ORAL HABITS Oral habits are habits that frequently children aquire that may either temporarily or permanently

be harmful to dental occlusion for and to the supporting structures. When habit cause defect in orofacial structure it is termed as pernicious oral habit. Buttersworth(1961):defined a habit as a frequent or constant practice or acquired tendency, which has been fixed by frequent repetition.

By William James: Useful habits (nasal breathing) Harmful habits (eg:- Thumb sucking, Tongue thrusting)

Useful habits:- The habits that considered essential for normal function such as proper positioning of tongue, respiration, normal deglutition. Harmful habits:- Habits that have deleterious effect on the teeth and their supporting structures. By morris and Bohana: Pressure. (lip sucking, thumb sucking, tongue thrusting) Non pressure (mouth breathing) Biting habit (nail biting, pencil biting, lip biting)

Pressure habit:- Habit that apply force on teeth & supporting structure. Non-pressure habit:- Habit that does not apply force on teeth & supporting structure. By Finn: Compulsive Non-compulsive

Compulsive :- These are deep rooted habits that have acquired a fixation in child. The child tends to suffer increased anxiety when attempt made to correct. Non-compulsive:- These are habits that easily learned and dropped as the child matures. By klein: Empty/unintentional habits Meaningful/intentional habits Empty habit:- They are habits that are not associated with deep rooted psychological pattern. Meaningful habits:- They are habits that have psychological bearings.

Various Habits : Thumb sucking. Tongue thrusting. Mouth breathing Bruxism Nail biting Lip biting. THUMBSUCKING INTRO It is observed that most children below 3 year suck their thumbs & finger. Thumb sucking in infants is common and is meant to meet both psychological and nutritional needs. Most children discontinue the habits 3-4 year of age. If habit continues beyond this period there is definite chance that may lead to dentofacial changes. DEF According to Gellin It is placement of thumb or one or more finger in varying depth into the mouth. Theories (1) Psychoanalytical/psychosexual theory: Formulated by Sigmund freud in 1928. According to which thumb sucking habit evolves from an inherent psychosexual drive where child derives pleasure during thumb sucking. (2) Oral drive theory: Formulated by sears and wise 1982.

According to this theory prolongation of nursing strengthen the oral drive & child begins thumb sucking. (3) Benjamins theory:- Rooting reflex: In this movement of infants head & tongue towards an object touching its cheek. This primitive reflex is maximal during first 3 month of life.

(4) Learning theory: Given by Davidson (1967) The infants associates sucking with such pleasurable feelings as hunger & recall these events by sucking the suitable object available.

Etiology

Classification
OBRIEN(1996)
a) Nutritive sucking habits: Provides essential nutrients Ex- Breast feeding , Bottle feeding. b) Non-nutritive sucking habits: Ensures a feeling of well-being, warmth and a sense of security. ExThumb/ finger sucking, Pacifier sucking

Classification of NNS habits Johnson and Larson 1993 (JDC )

a) Level Description Level 1 (+/-) Boys or girls of any chronological age with a habit that occurs during sleep. b) Level II (+/-) Boys below age 8yr with a habit that occurs at one setting during waking hours. c) Level III (+/-) Boys below age 8yr with a habit that occurs at multiple sittings during waking hours. d) Level IV (+/-) Girls below age 8yr or a boy over 8 yrs with a habit that occurs at one setting during waking hours. e) Level V (+/-) Girls under age 8 yr or a boy over age 8 yrs with a habit that occurs at multiple sittings during waking hours. f) Level VI (+/-) Girls over age 8 yrs with a habit during waking hours

Subtelnys grading(1973)
a)

Type A:- 50% children , whole digit vault of the palate , man max contact.

b) Type B :- 13-15% children , whole digit, not at vault of the palate , man max contact.

c)

Type C :- 18% children , 1st joint digit, not at vault of the palate , max contact.

d) Type D :- 6% children , very little digit, not at vault of the palate , man max contact.

