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Watching your little bundle of joy grow up into a healthy child is a great source of pleasure for every new parent. But there are some childhood habits which you can find bewildering, and you might wonder if these habits will do lasting damage to your child’s health. Thumb sucking is one such habit, and most parents have to deal with a child who sucks his or her thumb incessantly or frequently.

According to the American Academy of Pediatrics, thumb or finger sucking is a non-nutritive form of sucking - as opposed to sucking during breastfeeding or bottle-feeding, which provides the baby with nutrition. This is a natural process and starts while the baby is still in the womb, around the 29th week of pregnancy. It usually shows up in a prenatal ultrasound as well. After the baby is delivered, you might observe them sucking their thumb while sleeping during early infancy. 

This nighttime thumb sucking is natural, especially during the first three months of life. It makes the baby feel secure and helps them calm down naturally - just like sucking during feedings does. However, thumb-sucking becomes a problem when it converts into a daytime habit. This usually happens by the time the baby is 12 months old and can continue up to 3 or 4 years of age. 

According to a study published in the International Journal of Clinical Pediatric Dentistry in 2015, thumb-sucking habits in children naturally decrease as they grow up, and most kids spontaneously give up the habit by the time they are 3-4 years old. If thumb sucking continues beyond this point then it can lead to permanent damage to the skin and structure of the thumb, damage the child’s teeth and palate, and cause infections due to germ transference. This is the stage when active intervention is required to break this habit before it causes too much damage.

  1. Causes of thumb sucking
  2. Effects of thumb sucking
  3. How to stop thumb sucking
  4. What not to do to stop thumb sucking

While thumb sucking in early infancy is considered to be normal, especially while sleeping, it can become a disruptive and non-nutritive daytime habit which can cause harm. There are a number of reasons why babies suck their thumbs or other fingers. The act of sucking works as a physical and emotional stimulus, and children usually do it if they are:

  • Hungry
  • Bored
  • Stressed
  • Anxious
  • Happy
  • Hyperactive

An increase in any of these stimuli, especially stress and anxiety, can make the child believe that thumb sucking is an easy way to relieve them. This is how thumb sucking can become a habit beyond the age of 3 years. There are two theories about thumb sucking that might explain exactly what causes it.

  1. Emotional theory behind thumb sucking
  2. Learned behaviour theory behind thumb sucking

Emotional theory behind thumb sucking

Based on Freudian psychoanalytic concepts, the emotional theory stipulates that thumb sucking is related to the oral stage of child development. Freud believed that during the oral stage, the infant derives pleasure or gratification through the mouth. The mouth is the all-absorbing organ of pleasure during the first 18 months of life, and thumb sucking is a way to enhance this pleasure. But if thumb sucking continues beyond the first 18 months or the oral stage, then it has turned into an oral fixation and is considered to be a sign of regression. This fixation and regression is a sign of emotional disturbance, which means the child needs emotional support to let go of the habit.

Learned behaviour theory behind thumb sucking

Infants have an innate urge to suck. When they get an excessive urge to suck and there is an absence of breastfeeding or bottle-feeding, the baby will end up sucking his or her thumb. The learned behaviour theory stipulates that competent mothers usually make sure that the baby’s nutritive needs are immediately and quickly satisfied by breastfeeding or bottle feeding. Even though the nutritive needs are satiated, it does not mean that the need for non-nutritive sucking is also gratified - and this leads to thumb-sucking as a response to the absence of a bottle or breast to suckle on.

Thumb sucking in children above the age of 3 years need to be managed because it can lead to a number of damaging effects, especially to the child’s jaws, mouth and thumb. A continued thumb-sucking habit can lead to severe damage to the teeth, palate, skin and shape of the face as well as the thumb. While a lot of these damages can be corrected, the procedures involved can be long and socially isolating as well.

