I Am Not Sure I Would Have Believed It!

Thumb sucking is a topic that no one expects to discuss in terms of wound care, but much to our surprise, we had a patient referred to our wound center recently for treatment of a problem related to thumb sucking. As all know, thumb sucking is common in many children; there are even x-rays of babies in utero sucking their thumbs. Usually, children outgrow the habit by age 2 to 4 years. It is rare that problems are encountered as a result of thumb sucking, but if prolonged, the habit can result in the development of malocclusion of teeth, specifically an anterior open bite; abnormal development of the mandible and maxilla; soft palate abnormalities; blisters, calluses, or ulcers on the thumb or fingers; infections of the involved digits; and/or nail deformities.¹

Occasionally, injuries to the fingers occur because of trying to stop children from sucking their thumbs or fingers. Apparently, some parents will wrap their child’s thumb with bandages to discourage the activity. Surprisingly, there are numerous reports in the literature of “autoamputation” of a digit as a result of an elastic bandage being applied too tightly on the digit, with some of these cases occurring in an attempt to stop thumb sucking.^2,3   

Our case is a bit different. A 19-month-old child was referred to us because of an open wound on the right thumb. Approximately 4 weeks prior to being referred, the parents noted that the tip of the child’s right thumb was turning black. The child had sucked her thumb since birth, and the parents noted that she seemed to chew on the thumb when she sucked it. She continued this action once her front teeth developed. The parents did not notice any bleeding from the thumb. The pediatrician noted the wound on the thumb and referred the child to the children’s hospital, where the diagnosis was that the distal thumb was necrotic. The distal thumb was debrided, and the child was sent to the wound center for treatment of the open wound.

On examination, the wound of the thumb is healing well. It appears that the entire distal phalanx has been removed. There is no infection or exposed bone. Treatment was begun, and complete healing is expected.

This case is unusual in that the child apparently amputated her own thumb by combining thumb sucking with chewing. Over time, the child seemingly chewed through the tissue, which damaged the blood supply to the distal thumb and resulted in necrosis of the tissue that required partial amputation. This is a potential complication of thumb sucking that should be considered. As a child develops teeth, close observation should be done to be sure there is no chewing and damaging of the tissue.

When I was a child, I can remember my father telling me not to suck my thumb because it might fall off. I really didn’t believe that was possible, but then again, I would not have believed a child could suck their thumb and chew it off!

Terry Treadwell, MD, FACS

Editor-in-Chief, Wounds

woundseditor@hmpglobal.com