Why Sucking reflex- Engel 1962 - Seen even at 29 week of I.U. life . First coordinated neuromuscular activity of infant . Disappears during normal growth btw 1-3 yrs. Purpose: Nutritional/Physiological gratification b) Emotional gratification c) Also experience pleasurable stimuli from lips, tongue and oral mucosa & learn asset enjoyable sensations such as closeness of a parent.
a)

Babies restricted from suckling due to disease or other factors become restless and irritable. This deprivation motivates the infant to suck the thumb or finger for additional gratification

THEORIES: Psychology of Non Nutritive digit sucking Theories to explain the cause of occurrence of this habit Freudian theory (1905) Learning theory (Davidson, 1967) Oral drive theory (Sears and Wise, 1982) Johnson and Larson (1993)

FREUDIAN THEORY(1905): Distinct phases of psychological development Oral and anal phases seen in first 3 years of life. Oral phase- mouth believed to be Oro-erotic zone. The child has tendency to place his finger or any object into the oral cavity. Prevention of such an act : Results in emotional insecurity and passes the risk of the child diversifying into other habits. Thumb sucking is considered as manifestation of insecurity, maladjustment , internal conflicts. The Learning Theory: Davidson 1967 Non-nutritive sucking stems from adaptive response Infant associates sucking with hunger, satiety & being held. These events are recalled by finger or thumb. i.e habit stems from an adaptive response and assumes no underlying psychological cause as a result of learning BENJAMINS THEORY (1962):

Thumb sucking arises from ROOTING REFLEX, common to all mammilian infants. It is max during first 3months of life. If it persists, may lead to abnormal habit.

ORAL DRIVE THEORY - Sears and wise(1950): Acc to this, theory prolongation of nursing strengthens the oral drive. (i.e prolonged sucking can lead to thumb sucking)

PREVALENCE INCIDENCE: Popovich and Thompson-1973, Kelley et al 1973: Higher incidence in girls than boys :11.7% girls and 8.3% boys. Subtenly and Subtenly 1973: Equal distribution Race: Low incidence in Negroid races. (Brenchley 1992) Birth to 2 years of age: - 50-67% 2 to 5 years of age:- 24-43% 6 to 10 years of age:- 17% Above 10 years :- 10%

Adverse Malocclusion open bite Mastication difficulty Speech difficulty ( D and T ) Lisping Paronychia and digital abnormalities

Effects

CAUSE FAC

SOCI ECO

In high socioeconomic status the mother is in better position to feed baby, where as mother belonging to low socioeconomic group is unable to provide the infant with sufficient breast milk. Hence the infants suckles intensively for a long time to get required nourishment, thereby also exhausting the sucking urge. (2) Working mother:- Sucking habit is commonly observe to be present in children with working parents such children brought up in the hand of a caretaker may have feelings of insecurity n use their thumb to obtain secure feeling. (3) No. of sibling:- The development of habit can be indirectly related to number of sibling. As number increases the attention meted out by the parents to child gets divided. (4) Order of birth of child:- It has been noticed that later the sibling ranks in family, greater is change of having oral habits. (5) Age of child:- The time of appearance of digit sucking habit has significance In neonates:- Insecurities are related to primitive demand as hunger. During first few week :- Related feeding problems. During eruption of primary molar:- It may be used as teething device.

CLINICAL F Labial flaring of maxillary anterior teeth. Lingual collapse of mandibular anterior teeth. Increased overjet. Hypotonic upperlip and hyperactive lowerlip. Tongue placed inferiorly leading to posterior cross bite due to maxillary arch contraction. High palatal vault. Extra oral: Fungal infection on thumb Thumb nail exhibit dish pan appearance. DIAGNOSIS (1) History: Determine the psychological component involved. Question regarding the frequency, intensity and duration of habit. Enquire the feeding patterns, parental care of the child. The presence of other habits should be evaluated. (2) Extraoral Examination :-

(i)

The digits: Digits that are involved in the habit will appear reddened, exceptionally clean, chapped & short fingernail (dishpan thumb) Fibrous roughened callus may be present on superior aspect of finger.

(ii)

Lips:-

Upper lip may be short and hypotonic. Lower lip is hyperactive . (iii) Facial form analysis: Check for mandibular retrusion. Maxillary protusion. High mandible plane angle . (3) Intra oral Examination:(i) Tongue: Examine the oral cavity for correct size & position of the tongue at rest. Tongue action during swallowing. (ii) Dentoalveolar structures:-

Individual with severe finger or thumb sucking habits,where the digit applied an anterior superior vector to upper dentition and palate, will have flared & proclined maxillary anterior with diastemas & retroclined mandibular anteriors. Other intra oral symptoms will include high probability of buccal crossbite. PSYCOLOGICAL THERAPY: Screen the patient for underlying psychological disturbance that sustain thumb sucking habit. Once the psychological dependence is suspected child referred for counseling. Thumb sucking children between the age of 4 to 8 year need only reassurance, positive reinforcements and friendly reminders. Various aid are employed to bring the habit under the notice of child such as study model, mirrors etc. Dunlop hypothesis:Patient is made to sit in front of mirror and asked to suck his thumb this will make him realize how awkward he looks and want to stop sucking his thumb. Children & parents are informed about existing dentofacial deformities and long term risk of habit.

