In Margaret Mitchell's classic novel, Gone with the Wind, the rapscallion Rhett Butler becomes a (somewhat) domesticated daddy as he tries to deal with his daughter's thumbsucking habit. When one of the matriarchs of post-Civil War Atlanta recommends that he put bitter quinine on Bonnie Blue Butler's thumb, he eagerly adopts this idea (and artfully elevates his daughter's position in society).

While thumbsucking may or may not have an effect on your children's social future, it does have a signficant impact on their dental and emotional future. Using quinine or another bad-tasting substance is just one of many remedies that have been suggested over the years to cure this habit.

A common habit (with potential problems)

Thumbsucking is normal; for example, within 2 hours of being born, 90 percent of infants may suck their thumb, fingers, or hand. Also, it has been estimated that anywhere between 50 and 87 percent of children suck their thumbs. Thumbs, fingers, and pacifiers provide babies with a sense of security, a tool to learn about their surroundings, and a soothing way to fall asleep.

Sometime between the ages of 2 and 4, toddlers usually stop thumbsucking on their own. But if children don't stop by the time they are 5 years old, several problems may develop, including:

• Misalignment and crowding of their teeth and bite
• Development of narrowed jaws
• Changes in the roof of the mouth
• Nose tipping up instead of growing downward normally
• Sores, calluses, and infections on thumbs or fingers
• Tongue thrust disorder or other difficulties with swallowing
• Speech problems, such as lisping

Also, if their thumbs, fingers, or pacifiers are not clean, children run the risk of transferring dirt, viruses, or bacteria into their mouths.

According to the U.S. Centers for Disease Control (CDC), about 10 percent of American children between the ages of 6 and 11 still suck their thumb. In this age bracket, girls are more likely to suck their thumbs than boys. The CDC also reported that more African-American children (66 percent) suck their thumbs than white children (54 percent).

By the time children are 8 to 12 years old, the physical damage from continued thumbsucking may need to be corrected with braces or other orthodontic treatment. Children's self-image and self-esteem also may be damaged, especially if they are teased about their thumbsucking habit.

A curable habit (with patience)

As part of your children's regular dental checkup, we will examine the shape of their mouth and alignment of their teeth. It's important that children stop thumbsucking, so their permanent teeth can come in straight and their mouth can develop normally.

Here are some suggestions to help children break their thumbsucking (or finger- or pacifier-sucking) habit. Remember, changing a habit takes time, so be patient and positive.

• Feeling secure: Notice what is happening when children suck their thumbs. Is something making them feel anxious, scared, or uncomfortable? Make changes as needed so that they feel more secure.
• Giving reinforcement: Give positive responses to positive behavior. For example, don't yell at them, "I told you not to suck your thumb in the car any more!" Instead, say something like, "I am so proud of you for not sucking your thumb while we drove to school!"
• Earning rewards: Create a chart with times or situations (bedtime, watching TV, etc.) that they typically suck their thumbs. Every time that they avoid thumbsucking, give them a sticker. After an agreed-upon period of successful behavior, allow them to turn in the stickers for an additional reward; for example, a small item that they collect.
• Smiling and talking: Explain in simple terms how thumbsucking can affect their teeth and mouth. Use a mirror to show that thumbsucking hides their beautiful smile. Engage them in conversations, so they will be talking rather than thumbsucking.
• Keeping busy: Keep their hands busy with games, sports, puzzles, crayons, etc. Designate a specific item, such as "squishy ball," to be used as a substitute when they crave sucking their thumb.
• Trying safe deterrents: Put a bandage on their thumb, or give them a clean sock or puppet to put on their hand at night. Also, consult with us about other deterrents, such as medications or mouth appliances.

Depending on your children's age, they also may come up with great ideas on how to stop their thumbsucking. When children participate in the planning, they may be more likely to follow through with the results!