"Trying to end thumbsucking will do more harm than good," our genial dentist advised me. He was concerned that parents would end up fighting with their child or would damage the child's self-image by calling attention to sucking habits.
In response to this advice I initially tried to relax and let the thumbsucking continue in spite of my chagrin. Gradually I came to my senses.
"My dentist is great with teeth, but should I trust his psychological advice?" I thought, remembering that I in fact was a psychologist. So I put on my psychologist's hat and thought again.
"Looks are hugely important to one's success in life. Allowing thumbsucking to damage facial appearance is wrong advice. By the time a child is four or five, the habit no longer socially appropriate. With permanent teeth coming in shortly, the risks of continuing to thumb or finger suck clearly outweigh the benefits."
Fired up by these realizations, I sat down and wrote a story about a child who breaks a thumbsucking habit. I was mad at the bad advice my dentist had given me and wanted a gentle way to give him better information.
The next day I plopped my three year old son Jacob next to me and read the story aloud to see how it sounded. I also was curious to see if he would be interested.
My son was mesmerized. I'd never seen any of my children so intensely absorbed in a story. Even more astounding to me, at the end of the reading, Jacob promptly announced that he was making the same decision as David, the boy in the story, had made. Jacob decided to stop sucking his thumb.
From this experience came publication of my first book, David Decides About Thumbsucking, a story for children with an information section for parents. In addition, my background research for the parents' section educated me further on overcoming addictions.
Here's the main principles I learned.
Beyond thumbsucking, these lessons apply to mistaken childhood habits of all types, like nail-biting, hair-pulling or twisting, whining, shouting, biting and hitting. They apply also to grownup bad habits including addictions ranging from over-eating, using drugs or smoking cigarettes to gambling, affairs, too much TV or computer time, porn and excessive anger.
When does a bad habit qualify as an addiction? Usually it's a function of how much the habit has become physiologically essential so that people feel craving when it is missing. That definitely happens with thumbsucking.
Lesson #1 Addictions begin because they serve life-enhancing purposes.
In a study with premature infants, researchers found that infants who sucked their thumbs or a pacifier had shorter hospital stays. That was because rhythmic sucking soothed them so that they spent less energy in crying.
Sucking actually re-optimized the heart beats and breathing patterns of upset babies, slowing them and regularizing the rhythms.
Interestingly, sucking had the same optimizing impact on heart beats and breathing if infants were fussing because they had been getting bored, even though overcoming boredom meant speeding up rather than slowing down their rates.
Sucking even regulated the muscle movements of peristalsis in the babies' guts. Slowing these movements enabled the babies to digest their food more efficiently.
In studies comparing children who do or do not suck a thumb, finger or pacifier, it turns out that the suckers become emotionally more independent at a younger age. Researchers put a child and mom on one end of a long room. On the far end were appealing toys. The suckers ventured further and played with the toys away from Mom longer than the non-suckers. While all the children had similarly positive interactions with Mom on returning to her, the suckers seemed to have higher self-confidence about playing independently. They knew that if they felt stressed they could suck for a bit, feel better, and resume playing on their own.
It's generally not until they become toddlers that the downsides of thumbsucking begin to outweigh the gains. Kids then tend to suck when they are trying to fall asleep, when they feel bored, when they are idling between activities, and to self-soothe when they are upset. While these continue to be positive motivations, the facial appearance detriments of continuing to suck make it important that children by this age find other solutions to these natural challenges.
Understanding when the habit occurs and its well-intended purposes can help parents to assist their young children in developing alternative solutions.
Lesson #2 Addictions continue because they are gratifying.
Addictions, including thumbsucking, feel good. That's part of why they take on a life of their own long after the original purpose has passed. Once the original purpose no longer is there, they are "self-reinforcing" because they continue to generate positive feelings of some sort.
Four and five year old children do not have to suck to regain a positive emotional state. By then they have multiple means of calming themselves when they are upset and of entertaining themselves when they feel bored. No longer dependent on their thumb or pacifier as their only option, older preschoolers can walk into a different room and find a new toy if they are bored, run to mom for a hug if they feel upset, and open the refrigerator door to pull out an apple if they are hungry.
Yet the sucking is likely to continue. That's because it feels good.
Lesson #3 Ending a habit starts with a decision.
Almost all attempts to end addictions, at any age, begin with receiving new information about the habit's downsides.
Someone--in the case of kids' sucking addictions that's usually a parent, an older sibling, a dental professional, a teacher or a grandparent--needs to raise the issue and offer new information that makes continuation of the habit look less appealing. I wrote the book David Decides About Thumbsucking both to give this information to the adult, and to provide a non-threatening story that the adult can use to convey the information to the child.
The tone of this connversation is sensitive. Keep it friendly, more as cooperative adult-to-adult information-sharing than as parent-to-child advice-giving.
The communication skills that enable couples to talk collaboratively about sensitive issues apply to these conversations. Even though the child is young, the conversation is likely to go best if authorities appeal to the thinking part of the child. That part of a child's brain emerges by age three and a half or four, which makes that a good age for habit-stopping.
Avoid the kind of talking that makes the child feel bad about himself, motivating via shame or guilt. Avoid also setting up a power struggle by demanding that the child give up the thumb habit because of your superior power, i.e., "...because I said so!"
Lesson #4 Habit-ending proceeds most effectively when it's motivated by a combination of fear and desire.