 Patient should presented with positive mental and visual images of dentofacial ideals expected from habit cessation. During treatment adequate emotional support & concern should be provided to child by parents. When habit is discontinued the child can be reward with a favorite new toys.

(2) REMINDER THERAPY:(A) Extra oral approach: Employed bitter flavored preparations or distasteful agent that applied to finger or thumb eg. cayenne pepper, quinine asafetida. A commercially available product fimite can also be used.

It should be applied on skin and nails allowed to dry for 10 min. A new coat should be applied in mornings n evening till habit is broken. (B) Ace bandage approach:Ace bandage approach involve nightly use of an elastic bandage wrapped across the elbow pressure exerted by the bandage remove the digit from the mouth as child tries and falls asleep. (C) Use of long sleeve night gown. It has been found that long sleeve night gown prevent the child from practicing thumb sucking because it interfere with contact of the thumb and oral cavity. (2) Intra oral approaches:Various orthodontic appliances are employed to break the habit. Removable appliance palatal crib, rakes, palatal and lingual spur. Fixed appliances such as oral screen is more effective. (3) MECHANO THERAPY:(A) Fixed intra oral anti thumb sucking appliances- An intraoral appliance attached to the upper teeth by means bands fitted to the primary second molar or first permanent molar.

(B) Blue grass appliances - Consist of modified six sided roller machined from Teflon to permit purchase of the tongue. (C) Quad helix prevents the thumb from being inserted and also corrects the malocclusion by expanding the arch. Finger (Thumb) sucking & Nail Biting Management FACTS Most give up by 2 yrs If continued beyond 4 yrs number of squelae If resumed at 7 8 yrs : sign of Stress

TO DOS Reassure parents that its transient. Improve parental attention / nurturing.

Teach parent to ignore; and give more attention to positive aspects of childs behavior. Provide child praise / reward for substitute behaviors. Bitter salves, thumb splints, gloves may be used to reduce thumb sucking. Finger guards / Thumb guards , etc.

HISTORY Once the positive history of habit is determined the question regarding the frequency, intensity and duration of the habit is determined. The remedies that have been tried at the home, the feeding patterns, parental care of the child is also ascertained. EMOTIONAL STATUS It is essential to determine if the habit is meaningful or empty. This requires an insight into the emotional security and familial well being of the child. EXTRA ORAL EXAMINATION Digits that are involved in the habit will appear reddened, exceptionally clear, chapped and a short fingernail i.e. a clean dishpan thumb. Fibrous roughened callus may be present on the superior aspect finger Lips:The position of the lips at rest or during swallowing should be observed. A short, hypotonic upper lip frequently characterizes chronic thumb suckers. Lower lip is hyperactive and this leads to further proclination of upper anterior teeth.

14. Facial form analysis: Check for mandibular retrusion, maxillary protrusion, high mandibular plane angle and profile. When swallowing, the patient is observed for presence of a facial grimace or an excessive mentalis muscle contraction, a normal placement of the tongue against the teeth and palate and whether the pattern of speech of the child is essentially normal. Facial profile is either straight or convex. Other features include Associated symptoms hat should be watched for during the initial examination are habitual mouth breathers and tongue thrust swallow, particularly in children with anterior open bite. Active thumb suckers also have a higher incidence of middle ear infection and frequently have enlarged tonsils accompanied by mouth breathing. INTRAORAL EXAMINATIONTONGUE- Examine for tongue position at rest, tongue action during swallowing. GINGIVALook for evidence of mouth breathing; gum line etching, decay or excessive staining on the labial surface of upper central and lateral incisors.

