Eliminating Thumb Sucking
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Intro :: Daytime :: Bedtime :: Phases :: Review
Chronic thumbsucking beyond age 3 should be eliminated if for no reason other than its harmful effects on dental development, including such problems as open bite, over jet, and cross-bite-dental malocclusions. Research has demonstrated conclusively that chronic thumbsucking can be eliminated during both a child's waking and sleeping hours.
Suggested here are proven methods for eliminating chronic thumbsucking during daytime and nighttime hours. Note that I am addressing chronic thumbsucking. Nearly all children suck their thumbs to one extent or another. Children, from the moment of birth and before, learn that sucking is a very reinforcing thing to do. In fact, at the outset, their very lives depend on it! Consequently, parents shouldn't be alarmed if babies and little children suck their fists, fingers; and thumbs occasionally. By the same token, when they do suck their thumbs, particularly beyond age 1, parents shouldn't do things that call attention to that behavior. Avoid saying things like:
"Mary, you are sucking your thumb again! Don't do that. Do you want to ruin your teeth?" or angrily, "Billy! Stop that! Quit acting like a baby. Do you want me to put you back in diapers and feed you from a bottle? That's exactly what I'm going to do if you don't quit that baby behavior!"
Though the intent behind such statements is in the child's best interest, they only make matters worse. In the first place, the child is being asked questions for which no answer is expected. As I emphasized in Chapter 8, Questioning Children About Their Behavior, never ask a child a question about his inappropriate behavior unless you need information to aid problem solving. (If you haven't read Chapter 8 yet, or have forgotten its key points, I suggest you read it-or read it again-soon.) Also, belittling or threatening a child is hurtful at best, and potentially damaging. Lastly, telling a child to stop a behavior that has a long history of reinforcement, then expecting the child to stop, is an absolute waste of breath and a prelude to dashed-albeit desperate-hopes. It does nothing more than build in the parents and the child an image of a disobedient, weak child who never minds and can't control himself. What a terrible foundation upon which to build self-esteem and a parent-child relationship!
Intro :: Daytime :: Bedtime :: Phases :: Review
Daytime Thumbsucking
Daytime thumbsucking should simply be ignored. For emphasis, I'll say that again: Daytime thumbsucking should simply (and completely!) be ignored, put on extinction, while appropriate, non-thumbsucking behaviors should be selectively reinforced. Consider these scenarios as examples of how a parent should respond to a child who occasionally sucks his thumb:
| Scenario 1: | The parent and the child are in the same room together. The child begins sucking his thumb. |
| Response: Withdraw positive reinforcement: | The parent immediately, though calmly and without the slightest trace of frustration or despair on his face or reinforcement in his demeanor, terminates any interaction with the child, and leaves the room. |
| Selective reinforcement: | Once out of the child's view the parent watches to see when the child removes his thumb from his mouth. After the child has kept his thumb out of his mouth for approximately 30 to 45 seconds, the parent returns to the room, pats the child, says "You are playing so happily," smiles, then goes on with whatever he/she was doing before the child began sucking his thumb. |
| Scenario 2: | The parent and the child are sitting together. The parent is reading the child a story. The child begins sucking his thumb. |
| Response: Withdraw positive reinforcement: | The parent immediately quits reading and either sits there unresponsively or leaves the room. Remember, when this is done, nothing should be said or done that suggests rejection, disgust, or anger toward the child. |
| Selective reinforcement: | The parent waits until the child has taken his thumb out of his mouth and kept it out for 30 to 45 seconds, at which time he/she continues to read. |
| Scenario 3: | The parent(s) and the child are traveling together in the car. The child begins to suck his thumb. |
| Response: Withdraw positive reinforcement: | The parent(s) simply terminates/refrains from interacting with the child until he has kept his thumb out of his mouth for 30-45 seconds. |
| Selective reinforcement: | The parent(s) immediately, though naturally, begins interacting positively with the child when he quits sucking his thumb. |
| Note: | When parent-child interactions resume, do not say, "I'm glad you quit sucking your thumb," or words to this effect. Ignore thumbsucking completely! Don't attend to it, don't mention it, don't have a thing to do with it. Remember, behavior is strengthened by the attention given to it. |
| 8 | Red | Red | Red | Red | Green |
| 7 |
Red |
Red | Red | Red | Red |
| 6 |
Red |
Red | Red | Green | Red |
| 5 | Red | Green | Red | Red | Red |
| 4 |
Green | Red | Red | Green | Red |
| 3 | Red | Red | Red | Red | Red |
| 2 | Red | Red | Red | Red | Green |
| 1 | Red | Green | Red | Red | Red |
| Days | 1 | 2 | 3 | 4 | 5 |
With 5 days of recording, you have both the frequency of thumbsucking, and when it occurs. Once you have the data recorded and graphed, you are ready to begin your treatment.
