Concerning Behaviors: Thumb-sucking, "Picking," and Tantrums

What is it?

This Aftercare Instruction covers three topics that might seem to have little to do with each other: thumb-sucking, "picking" at skin or nose, and tantrums. These three topics actually do have several important things in common:

• They are all normal behaviors at certain times in a child’s development.
• They are all related to the growing child’s need to calm him or herself through physical activity.
• They can all be signs of deeper problems if they go on for too long.

A number of other habits, such as grinding the teeth, nail biting, and pacifier use are behaviors that share these common features as well.

As babies grow up into toddlers, they have to struggle between their urge towards independence ("me do") and their need for safety and security. The more successful a toddler is at gaining some independence, the more safety and security s/he must give up. This is a normal struggle for toddlers (and it happens again in the teenage years), but it does cause some internal tension. To deal with that tension, toddlers often turn to familiar behaviors that they are comfortable with, or they burn off some energy in a flash of emotion. Thumb-sucking can remind a toddler of when s/he felt snug and safe nursing in a parent’s arms. Tantrums are often a way of releasing some frustration and pushing away fear. "Picking" behaviors are often somewhere in the middle – they are signs of a child feeling some stress but not yet at the point of blowing up in a tantrum.

All of these are, as we said, normal behaviors at various times in a young child’s life. They almost always get better as the child gets older and more in control of the things that cause stress. They tend to get worse during "structured" times of the day, like nap-time and meal-time, which makes sense if you think about these as times when the child may feel less in control. They also tend to get worse when children are over-tired or in a bad mood for some reason; this also makes sense – none of us are at our best to deal with stress under those conditions.

Parents often have two main concerns with all of these behaviors. The first is usually a worry that the child will do him or herself harm by continuing to do the behavior. The second is a sense of embarrassment or annoyance that the child is "acting like a baby" or "acting immature." The truth is that all three behaviors can actually cause physical or emotional harm if they go on for too long or too intensely (we’ll touch on each of these in the specific sections below). But it is also true that such damage takes years to occur, and that most children don’t have any long-term effects at all. That means that in general, it’s best to play down these and similar behaviors for a long time after they first appear.

Here are some general tips for dealing with all of these habits – we’ll cover each one specifically below.

• Children have usually grown out of these habits by the age of four years. None of them are likely to do any harm before that time anyway. This means that patience is your best tool for dealing with them.
• Because these habits are indicators of the child’s need to deal with some emotional tension, please try to identify what might be causing an immediate episode. If you can help the child feel better with words of encouragement, you will be much more likely to succeed that if you add to the stress with your own.
• It’s best to focus as little attention as possible on these behaviors – the more attention they get the more likely they are to persist.
• Although it might be tempting when you are frustrated, it isn’t helpful to use words or actions that would embarrass or humiliate your child. Remember, these behaviors are signs that the child is struggling with growing up and being in control. If s/he is made to feel even worse, the problem will get even worse.

Here are some specifics about each behavior:

The real concern about thumb-sucking is that if it goes on for more than four years, it can actually cause changes in the child’s teeth and face bones. These changes are usually quite small, but they may interfere with normal chewing and speech later on. Thumb-sucking can also cause increased swallowing of lead and other toxins if these are in the immediate environment. But again, these risks are quite low in children who are thumb-suckers only for a few years. Most doctors recommend that the first thing to do about thumb-sucking is nothing. That is, just watch the child, try not to make a big deal of it, and give it time. As your child gets older, if the habit persists, you can try to distract your child to get him or her to pay attention to something else. Here is where your understanding of how s/he is feeling can be very helpful to both of you. It’s best not to try to get your child to stop sucking his or her thumb during a time when s/he may be feeling less in control, or tired, or frustrated. During those times, you can try to understand that the child is sucking his or her thumb for comfort and to stay in control – almost like an adult who learns to "count to ten" before reacting. Try to focus your efforts on times when the child seems happy and engaged in fun activities. Those are the times when thumb-sucking is truly just a habit, and your child will be much more likely to agree with you that s/he doesn’t need to do it.