  1. Overbite due to thumb sucking
  2. Open bite due to thumb sucking
  3. High-arched palate due to thumb sucking
  4. Speech impediments due to thumb sucking
  5. Deformed thumb due to thumb sucking
  6. Increased infection risks due to thumb sucking

Overbite due to thumb sucking

This type of dental malocclusion or tooth misalignment refers to the jutting out of the upper front teeth. Due to thumb sucking the upper front teeth are directed outward, and instead of the baby’s upper and lower front teeth touching normally, the upper teeth will overlap and hide the lower ones completely. This misalignment will affect the shape of your baby’s face and smile, and he or she will need orthodontic treatments like braces to correct this.

Open bite due to thumb sucking

In this type of dental malocclusion of tooth misalignment, both the upper and lower front teeth are directed outwards. This means that your child’s upper front teeth will not touch the lower front teeth, even when the mouth is completely closed. Because of this gap in the teeth, your child’s jawline will be long and it will affect his or her face and smile. An open bite can be treated with orthodontic treatments, but in severe cases, orthognathic surgery might also be needed to correct this.

High-arched palate due to thumb sucking

Because the thumb constantly presses against the palate or the roof of the mouth while thumb sucking, the roof will gradually become high-arched and lead to other complications. A high-arched palate means that your child’s tongue will not normally touch the palate, and this can lead to a narrowed airway and breathing problems like sleep apnea. A high-arched palate can also lead to speech and taste issues in your child.

Speech impediments due to thumb sucking

If the shape and alignment of the teeth and palate are changed due to continued thumb sucking, it can lead to many types of speech impediments. Your child can find it difficult to pronounce hard consonant sounds like D and T. Lisping is another speech impediment that usually occurs in children who suck their thumb. You might get speech therapy for your child in these cases, but they won’t be completely effective until the deformities in the mouth and palate are corrected.

Deformed thumb due to thumb sucking

The thumb is constantly in touch with moisture in the mouth in the case of children who suck their thumb. This continuous exposure can lead to problems in the skin of the thumb, apart from making it look narrow. The thumb can begin to look calloused, and the skin can crack and bleed. Because of the constant pressure and moisture, the thumbnail can become warped and cause ingrowth or peeling.

Increased infection risks due to thumb sucking

As your child grows up, his or her hands will be exposed to all sorts of surfaces and the germs latched onto them. If your child sucks his or her thumb, then chances are that these germs will easily be transferred to the mouth and then ingested, leading to bacterial infections, fungal infections and viral infections.

Thumb sucking beyond the age of 3 years can seriously affect a child and lead to many complications, like deformities of the teeth, palate, thumb and speech. While these complications can be corrected, the process is prolonged and can isolate the child socially. It is, therefore, best to prevent thumb sucking altogether, especially after your child crosses the age of 3 years. Here are a few popular methods endorsed by doctors, dentists and psychologists.

  1. Positive reinforcement therapy for thumb sucking
  2. Preventive therapy for thumb sucking
  3. Appliance therapy for thumb sucking
  4. Three-alarm system for thumb sucking
  5. Contingent reading therapy for thumb sucking

Positive reinforcement therapy for thumb sucking

During the early stage of life, especially up to the age of 5 years, your child is likely to learn behavioural cues from the parents, relatives, family friends and kindergarten. If the child is sucking their thumb then people within this circle can use positive reinforcements to stop the habit. This means constantly reminding the child that thumb sucking is bad, explaining all the problems it can lead to, and rewarding them when they stop or for quitting the habit.

Preventive therapy for thumb sucking

Thumb sucking starts out as a normal habit that relaxes or soothes a baby in early infancy, but continuing it until after 3 years of age is a sign that there are elements in the environment that are making the child insecure, stressed, anxious or sad. If you identify those triggers and prevent or modulate them, then your child will not feel agitated and, in turn, will not need to suck on the thumb. Separation from one or both parents as they go back to work after maternity or other leaves, spending a night away from home while travelling, a disruptive or violent home environment, verbal or physical abuse, etc can be triggers for thumb sucking and need to be dealt with to break the habit.