Begin treatment by showing the graph to the child and say: "(name), we are going to help you quit sucking your thumb at night."
"For the past 5 nights we have been quietly going into your bedroom when you were asleep to see if you were sucking your thumb. As you can see by this record, you suck your thumb a lot at night. The red squares mean you were sucking your thumb, and the green squares mean you were not. We want you to have all green squares."
This might evoke some discussion, but don't prolong it. If the child protests and says, "I do not suck my thumb that much! You are just making that up!" don't argue with him; rather, say, "I can understand that this would be a surprise to you. That's a lot of time sucking your thumb, especially if it means that it is happening all night-or even most of the night. Here is what we are going to do to help you."
Or, he might say something self-depreciating like, "Oh, I'm such a baby. I hate myself." If he says things like this, neither agree nor disagree. Do not try to convince him otherwise. Be directive and on task. Simply say, "Here is what we are going to do to help you quit sucking your thumb." Then explain and demonstrate the strategy, as described below.
Intro :: Daytime :: Bedtime :: Phases :: Review
In scientific terms, the strategy described below is called a "response prevention strategy using restraints." (This research was conducted by a team of Canadian scientists under the direction of Dr. Ahmos Rolider, University of Toronto.) What that means, simply, is that the child is restrained from sucking his thumb so he won't be reinforced for sucking his thumb. Thumb sucking is a self-reinforcing behavior; it is self stimulating. This strategy makes it impossible for the child to stimulate himself through thumbsucking. The strategy has the following five phases.
Phase 1: Boxing Glove Restraint
At bedtime, place a boxing glove on the hand of the thumb that is being sucked. If the child exchanges hands in the night and sucks both thumbs, put boxing gloves on both hands. Tell the child he is to keep the glove(s) on all night long for at least a week to help him stop sucking his thumb(s). Tell him that every day you will show him the graph you are keeping as a record of his performance.
Tell the child that he will receive something really good if he keeps the glove(s) on all night and doesn't suck his thumb(s). What this "really good" thing is should be agreed upon in advance. It could be tokens the child earns to be traded later for something he wants, like a video movie, a toy, some special activity with Mom or Dad, an immediate prize like a piece of candy, the privilege of playing with a toy for the entire day, the privilege of watching TV, and so on. Find what it is the child really wants, then make having that contingent upon his going all night long wearing the glove(s) and not sucking his thumb(s). Also, tell the child what he can expect if he takes the glove(s) off and sucks his thumb(s). For example, maybe he denies himself the privilege of watching TV after 5:00 o'clock that night, or he will lose the privilege of riding his trike/scooter/bike for 24 hours, and so on.
If the child cries and complains in the night about having to wear the constraint, just let him cry and complain. Don't go into the bedroom to comfort him. The discomfort is all part of the treatment.
