Sensory Self-Soothing and the Pre-school Child: Thumb sucking and other behaviors

Susan N. Schriber Orloff, OTR/L, FAOTA

Small children often suck their thumbs, mouth their fingers, suck the edge of the shirts, bite their nails, twist and/ or pull their hair…and this list goes on.

For children newborn through one-year thumb sucking, fingers in mouth, etc. is both developmentally and sensory appropriate.

Predominant current pediatric and child dentistry advice tells parents not to worry. “They will out grow it.” is the standard response. And they do for the most part.

We rarely see an adult sucking their thumb, or do any of the mannerisms noted above. But we do know adults, who constantly are cracking their knuckles, clicking the top of ballpoint pens, unconsciously bob their knee up and down, tap pencils to a desk, crack gum. All of these are sensory self-calming techniques and we do them sub-consciously and use them as mini-stress breaks.

However there are some medically sound reasons to address these behaviors. Thumb sucking can distort the teeth requiring orthodonture and in sever cases jaw realignment. Prolonged sucking on items can extend drooling beyond the chronological age when it should have been extinguished. Oral stimulation can replace the desire to eat and negatively impact adequate nutritional intake.

In adults these are habituated unconscious motor patterns. In children these are coping mechanisms. They are NEW patterns that have not had the time to have neural pathways. Initially they are just “habits”.

In very young children who start to do a specific repeated motor patterns addressing these quickly can often deter them from becoming imprinted and embedded. In young children these actions can have social consequences. A peer may not want to h old hands with a child with a saliva-wet hand. Kids taking turns on technology might complain to the teacher “Jonny left the keyboard messy”. At lunchtime the child who uses his/her mouth for self -soothing often replaces the (thumb/shirt/pencil top/etc.) stimulus with food. This is the child that seems to be stuffing everything in at once or who is the “messy eater” that others prefer not to sit next to.

Beyond identification it might be helpful to understand what is going on within the sensory motor network that drives the child to choose these patterns. These behaviors start because they are gratifying and serve a life enhancing experience.

In a study with premature infants it was observed that thumb sucking stopped the baby’s crying, decreased agitation and increased the resumption of normal bodily rhythms inclusive of swallowing and eating.

 

Another study surprisingly found that early (0-14 months) thumb suckers achieved higher and faster independent social maturity than their non-thumb sucking peers because the knew if they got stressed they could rely on themselves and not have to run to Mom for comfort. They had their comfort right with them. However the plus of thumb sucking steeply decreased as theses babies approached and became toddlers. That is when the social and physical negative ramifications begin to emotionally and socially impact the child.

Prolonged thumb sucking and other oral stimulatory actions are considered in these older children to be neurologically tied to sensory processing issues.

Our mouths are our first tactile discriminatory pathways. We use our mouths to eat, suck-soothe and touch. Tied to our olfactory (smell) receptors it allows us to taste, differentiate mommy from daddy, grounds us spatially and helps us develop our initial primary sense of security.

Conclusively and without question we all, child and adult, need and seek motor patterns that help us cope when under stress. At work adults can get up from their desks and get a snack, visit a co-worker, go for a short walk. These behaviors totally discouraged in most academic settings.

Susan Heller, PhD wrote in an article for Psychology Today that unchecked habituation of these behaviors can potentially evolve into other addictive behaviors throughout the life span. She continues that altering these behaviors is a mixture of self-motivation and increased self-awareness. Dr. Heller suggests reading with your child the book, David Decides About Thumb sucking.

With sensory issues redirection replace and redirect (the behaviors) is the course of least resistance. Going “cold turkey” will be a source of stress for you and your child. In fact it may even exacerbate the very behavior you are trying to eliminate.

A great starting place is to investigate using CHEWELERY. These fun items are available through ARK Therapeutics, amazon.com, and can be found in therapy catalogues. They are fun colorful and excellent oral stimulatory “substitutes”. The “CHEWELERY” come in necklaces for boys and girls (sports themes, gender neutral and princess options), bracelets, fidgets and more.

It is important to keep in mind that sensory issues rarely stand alone and like dominoes that are standing on edge lined up in a row, one system has impact on others as well. Occupational Therapy can evaluate your child’s sensory stability often circumventing developmental functional deficits that may evidence themselves as age/grade task demands increase. Developmental issues a do not self-resolve. Children do not outgrow them although unaddressed they often morph into other behaviors that can impede academic and social success.

What we touch, hear, smell, see and taste is what we understand, what we relate to, what we remember and process and what we alert to. Simply put it allows us to correctly and efficiently navigate our world. Only a registered and certified Occupational Therapist can competently evaluate your child’s sensory integrity and, if needed, give you a personally customized plan designed specifically for your child.