Appliance therapy for thumb sucking

This form of therapy is usually done when the positive reinforcement and preventive therapy don’t show enough results and with the help of a dentist or doctor. Fixed or removable habit-breaking appliances, like braces with rollers or rakes, elbow-guards, etc are used to make the act of thumb sucking uncomfortable or impossible. This style of therapy also includes the three-alarm system created by dentists LA Norton and ME Gellin.

Three-alarm system for thumb sucking

A type of appliance therapy, the three-alarm system needs special mention here because it has a tried-and-tested approval rate among therapists for severe cases of thumb sucking. This system involves three sets of alarms that are triggered in the child’s mind by placing three devices. Originally, a bandage was placed on the thumb, which the child tasted first and was revulsed. An elbow brace with a small needle then poked the child, which was a painful alarm. The elbow brace then tightened to stop the arm’s movement, which was the third alarm.

This system was devised by dentists Norton and Gellin in 1968 and has since been revised to suit children better. The needle has now been removed, and a more complicated elbow guard has been created to issue all three alarms without injuring the child in any way. If your child’s thumb sucking is severe and continuing way beyond the age of 5 years, then you should talk to a dentist about using the three-alarm system for therapy.

Contingent reading therapy for thumb sucking

According to a study published in the Journal of Applied Behavior Analysis in 1974, contingent reading therapy has also shown results in conditioning children during early childhood against thumb sucking. This therapy can be done at bedtime when children like to listen to stories to fall asleep. Since thumb sucking is associated with sleep in early infancy, especially below 3 years, this method can be used to teach the child not to suck the thumb (thereby nipping the habit at its budding stage).  

All you have to do is stop reading or telling the story every time your child sucks their thumb, remind them about this bad habit, and continue the story once the thumb sucking is stopped. Repeat this cycle every time the child tries to suck the thumb during bedtime, until it reinforces this habit as a bad one in their head.

There are some methods that are traditionally used to stop children from thumbsucking which can be counter-productive. Instead of breaking the habit, these methods tend to frustrate, distress or anger the child more - and this, in turn, can lead to obstinacy and behavioural issues. You should refrain from using these methods because even though they might look like they’re working, they will not be sustained for long and might build feelings of resentment in the child. The following are some of the methods you should refrain from using:

  1. Scolding or beating the child into submitting to your will can lead to major behavioural issues. 
  2. Criticizing or ridiculing your child might also cause issues with his or her self-esteem and confidence, especially if done in front of other peers.
  3. Applying chillies or other irritants on your child’s thumb is useless because these fade away quickly and with handwashing. What’s more, your child’s thumb is sore and moist from sucking, and applying irritants can cause inflammation and infections.
  4. Don’t physically remove the thumb from your child’s mouth or angrily confront them about it. Thumb sucking usually happens when the child needs soothing, so your actions might traumatize them more, and exacerbate the habit.
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  1. Shetty, Raghavendra M. et al. Three-Alarm System: Revisited to treat Thumb-sucking Habit. Int J Clin Pediatr Dent. 2015 Jan-Apr; 8(1): 82–86. PMID: 26124588
  2. Knight, Martha F. and McKenzie, Hugh S. Elimination of bedtime thumbsucking in home settings through contingent reading. J Appl Behav Anal. 1974 Spring; 7(1): 33–38. PMID: 4465372
  3. Skiba, Edward A. et al. A behavioral approach to the control of thumbsucking in the classroom J Appl Behav Anal. 1971 Summer; 4(2): 121–125. PMID: 16795284
  4. National Health Service [Internet]. UK; Thumb sucking and nail biting not key to preventing child allergies
  5. Tanaka, Orlando. et al. Breaking the Thumb Sucking Habit: When Compliance Is Essential Case Rep Dent. 2016; 2016: 6010615. PMID: 26904311
  6. Norton, LA and Gellin, ME. Management of digital sucking and tongue thrusting in children. Dent Clin North Am. 1968 Jul:363-82. PMID: 5240768
  7. Stanford Children's Health: Lucile Packard Children's Hospital [Internet], Stanford. USA; Thumb Sucking
  8. Stanford Children's Health: Lucile Packard Children's Hospital [Internet], Stanford. USA; Many Children Suck Their Thumbs
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