Decisions to end addictive habits generally include elements that are both fear-motivated and motivated by the gains that will come with overcoming the habit.
In the David Decides story David looks in the mirror and has a heart-to-heart talk with himself.
"My thumb in my mouth feels good but I look silly. My thumb in my mouth makes me look like a baby." In addition, thinking of what his brother Michael had explained about why he was wearing braces, David thinks, "I want my teeth to stay just the way they are right now."
It helps that David has a positive goal as well. He learns from his older brother Michael when Michael puts his arm around David's shoulder and explains, "Mom offered to take me to the toy store to pick out something special if I could sleep thirty nights without my thumb."
Lesson #5 Ceasing an entrenched addictive habit is hard. Keeping track of progress helps keep motivation up to make it all the way to the goal-line.
Michael explained further to David, "We made a chart to keep count of the nights. On the chart we wrote how many nights I had to sleep without my thumb to earn my prize. Then each night that I made it No Thumbs, we put a star on the chart."
Lesson #6 Blockng the habit is a big help.
Trying to end a thumbsucking or other addictive habit triggers a reaction very similar to the grief reaction triggered by a loss. There's a sense of something or someone missing, with an impulse to hunt for the lost person or object. It's vital therefore to have a way to block the option of resuming the old habit. Cutting off the thumb may not, however, be the best strategy.
In the David Decides story, David's older brother Michael, who has protruding teeth and braces, warns David about how hard a time he had at first going to sleep without his thumb.
"I kept lying there without going to sleep. I felt like something was missing. I really wanted to let my thumb back in my mouth. I locked my hands between my knees. Some nights I had them under my pillow. Finally sleep would come But during the night when I was sleeping, my thumb kept going into my mouth again."
Michael continued, "One night at bedtime I cried. I told Dad that stopping sucking was just too hard. I wanted to give up....That's when we came up with our best idea. We put socks on my hands. We taped the socks around my wrists so I wouldn't pull them off while I was sleeping. I reminded Dad every night to help me put on the socks. I kept the tape next to my bed so we wouldn't forget. The socks made my hands sweaty, but they did keep my thumbs out of my mouth. And in the morning if I still had the socks on my hands, I knew I had made it the whole night No Thumbs."
Lesson #7: Addictions are contagious.
Staying clear of others who still indulge in the habit is usually vital to ending your own habit.
After our first child turned out to be a confirmed thumbsucker, my husband and I resolved with the second to use a pacifier, even though that meant many nights of multiple wakeup calls to find the pacifier when it had fallen out. A pacifier, we assumed, was under parental control. When we felt that the time had come to end the habit, we could remove it.
Which we did. Except that by then, our four year old pacifier-sucking daughter had two younger siblings, both confirmed thumbsuckers. She took a good look at them, tested the taste of her own thumb, and with consummate ease proceeded to fill the space left empty by the no-longer-available pacifier with her own ever-available thumb.
Lesson #8: Patience and persistence are essential.
Even the simple addiction to thumbs takes surprisingly long time, and generally multiple slip-ups, to end. Aim for the rapidity of the hare, coupled with the slow, long doggedness of the tortoise.
Expect set-backs. In the quote from David Decides in Lesson #6 above, note that when success seems to be slipping away, the thumbsucker and his parents pause, talk together to clarify what the specifics of the difficulty are, and create a plan of action to overcome that particular barrier to success.
Lesson #9: Replacements help.
It's generally easier to add a new behavior than to inhibit doing something familiar.
Replacing thumbsucking with a new but healthier habit helps. Older daytime thumbsuckers may do best at ending the habit by substituting chewing gum. Replacing wine-drinking with drinking cranberry juice has higher odds of success than just aiming to stop drinking wine.
Beware of the choice of replacement habits. The cute little boy who plays David in the photographs in the book was in real life an ardent thumbsucker. Now, thiry years later, refraining from nail-biting still challenges him.
In her intriguing book Meet Your Happy Chemicals, Loretta Graziano Breuning PhD suggests a particularly all-purpose replacement habit that can work for virtually any addictive challenge. She recommends learning to pause. The impulse to do the counter-productive behavior usually will pass, particularly if the pause is followed by distraction, that is, by doing something else, anything else.
Lesson #10: Supportive allies help hugely.
Whether the problem is nail-biting, whining, shouting, hair twirling and pulling, or thumbsucking, the support of caring parents helps children enormously in their struggles to overcome addictive habits. The same goes for adults attempting to end gambling, compulsive affairs, alcohol or any addiction.
Yet, as AA and Alanon often point out, supportive others need to walk a fine line. They can be a huge asset by being there to share and augment the joy of successes. They can help with brainstorming to figure out solutions to set-back challenges.
At the same time, the person with the addictive habit must want to make the changes for him or herself. If loved ones want the changes more than the person with the problem, they become at risk for over-involvement. Loved ones belong on the sidelines, not on the playing field. Loved ones can cheer and offer informational coaching, but David himself must decide to go out on the field. Ultimately, only he can tackle and conquer the problem.
Susan Heitler, PhD, a Denver Clinical psychologist, is author of David Decides About Thumbsucking for children and parents, From Conflict to Resolution for therapists, and for couples, The Power of Two.
Dr. Heitler's most recent project is an interactive website for couples who want to better their marriage, PowerOfTwoMarriage.com.