In the morning, show him the graph of your observations from the night before. If the child made it through the night with success, enthusiastically say something like, "Super good job! You left the glove(s) on all night and didn't suck your thumb(s). That's wonderful!" Then give the child the agreed-upon prize. If he was not successful, say nothing and withhold all reinforcers. When you do this, don't be moody or show disgust or displeasure, or put the child down. Complete your graph, and have it handy that night to show the child when he goes to bed. The graph becomes both an incentive and a reinforcer, so keep it up to date every day.
After the child has had 7 to 8 successive successful nights, move to Phase 2.
Phase 2: Absorbent Cotton Restraint
Tell the child that since he has been doing so well for the last 7 to 8 days, he won't have to wear the boxing glove(s). Rather, he will wear cotton over his thumb(s), held in place by adhesive tape. It will be very evident if the child sucks the cotton. If he does so two nights running, in addition to the denial of privileges, go back to Phase 1, using the boxing gloves. But don't threaten the child with this. It's okay to tell him in advance in a matter-of-fact way that this will happen, but don't say something like, "You'd better not suck on this cotton or it's back to wearing boxing gloves for you! Do you understand that!" Let the consequence deliver the message. If the child does go back to wearing the boxing glove(s), return to the use of the cotton restraint after 5 successive days of continuous success with the glove(s).
Use the cotton restraint until the child has had 11 days (nights) of continuous success. Again, keep the daily record and follow each success with enthusiastic verbal praise and the agreed-upon reinforcer. Eleven days might seem like a long time, but stick with it. For more difficult behaviors such as self-stimulating or self-reinforcing behaviors, "over learning" is often the best way to go.
Phase 3: Finger Tip Bandage Restraint
After 11 continuous successful nights using the absorbent cotton restraint, replace this with a bandage over the end of the thumb(s). Use a bandage that is 2" long and 13/ 4" wide. Secure it on the thumb(s) with adhesive tape so it won't come off easily. Continue with this phase, as described for the other two phases for 11 consecutive days of success. In the event of 2 consecutive days of failure, go back to 5 days using the cotton restraint. After 11 consecutive days of success using the bandages, proceed to Phase 4.
Phase 4: No Restraint
During this condition, fingertip dressings are no longer used and no restraint of any kind is to be placed on the thumb(s) or hand(s). However, any failure is met with the loss of privileges/reinforcers, and if failure is experienced two days in a row, go back to Phase 3, the bandage restraint. After a week of continuous success at this phase, move to Phase 5.
Phase 5: Follow-up
Continue to check the child 3 nights a week: every other night or 3 randomly selected nights. Success is to be reinforced with the agreed upon privileges/prizes. Any thumbsucking is met with a loss of privileges. If at any time 2 consecutive nights of thumbsucking are observed, go back to Phase 3. Continue this follow-up phase for 3 months.
This five-phase strategy has been shown to be 100% effective when used properly. It is permissible to modify it if you have good reasons to believe the child is making rapid progress. The number of days per phase can be reduced. An entire phase can be skipped. But don't make these adjustments unless you are absolutely certain the behavior is changing for the better. Let the behavior tell you, as shown by the data, how much to modify the program, not the child. If the child says, "Honest, I won't suck my thumb tonight. Please! Don't make me wear that dumb boxing glove!" Say, "I can understand why you wouldn't want to wear it. Neither would I. As soon as you have learned to go all night without sucking your thumb, you won't have to wear it." Then proceed with the program.
Don't get excited or angry at a child's resistance to the program. If you calmly and systematically proceed, you will calmly and systematically succeed.
Intro :: Daytime :: Bedtime :: Phases :: Review
NOW TO REVIEW
- Daytime thumbsucking can be eliminated with the systematic application of
- withdrawing positive reinforcement, and
- selective reinforcement of appropriate behavior.
- Chronic bedtime (nocturnal) thumbsucking can be eliminated using a five-phase process called "response prevention strategy using constraints," as follows:
- Phase 1: Boxing glove restraint.
- Phase 2: Absorbent cotton restraint.
- Phase 3: Finger tip bandage restraint.
- Phase 4: No restraint.
- Phase 5: Follow-up.
