth Pandya, Kuntal Bhatt, Nirav Barad, Nilay Shah, Karthik Venkataraghavan, K. Ramesh. (2015). Evaluation of Health on the Net seal label and DISCERN as content quality indicators for patients seeking information about thumb sucking habit: J Pharm Bioallied Sci. 2015 August; 7(Suppl 2): S481–S485. doi: 10.4103/0975-7406.163509
Stricker, J. M., Miltenberger, R. G., Garlinghouse, M. A., Deaver, C. M., & Anderson, C. A. (2001). Evaluation of an awareness enhancement device for the treatment of thumb sucking in children. Journal of Applied Behavior Analysis, 34(1), 77-80. doi:10.1901/jaba.2001.34-77
Suwwan, I. Y. (2008). Longitudinal effects of habit-breaking appliances on tongue and dento-alveolar relations and speech in children with oral habits (Order No. MR58896). Available from ProQuest Dissertations & Theses Global. (250986185). Retrieved from http://search.proquest.com.library.capella.edu/docview/250986185?accountid=27965
Tanaka, O., Oliveira, W., Galarza, M., Aoki, V., & Bertaiolli, B. (2016). Breaking the thumb sucking habit: When compliance is essential. Case Reports in Dentistry, 2016, 6010615. doi:10.1155/2016/6010615
Tryon, A. F. (1968). Thumb-sucking and manifest anxiety: A note. Child Development, 39(4), 1159-1163. doi:10.1111/j.1467-8624.1968.tb04492.x
Thumb sucking. (2013). In D. Venes (Ed.), Taber's cyclopedic medical dictionary. Philadelphia, PA: F.A.Davis Company. Retrieved from http://library.capella.edu/login?url=http://search.credoreference.com/content/entry/fadtabers/thumb_sucking/0
Watson, T. S., Meeks, C., Dufrene, B., & Lindsay, C. (2002). Sibling thumb sucking: Effects of treatment for targeted and untargeted siblings. Behavior Modification, 26(3), 412-423. doi:10.1177/01445502026003007ģ
Unborn babies suck their thumbs as a way to self sooth and will continue to utilize sucking behaviors through infancy into the toddler years. Most babies suck their thumbs significantly less or have stopped by 9 months. For most children it is not necessarily seen as something that needs to be prevented until later on in their development when it causes problems with the teeth or is being done in public settings leading to teasing. This product is designed to be used by children 9 months and older as a way to prevent future thumb sucking therefore eliminating the previous concerns and the need for more intense interventions later. It has been advised by Dr. Barton D. Schmitt author of “My Child Is Sick,” American Academy of Pediatrics Books:
"That most children depend heavily on the sucking activity to relax and fall asleep at naptime and bedtime. The sleeping habit is the strongest part of the behavior and it takes the longest to eliminate. It will be important to address the sleep time sucking at the same time you are working on the daytime habit to minimize frustration and enhance success." (2015)
The thumb sucker sleep shirt has a snug design with a sleeve that opens up around the wrist to allow movement of the hand of the child without allowing the child access to the thumb and fingers. The sleeves of the shirt are extended and enclosed at the end with a satin seam on the inside of the shirt. The satin seam is designed to simulate the silky edging of a baby blanket which allows the child to self sooth by rubbing the satin between their fingers. This is a behavior that children tend to develop naturally by rubbing the silky trim of their baby blanket prior to falling a sleep. This behavior is the alternative behavior to thumb sucking that this shirt can provide early on.
This shirt should be used nightly and during nap time as a way to prevent thumb sucking. Use during long car rides can extend the benefits of the shirt for stopping thumb sucking faster. The shirt should be put on prior to starting the bed time routine such as reading, rocking or swinging. The parents should be enthusiastic about the shirt and try to make wearing it as fun as possible. With my daughter I pretended she has monster puppets on her hands and she will say, 'roar' while I would talk excitedly pretending that they were real. This made the sleep shirt fun for her and the fact that she got her nightly milk and story book time immediately following her putting the shirt on made it reinforcing to her.
