Thumb sucking
This is an innocent habit, not a sign of emotional insecurity. It gives pleasure to one-third of young children; the other two-thirds never suck their thumbs. The average age that children stop is three and a half years, though many continue until they're five and two per cent are still sucking at thirteen years.
The main reason that parents discourage thumb sucking is the criticism they get from passers by and well-meaning relatives: 'That child has an emotional problem. He's behaving like a baby.' Dentists become worried once the second teeth are about to appear, because heavy sucking increases the risk of protruding front teeth, which may need wiring and realign. Bank managers are not unhappy with thumb sucking and are quick to provide a large loan to fund the wires.
At school age most thumb sucking is in times of boredom, tiredness and especially when settling to sleep. A little gentle comfort is never a problem, but hours of heavy tooth bending could prove expensive. . The old-fashioned psychoanalysts had no interest in tooth alignment. To them this was frill of the sexual symbolism of large upstanding lighthouses, trains and tunnels. Treatments used to involve elbow splints, sleeping in gloves and covering thumbs in foul-tasting paint. Nowadays there is no such interpretation: we just let the child know we worry what other people think and we explain the risks of sticking-out teeth.
It's okay to allow gentle sucking while settling to sleep, but on other occasions distract or give a low-key reminder. Never nag or become too heavy as this causes stress, which increases sucking and then drives it underground. When in doubt, talk to your dentist. They will advise and tell you if damage is occurring.
Tics and twitches
A tic is caused by an involuntary twitch of a small muscle. Usually this involves the head and neck, the most common being a blink or twitch of the eyelid. Tics may show as movement of the lip, nose, neck or shoulder or a clearing of the throat.
When a child twitches they have no direct control of this movement. Stress makes things worse, while the tic totally disappears in sleep. Tics can be there most of the time, but they are usually intermittent .They tend to wax and wane and many, if not most, resolve spontaneously. The peak starting age is around seven years, but tics can appear at any time from four years to twelve years.
Tics cause frustration to parents and teachers, but are usually of less concern to the child. By themselves they are benign, though they are often not alone, being associated with ADHD difficulties with learning and behavior. In this combination it is ADHD that causes most of the problem and is the main priority for treatment.
The best management is to remain calm and make a minimum of fuss. Give gentle reminders but don't over-focus, as this makes things worse. Counseling to reduce tension, relaxation and reward techniques are sometimes recommended, but the results are fairly unimpressive. Very occasionally we treat children with tic-reducing medication but this is only in extreme cases. A severe case may be termed Tourette syndrome, which involves major movements of the neck and shoulder and noises in the throat.