Once your child is old enough (around 3 years), you can choose a time when both of you are feeling happy and not stressed to have a conversation about thumb sucking. Many parents are successful when they talk with their pre-school child about this. Children at this age are very anxious to please their parents, and also to show that they are growing up. If you use positive, encouraging language ("You are so good – I know you can stop sucking your thumb; think how proud you and I will both be when you stop"), you are likely to succeed.

If your child sucks his or her thumb to get to sleep, it can help to recognize that this is an important self-comforting behavior. Bed-time is not the time to get into a battle over thumb sucking, but after your child has fallen asleep, you can try to gently remove his or her thumb from the mouth. If s/he struggles or awakens, drop the issue immediately, but very often this is one good way to help a child get used to feeling safe and secure without the thumb.

Doctors and dentists have different opinions about using pacifiers. Pacifiers do cause some of the same bone and tooth changes as thumb-sucking, but usually to a smaller degree. Many experts also feel that children are more likely to discard the pacifier on their own between 2 and 4 years of age than they are to stop sucking their thumbs.

Some things that (don’t work or can cause harm if they do work) are:

• Angry or demeaning language
• Punishment, either verbal or physical

For children who do persist in thumb-sucking beyond the age of four, please work closely with both your doctor and your dentist. In extreme cases a dentist can put in an oral device that keeps the child from sucking the thumb, but this is rarely needed.

All children pick their noses. It’s an annoying and unattractive behavior to most people, and as children get older they typically learn to do it less (or at least less obviously). Younger children pick their noses just because they feel something there, and want to get rid of it. They often scratch or pick at their skin, nails, or scalps for the same reasons. These activities usually go away as children get older and learn that adults don’t like to see them do it. If they persist, these habits can be signs of a child who has a lot of stress and perhaps does not feel safe or comfortable talking about it or showing it in a more appropriate way. Just as with thumb sucking, there are some general do’s and don’ts about dealing with picking behaviors:

DO:

DON'T:

Ignore the behavior in children under 2 years old – they are just doing what comes naturally Talk to your pre-school age child about it when you are both in good moods Use encouraging and positive statements Remember that your child will do the behavior more when stressed See if you can reduce the stress level and distract your child with positive activities Encourage your child to express anger or frustration with words

Make a big deal of it if you can help it Punish or humiliate your child about the behavior React to it at a time when either you or your child is under stress Punish or discourage your child for expressing anger, fear, or frustration in words

All children have tantrums. They are a normal response to anger and frustration in children between 1 and 4 years of age. They are most likely to happen when the toddler or child’s need to be in control of a situation runs into an adult’s need to maintain control or safety. Active, energetic children who are determined to succeed are most likely to have tantrums. Even more than with thumb-sucking and picking behaviors, general parenting practices have a big influence on how often a child has tantrums and how soon s/he outgrows them. Here are some things that can make your child more likely to have tantrums:

• Being inconsistent (changing the rules or consequences)
• Having unreasonable expectations for your child’s age (sets him or her up to fail)
• Excessive strictness (this doesn’t give your child enough control)
• Over-protectiveness (also doesn’t give enough control)
• Over-indulgence (gives too much control)

Some things about the situation can also make a tantrum more likely, like boredom, being tired or hungry, or coming down with an illness.

