Thumb sucking and Nail Biting

by NM
(Mumbai, India)

Dear Doctor, My 8 years old son still sucks his thumb and has the habit of biting his nails. Whenever he is free his thumb goes into his mouth or he is biting nails.

He is performing very well in school. The feedback from school teachers is all positive. He is a very active child.

Wondering what the reason could be for nail biting and thumb sucking habits!
Could it be fear, lonliness or is it the manifestation of some sort of deficiency in his body-say, vitamins?
Please let me know your thoughts on this.
Regards. NM
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The Expert, Ren Chats, Answers -

Thumb Sucking

The inborn sucking reflex develops during the intrauterine life and facilitates breastfeeding during infancy. The reflex sucking disappears at about 4 months of age.


The action of rhythmic sucking has security and self-soothing effects. It is therefore, the dummy soothers are so popular during infancy.

However, unlike sucking reflex, thumb sucking is not an inborn pattern of behaviour. Children use its calming effect to fight their frustration.

Consequently thumb sucking often continues through the childhood, with an incidence of about 25 % in under 2 years and 15% under 5 years.

Thumb sucking is a socially accepted behaviour among infants and toddlers. The professionals discourage parents to prevent thumb sucking in children up to 3 years of age.

By the age of 5 years, most children are able to overcome their desire to suck their thumb in face of the on coming social, behavioural and developmental demands. Older children, who continue to suck their thumb, do it just as a habit.

How can I help my child overcome this habit disorder?-

1.
Pretend to ignore the action.

2. Educate
the child on the ill effects of thumb sucking like –

Fingers carry germs.

While sucking, person breaths through mouth which aggravates the chances of repeated sore throats during early childhood.

Prone to peer group teasing.

Not an accepted norm of society for the age.

Muscular and/or temporo-mandibular (jaw) joint pain.

Inflammation at the angles of the mouth is often mistaken for vitamin B deficiency, but is not.

Development of chronic paronychia (infection of the nail folds).

Spoils the looks due to teeth and jaw changes.

3. Look out for precipitating factor
and try to resolve it.

Boredom/loneliness –
Often in the evenings, when parents come home but are busy with household curriculum. The child is left alone with TV or studies and told not to disturb.

A child, who has waited almost all day long for parents’ company, finds himself alone.

Thumb sucking / nail biting then becomes his way to calm/sooth himself and meet the expected behavior.

Meal time –
Strict discipline at the table or disinterest in eating.

TV time –
TV programmes often make children anxious for many reason.
They develop their role models from there and set unreachable goals for themselves.

Homework studies time.

Bed time.

4. Behaviour therapy.


Help the child to relax. Take it easy policy should be adopted by the parents and the teachers in order to motivate children meet the set goals in an easy going manner.

Divert child’s attention towards something more interesting when you notice him sucking his thumb. This will help attain a state of increased calmness and reduce anxiety, stress or anger.

Praise the child when he does not suck his thumb.

Simple reinforcement with small gifts, like a star or his favourite sticker for each block of time that he does not indulge into thumb sucking.

Introduce self monitoring. That is let the child maintain the record of time blocks when he did not give in to his urge for thumb sucking. This acts as a gentle reminder and gives the child a feeling of achievement.

5. Noxious agents, like bitters, are rarely used.

Their stringent taste acts as a reminder and enforces self-regulation. It is an effective way to control impulsive thumb sucking, when used with a gentle gesture and not as a tool of punishment.

If you plan to introduce noxious agent, it should be done with full informed consent of the child. Child should not take it as a form of punishment, or else the purpose will be lost.


Negative practices like scolding, using harsh words, teasing and punishment are traumatizing to child’s self-esteem and may even perpetuate the habit in-stead of getting rid of it.

Points that warrant medical intervention.

Defective teeth alignment.


Flaring of front teeth of the upper jaw (maxillary incisors erupt between 7-8 years), an open bite and posterior cross bite may need dental intervention.

In the resistant cases.

With parental support, children usually overcome thumb sucking on their own. However, in small percentage of cases, it is retained well in to teen years.

Parents’ efforts fail in these cases. Most of the time, even in these resistant cases, the underlying cause is just continuation of the bad habit.

Nevertheless, in the resistant cases, medical consultation should be sought to rule out forms of impulse control disorders, psychological disturbances and stereotypic movement disorder.

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Nail Biting (Onychophagia)

Nail biting is a bad habit, which is notoriously difficult to break. It is a widespread problem of the growing years.

The incidence among tweens (usually between 8-12 years of age) is noted to be as high as 33%. Children often do not even notice when they are biting their nails. They just do it along with their routine day to day actions.

How is the habit of nail biting evolved?

Nail-biting is not always stress-induced, certainly not at the onset. At the onset, children take up nail biting just as a gesture that they have liked in someone else.

Most children bite their nails while watching television, reading, socializing, or even while talking. Later it develops into a habit and has no particular trigger attached to it.

Eventually, these children start biting their nails each time they face a stressful situations. Therefore, it is generally interpreted as a sign of nervousness and lack of confidence.

The habit acquired innocently during early childhood frequently tracks its way into teens. Teenagers, on their way to adulthood, travel through a tortuous emotional path. It is then, that nail biting habit develops in to a clinically recognised disorder, medically known as Onychophagia.

Nail biting is commonly seen in children of anxious personality.
Periods of physical inactivity, boredom, stress or even excitement arouses in them an uncontrollable urge of nail biting. They keep chewing the nails in spite of the injuries they sustain.


Consequently, these children usually have exceedingly short nails and torn nail fold cuticles.

This extreme form of nail biting is the outward manifestation of anxiety in children. It is also considered a form of motor discharge of inner tension and it is classified as an impulse control disorder.

Presence of bitten short nails with torn nail folds should alert parents and teachers of the possibility of emotional imbalance in the child.
Early intervention will prevent the anxiety associated oncoming teenage depression. .


In recent years, the habit of nail biting is so commonly seen, that it is thought provoking –
Is our society laying unrealistic demands on children?
Are children being exposed to information overload too early in life?
Is it due to over exposure to electromagnetic energy, generated by increasingly used electronic gadgets in modern communication and entertainment system? – even toys are electronic!

Possible causes of anxiety in children –

1. The social situation –


a. Competitive school curriculum.

b. Effort to meet high expectations of the parents and society.

c. Achievers – with high set goals for self.

d. Having problems at school.

e. Peer disputes.

2. Working parents
are often too busy in the evenings meeting the daily chores.
In this situation, it is best to involve children in the chores so that parents-child interaction continues and the children do not feel left out alone.

3. Depression and anxiety co-exist.
It manifests clinically usually during teenage when the stresses increase, and therefore, is commonly known as teenage depression.

To help children overcome nail biting habit disorder – follow the same guidelines as noted above under “Thumb Sucking”.

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