15. CLINICAL FINDINGS The type of malocclusion produced by digit sucking is dependent on a number of variables (NANDA 1989) Position of digit Associated orofacial muscle

contraction Mandibular position during sucking Facial skeletal pattern Intensity, frequency and duration of force applied DENTOFACIAL CHANGES ASSOCIATED WITH THUMB SUCKING (JOHNSON & LARSON 1993) 16. EFFECTS ON MAXILLA EFFECTS ON THE MANDIBLE Increased proclination of maxillary anteriors with diastema Increased maxillary arch length Increased anterior placement of apical base of maxilla increased SNA increased clinical crown length of maxillary incisors increased counterclockwise rotation of the occlusal plane. Decreased SN to ANS-PNS angle. Decreased palatal arch width. Increased atypical root resorption in primary central incisors. Increased trauma to maxillary central incisors Increased proclination of mandibular incisors Increased mandibular intermolar distance Increased distal position of B point Decreased maxillary and mandibular incisal angle Increased overjet Decreased oerbite Increased posterior crossbite Increased unilateral and bilateral Class II occlusion EFFECTS ON THE INTERARCH RELATIONSHIP EFFECTS ON LIP PLACEMENT AND FUNCTION Increased lip incompetence Increased lower -lip function under hte maxillary incisors EFFECTS ON TONGUE PLACEMENT & FUNCTION Increased tongue thrust Increased lip to tongue resting postion Increased lower tongue position Risk to psycologic health OTHER EFFECTS Increased risk of poisoning Increased deformation of digits Increased risk of speech defects,especially lisping 17. PREVENTION OF THUMB SUCKING 1) Motive based approach The etiology of thumb sucking focuses on a predominant psychological background. Its prevention should be directed towards the motive behind the habit. History serves as an important tool for diagnosing the etiology. 2) Childs engagement in various activities Parents when questioned may reveal that the child practices the habit when bored and left to himself, or it could be just before he goes to sleep. In such cases, the parents can be counseled on keeping the child engaged in various activities. This gives little chance for child to practice the habit. 3) Parents involved in prevention When parents are at home they should be advised to spend ample time with the child so as to put away his feeling of insecurity. 4) Duration of breast feeding Care should be taken when feeding infants in that the duration of feeding should adequate so as to enable the child to exhaust his sucking urge and feel completely satisfied. 5) Mothers presence and attention during bottle feeding Bot tle fed babies should be held by the mother and enough attention should be given in the process. This will promote a close emotional union between the mother and baby similar to that in breast feeding. 6) Use of physiological nipple A physiological nipple should be used for bottle feeding and size and number of holes should be standardized to regulate a slow and steady flow of milk.

18. 7) Use of dummy or pacifier Acquiring a digit sucking habit can be prevented by encouraging the baby to suck a dummy instead. If the child already has thumb sucking habit, it will not be easy to introduce a dummy. It is necessary to offer a dummy to a child whose behavior indicates an urgent desire to suck a digit or dummy. TREATMENT CONSIDERATIONS Psychological status of the child Diagnosis and management of any psychological problem should be planned before the treatment of any potential or present dental problem. The frequency, duration and intensity of the oral habit are important in evaluating the psychological status of the child. If the oral habit was associated with an emotional problem this would suggest the need for psychological consultation. Age factor If the child desists with finger sucking habit within the first three years of life, the damage incurred such as open bite, is temporary provided the childs occlusion is normal. No treatment is provided in this age group. If a malocclusion is caused by digit sucking and the habit is discontinued between the age of 4-5 years, self correction of habit can be exempted. When digit sucking continues after 6 years or into mixed dentition, the malocclusion will not be self corrected. Motivation of the child to stop the habit It is also important to assess the maturity of the child in response to new situations and to observe the childs reactions to any suggestion. The treatment approach for the digit sucking habit should deal directly with the child.

19. Parental concern regarding the habit If the parent is unable to cope with the situation positively then both the parents and the child should be dealt with during the treatment. It is important that the child should not be embarrassed or criticized, rather help should be offered to deal with this difficult habit. Other factors Self correction again depends on the severity of the malocclusion, anatomic variation in the peri oral soft tissue, and the presence of other oral habits such as tongue thrusting, mouth breathing and lip biting. MANAGEMENT OF THUMB SUCKING The treatment can be broadly divided into the following (according to PINKHAM) i. ii. iii. iv. i. PREVENTIVE THERAPY PSYCHOLOGICAL THERAPY REMINDER THERAPY- a) chemical APPLIANCE THERAPY b) mechanical PREVENTIVE THERAPY (Hughes 1941) Firstly, feed the child whenever he is hungry and let him eat as much as he wants. Secondly feed the child the natural way. Thirdly never let the habit to be started the practice must be discontinued at its inception. ii. PSYCOLOGICAL THERAPY Screen the patient for underlying psychological disturbances that sustain a thumb sucking habit. Once psychological dependence is suspected, the child referred to professionals for counseling. -HYPOTHESIS OR DUNLOPS HYPOTHESIS. He believed that if a subject can be forced to concentrate on the performance of the act at the time he practices it, he could learn to stop performing the