Tantrums have certain phases, and your reaction to the tantrum will be different during each phase:

PHASE	DO:	DON’T:
"Build up" – in this phase the child has growing frustration and stress as s/he finds that s/he can’t get something s/he wants, or can’t maintain strong control over a situation. During this phase the child may fuss, whine, fidget, or give other signs of stress	Remember that your child is telling you s/he is frustrated and losing control Keep your own temper Be reasonable – invite your child to express his or her frustrations Be consistent – stick to your rules and limits Distract your child – offer alternatives that give control	Lose your temper Keep changing your limits to avoid a tantrum Give in or indulge your child just to quiet him or her down Threaten or humiliate your child
Anger – This is the "explosion." Once the child reaches the anger stage, the tantrum is inevitable. This is also the stage in which the energy of frustration gets released.	Ignore the outburst Quietly check to make sure the child is safe Stay nearby but not right "in your child’s face"	Try to reason or negotiate during this phase Lose your own temper Apply any form of punishment during this phase
Distress – this is the winding down phase, and is when the child often can tell you what was really wrong. This is the time when the healthy emotions may come to the surface.	Offer comfort, hugs, and expressions of love Encourage and support your child’s efforts to succeed Remind your child (gently) of your rules and limits Carry out any appropriate consequences that you warned the child about before the tantrum Help your child learn to express negative feelings now and in the future	Physically punish or humiliate your child Threaten your child with unrealistic or unfair punishments Apologize to your child for sticking to your own rules and limits Give in or coddle your child because you feel badly for him or her
"Build up" – in this phase the child has growing frustration and stress as s/he finds that s/he can’t get something s/he wants, or can’t maintain strong control over a situation. During this phase the child may fuss, whine, fidget, or give other signs of stress	Remember that your child is telling you s/he is frustrated and losing control Keep your own temper Be reasonable – invite your child to express his or her frustrations Be consistent – stick to your rules and limits Distract your child – offer alternatives that give control	Lose your temper Keep changing your limits to avoid a tantrum Give in or indulge your child just to quiet him or her down Threaten or humiliate your child
Anger – This is the "explosion." Once the child reaches the anger stage, the tantrum is inevitable. This is also the stage in which the energy of frustration gets released.	Ignore the outburst Quietly check to make sure the child is safe Stay nearby but not right "in your child’s face"	Try to reason or negotiate during this phase Lose your own temper Apply any form of punishment during this phase
Distress – this is the winding down phase, and is when the child often can tell you what was really wrong. This is the time when the healthy emotions may come to the surface.	Offer comfort, hugs, and expressions of love Encourage and support your child’s efforts to succeed Remind your child (gently) of your rules and limits Carry out any appropriate consequences that you warned the child about before the tantrum Help your child learn to express negative feelings now and in the future	Physically punish or humiliate your child Threaten your child with unrealistic or unfair punishments Apologize to your child for sticking to your own rules and limits Give in or coddle your child because you feel badly for him or her

None of these behaviors are dangerous, and all of them are appropriate at some time in your child’s life. If any of them persist much beyond the age of about 4 years, or if they begin to show signs of causing physical or emotional harm to your child, please schedule an appointment with your doctor to talk about it.

Please remember that any of these behaviors can be signs of increased stress or anxiety in your child’s life. If any of these behaviors comes back after your child seemed to outgrow them, they could be warnings of a more significant problem. A child who begins to pick his or her skin to the point of bleeding or infection, or a child who suddenly starts having violent tantrums may be experiencing frightening feelings. Please remember to encourage your child to speak frankly and openly to you about these things. If you become concerned that your child is being threatened in any way by another person, please get yourself and your child to a safe place, and then call someone you trust for help, or go to a hospital emergency room.

Some specific syndromes or forms of developmental delay can cause some of these behaviors. Excessive skin picking in a child who is obese can be a sign of a condition called "Prader-Willi Syndrome." Children with a very rare genetic disorder called "Lesch-Nyhan Disease" may also have extremely damaging picking or chewing behaviors. Some children who have disturbances in the way their bodies manage certain chemicals can pick or bite at their skin and cause serious damage. Self-mutilating behavior such as picking, or skin cutting in older children, can also be signs of obsessive-compulsive disorders, depression, or other forms of mental illness.

Caring for children with any of these concerning habits can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.