Q: My 8-year-old son is sucking his thumb and will not give it up. How can we break him of this habit?
-- Tim Richardson,
A: At age 7 or older, this becomes a delicate situation. It is possible to help older children stop thumb sucking, but parents must know how and when to get involved.
They must also be patient. Even under the best of circumstances, breaking the habit in older children usually takes a month to six weeks.
The first thing parents need to do is bolster their resolve as to why it's important to go to the trouble it's going to take to end this destructive cycle.
"Thumb sucking can have a major impact on teeth alignment and facial appearance, and facial appearance has a major impact on how people initially respond to you," says Susan Heitler, a clinical psychologist who has been helping children quit thumb sucking for the past 10 years.
"This is not a trivial factor," says Dr. Heitler, author of "David Decides: No More Thumb Sucking" (Avon Books) and a private therapist in Denver, Colo.
Then there are the risks to self-esteem. Most school-age children figure out on their own that thumb sucking is not socially acceptable.
Indeed, a 1993 study published in the Journal of the American Academy of Pediatrics indicated that first-graders viewed their thumb-sucking peers as being less attractive and desirable as friends.
Research shows about 6 percent of all children age 7 to 11 still suck their thumbs, and by this age, Ms. Heitler says most of them probably do it only in private. Hiding this habit can lead to shame.
Deep down, most children at this age probably do want to stop, and the trick for parents is to help them make this decision on their own. That's the crux of the method Dr. Heitler devised to help her four children stop thumb sucking, a method that has since been used by dentists all over the country.
Ms. Heitler's method contains a lot of components that other parents also called Child Life to suggest:
Explain the negative effects of thumb sucking to the child's teeth and bone structure. Cover the thumb with bandages or gloves, especially at night, to help remind the child not to suck. Mark each successful half-day or day with a star on a calendar and let children earn $1 (or points toward another desired reward) for every thumb-free period.
Dr. Heitler's method uses all of these techniques simultaneously. Plus, it adds the essential first step of leading the child to decide to quit on his or her own.
"The first step is to motivate the child," Dr. Heitler says. "Make it the child's project, and you are just the consultant, not a policeman. When you transfer the responsibility onto the child, the odds of success go zooming up."
In 30 years as a pediatric dentist, Arthur Nowak, president-elect of the American Academy of Pediatric Dentistry, hasn't seen a lot of 8-year-old thumb suckers, probably because he begins counseling parents on how to help their children stop when they are much younger.
But in his experience, children who are still sucking at age 8 typically have other problems or pressures that he feels attribute to the tenacity of the habit.
"I always ask if the child has any problems at home or school, what sort of friends does he have and whether he feels good about himself," says Dr. Nowak, a professor in the departments of pediatric dentistry and pediatrics at the University of Iowa.
If the child isn't ready to quit, Dr. Heitler suggests waiting three months and trying again. "That can be face-saving for everyone."