act. Forced purposeful repetition of habit eventually associates with unpleasant reactions and the 20. habit is abandoned. The child should be asked to sit in front of the mirror and asked to observe himself as he indulges in the habit. THUMB SUCKING BOOK-The Little Bear who Sucked His Thumb is a book directed at children, for children. The book has been written and illustrated by DR.Dragan Antolos, an experienced dentist with a special interest in thumb sucking habits in children. The book and chart are a non-invasive and effective strategy for stopping thumb sucking, and have received positive support from psychiatrists, speech pathologists and pedodontic societies. DR.Dragan Antolos,It is important to balance the psychological benefits of thumb sucking with the negative impact it has on developing, permanent teeth.The Little Bear who Sucked His Thumb is a book that the child will relate to the story and it will deliver a positive message without pressure. 21. iii. REMINDER THERAPY CHEMICAL THERAPY Recommends the use of hot flavoured,bitter and sour tasting or foul smelling preparations, placed on the thumb or fingers that are sucked. The chemical therapy uses Cayenne (red) pepper dissolved in a volatile liquid medium. Quinine and Asafoetida, castor oil which have bitter taste and an offensive odor respectively, also may be used. This should be done only when the patient has a positive attitude and wants treatment to break the habit.A commercially available product FEMITE (Denatonium benzoate) is also used for prevention of digit sucking. MECHANICAL THERAPY Mechanical restraints applied to the hand and digits like splints, adhesives tapes. Thumb guard is the most effective extra oral appliance for control of the habit. 22. a. THERMOPLASTIC THUMB POST was devised by Allen in 1991 where a thermoplastic material was placed on the offending digit. A total of 6 weeks of treatment time was required for elimination of habit. b. ACE BANDAGE APPROACH: other approach include the use of ace bandage which is an at home program to assist children with nocturnal digit sucking habits. The program involves nightly use of an elastic bandage wrapped across the elbow. Pressure exerted by the bandage removes the digit from the mouth as the child tires and fall asleep. c. NORTAN AND GELLIN(1968)- proposed a 3 alarm system often effective in children between 3-7 years Offending digit is taped and when the child feels the tape in te mouth it serves as the first alarm. Bandage tied on the elbow of the arm with the offending digit, a safety pin is placed lengthwise. When the child flexes the elbow, the closed pin mildly jabs indicating a second alarm

23. Bandage tightens if the child persists serving as a third alarm d. USE OF LONG SLEEVE NIGHTGOWN-This is useful in children who sincerely want to discontinue the habit and only perform during their sleep. The arms of their night suit are lengthened so that they cannot reach their thumb during night. e. THUMB-HOME CONCEPT-This is the most recent concept. In this method a small bag is tied around the wrist of the child during sleep. It is explained to the child that just as the child sleeps in his home, the thumb also sleeps in its house. Thus the child is restrained from thumb sucking during night.

24. f. USE OF HAND PUPPETS-Currently the use of hand puppets is gaining popularity. These help in eliminating thumb sucking. g. MY SPECIAL SHIRT-This helps in minimizing the damage of the finger sucking by providing a number of tools to address the habit in a phased manner.

25. iv. APPLIANCE THERAPY Various orthodontic appliances are employed to attenuate and eventually break the habit. Removable appliances used may be palatal crib, rakes, palatal arch, lingual spurs, and Hawleys retainer with and without spurs. Fixed appliances such as upper lingual tongue screens appear to be more effective in breaking these habits. Removable or fixed palatal crib-It breaks the suction force of the digit on the anterior segment, reminds the patient of his habit and makes the habit a non-pleasurable one. Oral Screen-Oral screen is a functional appliance introduced by Newell in 1912.It produces its effects by redirecting the pressure of the muscular and soft tissue curtain of the cheeks and lips. It prevents the from placing the thumb or finger into the oral cavity during sleeping hours.

26. Hay Rakes-Mack (1951) advocated the use of dental appliance in children over 3 1/2 years of age who persistent thumb suckers. The device was called hay rake as it was designed with a series of fence like lines that prevented sucking. Blue Grass applianceDeveloped by Bruce S Haskell (1991).It is a fixed appliance using a Teflon roller, together with positive reinforcement. Used to manage thumb sucking habit in children between 7 and 13 years of age. The patient believes that he has acquired a new toy to play with. Instructions are given to them to roller instead of sucking the digit. Quad helix-The quad helix is fixed appliance used to expand the constricted maxillary arch. The helixes of the appliance serve to remind the child not to place the finger in the mouth.