This night shirt with regular use prior to and during sleep will help prevent the life long habit of and long-term physical effects of thumb sucking. Like any thing in your child's life early intervention and prevention is the best thing you can do for them. Don't wait until their behaviors require costly and painful medical interventions to stop!
Research
"Prevention and Intervention for thumb and finger sucking should begin prior to age 2, due to changes in the oral palette by age 2 from this behavior in order to avoid the need for more intensive and invasive interventions for those who do not stop before then."
The damage that is caused by prolonged intensive thumb sucking was clearly outlined in the article by, Mills, 2010, "What about thumb sucking?" the author writes:
"Progressive pediatricians understand that chronic thumb/finger sucking needs to be addressed in most children. Many dentists are satisfied to wait until the child is ready to see the orthodontist. Those dentists interested in prevention may want thumb sucking to cease early so that the normal processes of orofacial growth and development are not disrupted. If a thumb or finger exerts a force for hours per day against the anterior teeth, positional changes, usually tipping, of the teeth can occur. The most common changes to the dentition include the development of posterior crossbites, anterior excessive overjet, and anterior open bite. The direction of jaw growth may also be negatively affected. The constant pressure of the thumb or finger against the roof of the mouth can also contribute to the development of a narrow, high arched palate. Thumb sucking can lead to abnormal tongue rest and functional patterns, altered respiration, and an open rest posture of the lips. The thumb or finger can anchor the tongue down and forward instead of allowing the tongue to rest in the proper position on the roof of the mouth. Chronic thumb/finger sucking can cause skin or cuticle infections and/or calluses on the thumb/finger from the pressure being exerted. The facial muscles utilized in chewing, swallowing, and speech constitute an important part of the foundation upon which speech is constructed. When the thumb anchors the tongue down and forward and serves to reinforce an incorrect rest posture of the tongue, an inaccurate and inappropriate spring-off point for speech sound production occurs. Some sounds may be produced incorrectly. When the tongue is resting low and forward, the production of a frontal /t/d/n/l/, or interdental /s/ lisp may occur" (Mills, 2010).
"Thumb sucking is a common habit in the pediatric age group and is frequent at bedtime, during illness, and in times of emotional tension" (Shital Kiran et al, 2015). "It is usually related with oral pleasure and self-comforting behavior, persisting approximately into the 5th year" (Shital Kiran et al, 2015). According to the research thumb sucking is a common behavior that occurs in approximately 23-46% of children aged 1-4 (Ellingson, 2000). "The prevalence of finger sucking is 42% in 2-, 46% in 3- and 37% in 4-year old children" (Eslamian, 1999). Fetal scans that looked at thumb sucking during gestation noted thumb sucking as a potential indicator of how prepared babies are for feeding as seen in a study on 60 scans of 15 healthy fetuses at monthly intervals with thumb sucking increasing with time (Community Practitioner, 2013). Intermittent thumb sucking in infants and young children is not seen as abnormal as it is a comforting device (Babbush, 2013) especially when tired, lonely, unhappy or hungry, however, prolonged and intensive thumb sucking past the time of the first eruption of the permanent teeth at 5-6 years of age can lead to a misshapen mouth and displaced teeth (Venes, 2013). Although new research is stating the damage has already been done to the oral palette by age 2. Further research is currently being to try and change the recommendation to treat thumb and finger sucking later in life to provide patients with more current information and provide interventions for thumb sucking earlier, prior to age 2 and perhaps even during the second 6 months of life just as you would a pacifier.
Treatments for thumb sucking should include combined "dental intra-oral, extra-oral methods" (Eslamiam, 1999) and psychological therapies (Venes, 2013). Marcovitch, 2010, states that "it is cruel to use threats or punishment to try and stop the habit." Treatment for thumb sucking is intensive and requires a treatment duration ranging from 2-5 months with fading procedures lasting weeks-months beyond the 5 month time frame for children over age 4 (Stricker, et al, 2001). There is limited research and information about the cause of thumb sucking, however one study in 1968 assessed 52 thumb suckers and 53 non thumb suckers using the CMAS, Children's Manifest Anxiety Scale. The results of the study showed that the two groups had no difference and therefore there was no relationship between anxiety and thumb sucking (Tryon, 1968). Though one might hypothesis that the lack of difference just shows that non-thumb suckers have developed different coping mechanisms and therefore the scale would not find a difference between the two. The thumb sucker sleep shirt provides an alternative device for self soothing in an effort to help teach an alternative replacement behavior to thumb and finger sucking for self soothing. Inside the sleeve there is a soft padded area to rub between the fingers as a replacement behavior for thumb sucking.
