Dr. Howard Gollup is a board-certified pediatrician with Aurora Advanced Healthcare in Germantown. He cares for children from birth through adolescence. Though he cannot respond to individual medical questions, he welcomes your feedback and suggestions for future topics.
Parents often ask how they can eliminate a habit, such as thumb-sucking. Most parents quickly discover that reminding a child not to thumb-suck starts to look like nagging, and rapidly becomes frustrating. It just plain doesn’t work—like many habits, most of the time the child is not even aware of it. Taping the thumb to the hand is also ineffective. For a simple habit, I recommend a behavioral modification scheme that utilizes positive reinforcement of increasingly compliant behavior. If there is a way to help the child self-monitor that is even better.
Thumb-sucking isn’t generally harmful if a child is doing it at brief intervals as a self-comforting or self-soothing activity. If your child has his or her thumb in the mouth for a few minutes when settling down for a nap, or before sleep, it is not going to have any significant effect other than aesthetics. If the thumb is in the mouth a considerable potion of the day, it can impact dental structure. I’ve also seen inflamed and even infected thumbs, though not often.
Don’t even try to break an infant or toddler of thumb-sucking—it will just not work. In order for a plan to work, a child has to understand what you are trying to accomplish, and be willing to change. If an older child has no desire to break a habit, he or she won’t. That’s where behavioral modification and rewards come in. You must somehow find a way to make them want to stop as much as you want them to.
First, decide the behavior you want to see more of. Define what you want to increase—in this case, more time not thumb-sucking. That is the behavior you will target for rewards.
Next, construct a chart which has a time intervals on the left hand side and a place for a sticker or check mark on the right. Start with easily achievable time intervals written in the left column. For an almost continuous behavior, this may mean starting with only five seconds. For a less common one, you may start with a longer time interval.
Then, sell your child on the program: If he or she doesn't thumb-suck for the next five seconds, he'll get a sticker or a check mark on the chart across from where you've written "five seconds". Once that has been done, the next interval becomes ten seconds, then fifteen, twenty, thirty, etc. Allowing for easily achievable time intervals at first allows your child to see how the scheme works and get an immediate taste of success. Then, if you can do something for five seconds, certainly you can do it for seven, or ten, and so on.You'll want to use a timer because young children don't have a well developed sense of time. And, hearing the buzzer is a tangible and unmistakeable endpoint.
After an entire column has been filled with stickers or check marks, a larger reward is earned (such as an item at the dollar store) and you move on to the next column. By then, of course, you will be up to longer intervals, and the columns get filled more slowly. Larger rewards come less often, but by then the child has mastered not sucking his or her thumb for, perhaps, hours at a time.
If you don't succeed at a particular level, back up to the previous time interval. Be patient with the scheme--it's mean't to work over time.
There is another necessary component to this plan. A child must have a way to self-monitor the behavior and ultimately be able to interrupt it him or herself. Consider using one of the bitter tasting preparations that are commercially available for thumb-sucking and nail-biting. (Two brands are Thum® and Stopzit®. Not all pharmacies carry these—they can be hard to find—but I have seen them on-line.)
These aversives are not usually sufficient to eliminate thumb-sucking themselves, without behavioral modification (i.e. they are not very strong negative reinforcers), but when used as an aid to facilitate self-monitoring can add an important element to the scheme described above. They remind a child “oh yeah, I’m trying to win valuable prizes!” and will help “teach” not to substitute.
If the thumb-sucking is an anxiety-reducer, stress-reliever, or self-calming habit, it may also be helpful—and humane—to replace it with some other coping mechanism such as encouraging a security object, a song, or another activity.
You can use this method for other habit-like behaviors. To summarize,
- Pick the behavior you want to see increase
- Set up an incremental reward system with easily achievable short term rewards, and larger “milestone” rewards interspersed within the scheme
- Whenever possible, incorporate some way for your child to be able to self-monitor or self-enforce compliance
- Look for an alternative activity or object to replace the habitual behavior
Now, if I could only get this to work on some of my own bad habits......