27. Modified Blue Grass appliance-This is a modification of the original appliance with the difference being that this has two rollers of different colors and material instead of one. If the patient tries to suck on his thumb the suction will not be created and his thumb will slip from the rollers thus breaking the act. GRABER explained the working of these appliances

 Render finger habit meaningless by breaking suction Prevents finger pressure from displacing maxillary central incisors thus avoids/labially from creating worse a malocclusion. Forces the tongue backwards changing its postural rest position, thus exerting more lateral pressures 28. HABIT BREAKING APPLIANCE DESIGN FOR HABIT CORRECTION 29. REFERENCES TEXT BOOK OF PEDODONYICS-SHOBHA TANDON TEXT BOOK OF PEDIATRIC DENTISTRY-NIKHIL MARWA TEXT BOOK OF PEDIATRIC DENTISTRY- S G DAMLE PRINCIPLES AND PRACTICE OF PEDODONTICS-AARTHI RAO PEDIATRIC DENTISTRY(INFANCY THROUGH ADOLESCENCE)-JIMMY PINKHAM;HENRY FIELDS HANDBOOK OF PEDIATRIC DENTISTRY-AGNUS C CAMERON DENTISTRY FOR CHILD AND ADOLESCENTDEAN,McDONALD,AVERY CLINICAL PEDODONTICS-SIDNEY B. FINN GOOGLE SEARCH ENGINE During the 1950s, parents could get a series of sharp prongs known as "hay-rakes" cemented to a child's teeth to discourage sucking. The longer and harder a child sucks his thumb the more harm is done to the teeth and jaws. Regular, strong thumb sucking makes front teeth move and can even reshape the jaw bone. Upper front teeth flare out and tip upward while lower front teeth move back and inward. But, how can something as small as a child's thumb or finger actually move bone? Childrens jaws are rich in blood supply and fairly low in mineral content like calcium. This makes jaws of children under age eight especially soft and flexible. As a result, prolonged thumb or finger sucking easily deforms the bone around the upper and lower front teeth. The deformity produces a hole or gap when teeth are brought together, known as an open bite. If a child stops thumb sucking before loss of baby front teeth and arrival of adult front teeth, most or all of the damage may disappear. However, if the habit persists, there may be lasting damage. Flared upper teeth, delayed arrival of front teeth, and open bites are all common problems. This can result in chewing difficulties, speech abnormalities, and an unattractive smile.

The American Dental Association recommends: Praise children for not sucking, instead of scolding them when they do. If a child is sucking its thumb when feeling insecure or needing comfort, focus instead on correcting the cause of the anxiety and provide comfort to your child. If a child is sucking on its thumb because of boredom, try getting the child's attention with a fun activity. Involve older children in the selection of a means to cease thumb sucking. The pediatric dentist can offer encouragement to a child and explain what could happen to its teeth if it does not stop sucking. Only if these tips are ineffective, remind the child of its habit by bandaging the thumb or putting a sock/glove on the hand at night.

Clinical studies have shown that appliances such as TGuards can be 90% effective in breaking the thumb or finger sucking habit. Rather than use bitterants or piquants, which are not endorsed by the ADA due to their causing of discomfort or pain, TGuards break the habit simply by removing the suction responsible for generating the feelings of comfort and nurture.

How Can I Help My Child Quit Thumb-Sucking? Should you need to help your child end his habit, follow these guidelines: 1. Always be supportive and positive. Instead of punishing your child for thumb-sucking, give praise when he doesn't suck. 2. Put a band-aid on his thumb or a sock over his hand at night. Let him know that this is not a punishment, just a way to help him remember to avoid sucking. 3. Start a progress chart and let him put a sticker up every day that he doesn't suck his thumb. If he makes it through a week without sucking, he gets to choose a prize (trip to the zoo, new set of blocks, etc.) When he has filled up a whole month reward him with something great (a ball glove or new video game); by then the habit should be over. Making your child an active participant in his treatment will increase his willingness to break the habit. 4. If you notice your child sucking when he's anxious, work on alleviating his anxiety rather than focusing on the thumb-sucking. 5. Take note of the times your child tends to suck (long car rides, while watching movies) and create diversions during these occasions. 6. Explain clearly what might happen to his teeth if he keeps sucking his thumb.