Most of the research on thumb sucking is about interventions and treatments of thumb sucking. Findings have been made that show children who suck their thumbs beyond age 2 are at a higher risk for conditions such as buckteeth and are more likely to need braces. The American Dental Association monitored 372 children's long-term dental care with "findings that countered the traditional concept that thumb sucking is more or less benign up until age 5" (Hefner, 2002). A survey done by the Division of Health Examinations Statistics, “An assessment of the Occlusion of Children Ages 6 to 11 Years Old,” concluded that an estimated 2.4 million children suck a thumb/finger (Tanaka, 2016). Regarding the frequency of sucking, it was estimated that 60% suck “almost every day or night and 40% “just once in awhile” (Tanaka, 2016). They estimated that of these thumb suckers, 79.4% produced an open bite and 56.6% produced an overjet dental malocclusion (Tanaka, 2016). The results of the Iowa Study were published in the journal, Pediatrics for parents, 2002, and showed that "sucking past age two increases the risks of developing protruding front teeth or an improper bite with narrowing of the upper jaw relative to the lower jaw (crossbite)." The report further showed that increases in age while thumb sucking increased the "incidence of crossbite from 5.8% in children who stopped the habit by one year of age to 13% for children who stopped between two and three years of age, and 20% for those who stopped after they were four years old." The study found changes in the bites of children who sucked their thumb after age 4 and found other problems before that age, suggesting dentists should alter the current advice to parents about ignoring sucking behavior until children are in school (Hefner, 2002). The recent literature shows that sucking habits have detrimental effects on occlusion, and these effects extend well beyond habit elimination (Suwwan, 2008). The recommendation is now to stop the habit by the age of 3 years (Suwwan, 2008). The conclusions of this study provide further support for a more preventative then intervention based treatment for thumb sucking. If the habit is prevented through treatment during the 6-18 month range then increased stress on the child and parent to stop the habit as well negative feelings about thumb sucking could be prevented.
Studies that have assessed the social acceptance of children who suck their thumb during school have resulted in peers rating them with reduced social acceptance. In one study they used pictures of peers sucking their thumb and they were rated by their peers as being less intelligent, happy, attractive, likeable, fun, less desirable as friends, playmates, seatmates, classmates and neighbors (Friman et al, 1993). The same peers was in of them not sucking their thumb (Friman et al, 1993). This study is even more concerning as in recent times it is more common for children to attend pre-school at age 3-4 with students who potentially could be in their kindergarten and future elementary classes. The impression of these students made during the pediatric and dental acceptability ages of up to age 5 may no longer be applicable as social factors currently come into play much earlier in children's development then in previous years.
Case studies involving treatment of thumb sucking suggest that in siblings thumb sucking could be a learned behavior and that the treatment of one sibling can lead to similar results on the other sibling (Watson et al, 2002). Transitional objects are seen to influence thumb sucking behaviors, "individuals who exhibit habits may also simultaneously engage in other behaviors, creating a covariation, where changes in one response has a function of creating changes in another response" (Watson et al, 2002 ). "Modeling, from the social learning model, is seen as another powerful behavior change technique" that would explain the reason that the treatment of one sibling would effect the other sibling without any intervention being applied to them (Watson et al, 2002).
Other research articles that examined the concept of TOs, Transition Objects, on the behavior of thumb sucking find that the thumb sucking behavior occurred only in the presence of the transitional object (Friman, 2000). The research suggests that the TO could be an EO, Establishing Operation, for thumb sucking (Friman, 2000). The treatment implications are that when treating thumb sucking in children who also has a TO, therapeutic control may be obtained through limiting access to the TO (Friman, 2000). Suggesting that attachment behavior literature can be a valuable source for future research and data on TOs and their function in thumb sucking behavior (Friman, 2000).
Research on thumb sucking and pacifiers found that pacifiers stunted the emotional development of children due to "their limited ability to participate in facial expression mimicry as their mouths were hidden and occupied by a pacifier, their emotional growth and eventual competence were compromised" (Seckman, 2013). The article concluded that parents should begin to wean the pacifier habit in the second 6 months of life, between 6-12 months of age (Seckman, 2013). The implications of this study also suggest that a similar time frame for weaning the thumb sucking behavior should begin in that same range however, it is difficult to keep an infant from sucking their thumb whereas a pacifier can simply be taken away. The prevention and intervention methods for infants this young should be assessed in future research.
In children who do not have a known transitional object to use as part of the intervention for thumb sucking an awareness enhancement device (AED) for thumb sucking in children over the age of 5 might be a treatment option (Stricker et al, 2001). A study assessed 2 children ages 14 and 7 as they utilized the AED to treat thumb sucking (Stricker et al, 2001). This device makes a noise when the wearer put their hands close to their head the noise acted as a deterrent and auditory reminder to prevent thumb and finger sucking (Stricker et al, 2001). The study found that thumb sucking was more likely to occur in the alone condition of the functional analysis and rarely occurred in the other conditions (attention, escape and control) (Stricker et al, 2001). These results suggest that thumb sucking occurs as the result of automatic reinforcement (Stricker et al, 2001). The end results of the study showed a clear functional relationship between contingent delivery of the tone from the AED and levels of thumb sucking (Stricker et al, 2001). The AED device can be worn while the participating in other activities and the study sees the possible affects of the AED device are that it increases awareness of thumb sucking which led to the reductions in the behavior (Stricker et al, 2001). This device does need to be faded out to ensure that the treatment was successful and that the thumb sucking has been fully eliminated this treatment averaged between 2-5 months of time with fading procedures extending that period per individual needs and could last for weeks to months.
More common treatments include bitter tasting polishes, that are not recommended for children under age 3, thumb guards, that range from manufactured plastic guards to home made sewn covers, and dental interventions such as metal mouth pieces, fixed appliances, used to break the habit like the palatal crib appliance that causes discomfort and the inability to suck one's thumb, emotional reactions and effects on speech and eating are evident for these procedures (Suwwan, 2008). Other interventions include counseling, positive reinforcement and a calendar with rewards (Suwwan, 2008). The prevalence of this behavior, the noted damage to the mouth and the number of interventions available to parents and their children demonstrate a need for a prevention or early intervention method as most treatments are not recommended for children under 3 that can be used prior to age two and perhaps even start in the 6-12 month age range as recommended by Seckman, 2013, for pacifier use termination. Research on successful interventions for infants and toddlers is an area of need. With early prevention and intervention the thumb sucking habit may never fully develop into a behavior that requires intervention. Like any habit the longer an individual engages in a behavior the harder it is to quit. This research and development is necessary to provide a valuable option for children and their parents before more intensive interventions are required later in life. This is why the thumb sucker sleep shirt is a valuable product to infants, toddlers and children. Research also shows that stopping night time thumb sucking is the first step in the treatment of thumb and finger sucking. The thumb sucker sleep shirt is soft comfortable and snug fitting making it a viable treatment for children under 3.
References
Foetus thumb sucking 'could indicate healthy development'. (2013). Community Practitioner, 86(12), 7. Retrieved from http://search.proquest.com.library.capella.edu/docview/1470062523?accountid=27965
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Thumb-Sucking. (2010). In H. Marcovitch (Ed.), Black's medical dictionary, 42nd edition. London, United Kingdom: A&C Black. Retrieved from http://library.capella.edu/login?url=http://search.credoreference.com/content/entry/blackmed/thumb_sucking/0
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Watson, T. S., Meeks, C., Dufrene, B., & Lindsay, C. (2002). Sibling thumb sucking: Effects of treatment for targeted and untargeted siblings. Behavior Modification, 26(3), 412-423. doi:10.1177/01445502026003007ģ