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ORIGINAL ARTICLE
Year : 2019  |  Volume : 37  |  Issue : 1  |  Page : 18-24
 

Knowledge and attitude of pediatricians toward digit sucking habit in children


1 Department of Pedodontics and Preventive Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
2 Department of Pedodontics and Preventive Dentistry, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India
3 Department of Pedodontics and Preventive Dentistry, Geetanjali Dental College and Research Institute, Udaipur, Rajasthan, India

Date of Web Publication25-Feb-2019

Correspondence Address:
Dr. Vinod Kumar
Department of Pedodontics, Navodaya Dental College and Hospital, Raichur - 584 103, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_136_18

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   Abstract 


Background: Finger sucking and prolonged dummy sucking are the most prevalent oral habits among infants, toddlers, and children. Pediatricians are more likely to see infants and children much earlier than dentists. Thus, it is essential for these specialists to be aware of the harmful nature of digit sucking habit and its associated complications. Aims and Objectives: The present study was designed to evaluate the knowledge and attitude among pediatricians about digit sucking habit in children. Methodology: The survey was carried out using a self-administered questionnaire which was delivered to the study subjects by hand or by mail. The returned questionnaires from the pediatricians were statistically analyzed using descriptive statistics (percentage). Results: This study showed that many respondents were unaware that oral habits could be responsible for malocclusion. A high percentage of respondents preferred not to examine oral features in digit sucking child. Among the etiological factor that may contribute to digit sucking habit in a child, most of the respondents expressed that habitual, psychological and inadequate parental care are possible causes. Most of the participants answered that parental and child counseling is essential to stop the habit. Most of the respondents did not refer the digit sucking child to the dentist for the better management of associated malocclusion. Conclusion: Knowledge and attitude among pediatricians about digit sucking habit in children were found to be unsatisfactory. Continuing dental education programs and symposiums can be conducted for pediatricians to enhance their knowledge about pernicious oral habits.


Keywords: Attitude, digit sucking, knowledge, oral habits


How to cite this article:
Kumar V, Shivanna V, Kopuri RC. Knowledge and attitude of pediatricians toward digit sucking habit in children. J Indian Soc Pedod Prev Dent 2019;37:18-24

How to cite this URL:
Kumar V, Shivanna V, Kopuri RC. Knowledge and attitude of pediatricians toward digit sucking habit in children. J Indian Soc Pedod Prev Dent [serial online] 2019 [cited 2019 Sep 21];37:18-24. Available from: http://www.jisppd.com/text.asp?2019/37/1/18/252847





   Introduction Top


Some oral habits are part of the behavior of small children; however, they may become harmful or damaging when occurring in an extensive or inappropriate way.[1]

“Habit” is a practice acquired by the frequent repetition of the same act, which occurs consciously at first, then unconsciously. Nasal breathing, chewing and swallowing are considered physiological and functional habits. However, digital sucking, pacifier sucking and mouth breathing, among others, are considered nonphysiological, therefore, deleterious or parafunctional habits.[2] Pacifier sucking, followed by finger sucking are the most common harmful habits in childhood, mainly from 0 to 3 years.[3]

Finger sucking and prolonged dummy sucking are the most common oral habits among toddlers. Digit sucking in literature is considered as a component of rooting reflex which for some children can be observed in utero while for others it can start spontaneously during 1st month after birth. Thumb sucking is not just a simple habit but may be it should be considered as an activity that serves as adaptive function for infants and toddlers by providing stimulation or self-soothing.[4] Furthermore, it seems to be closely related to the child's psycho-emotional maturity. That's why digit sucking habit is more prevalent and considered as normal phenomenon in the first 2 years with a reported prevalence of 20%–30%.[5],[6] Afterward, the majority of young children spontaneously discontinue the habit by the age of 4 years when a more developmentally sophisticated repertoire of self-management skills develops.[4] From the age of 4 years possibly until 7 years of age, finger sucking has been reported to remain at a fairly constant level with the reported prevalence between 5% and 17% in different populations.[7]

All members of the health profession have the potential to promote oral health by supporting accurate oral health-care messages, showing dental health-related behaviors, encouraging regular dental visits, and participating in oral health promoting activities within their scope of duties.

Improving the oral health of children prevents complications of dental diseases. Hence, it becomes necessary for pediatricians to be aware of pernicious oral habits so as to detect and guide the children visiting their clinics/hospitals.

Pediatricians and other medical professionals are more likely to see infants and children much earlier than dentists. Thus, it is essential for these specialists to be aware of the harmful nature of digit sucking habit and its associated complications. Hence, the present study was designed to evaluate the knowledge and attitudes among pediatricians and to educate them about digit sucking habit.


   Methodology Top


This is a cross-sectional study carried out in India. A study-specific questionnaire was prepared to assess the knowledge and attitude of pediatricians about digit sucking habit in children. The validity of the questionnaire was assessed, by asking 20 pediatricians to indicate their level of agreement to the question statements using a five-point rating scale (extremely appropriate, appropriate, no idea, inappropriate, and extremely inappropriate). Some of the test questions were modified as a result of item analysis to improve the clarity of the questions, and later discussion was done with each subject to validate the items of the questionnaire, and the necessary changes were made to validate the questionnaire. Overall validity of the questionnaire was 81%, and the validity of each question was 77%–90%, which was acceptable for the study.[8] The reliability of the questionnaire was determined using the Cronbach's alpha, and the replies given by 20 pediatricians to the same questionnaire within a 15-day interval was analyzed. Cronbach's coefficient for the reliability of the questionnaire was 0.83, which was acceptable for the study.[9]

The questionnaire included knowledge of habit, methods adopted by pediatricians to prevent, etiology of habit, and their willingness to refer the affected children to dentists. The anonymity of the study subjects was maintained by not collecting their personal information. Before the commencement of the study, the information about the pediatrician's place of working in the teaching hospitals and private hospitals (or clinics) of India were collected from the website by browsing through the college and hospital websites. The specific pretested questionnaire which was prepared was physically distributed to the pediatricians who are available in our Residing city and pediatricians who are away from our residing city were sent the questionnaire through post to their working place address or E-mailed to their personal E-mail address. The questionnaire directly handed to the pediatricians at their working place was either collected on the same day or the next day. After collecting the questionnaire, each individual was briefed about the important aspects of oral habits, and its adverse effects on dentition and a relevant handout were given to each. Moreover, if the questionnaire was posted to their working place, then the return postcover with postage stamp was placed inside the envelope to send back us after filling the questionnaires. The envelope which was posted to the pediatricians had two pages. Page 1 contained informed consent and objective of the study and page 2 contained questionnaires. When the pediatrician returns the filled questionnaire, as a mark of appreciation for participating in the study the acknowledgment letter and with a note on oral habits and its adverse effects on dentition was again posted to their working place. The completely filled questionnaires were taken for statistical analysis. Half-filled questionnaire and incomplete filled questionnaires were discarded. Statistical analysis was done using descriptive statistics (percentage) with the help of statistical package for social sciences and Microsoft Excel Software (2007).


   Results Top


The age and gender of study participants are presented in [Table 1]. The age of all study participants ranged from 30 to 70 years.
Table 1: Distribution of study participants

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We had sent questionnaires to 400 pediatricians among them 302 pediatricians returned the questionnaires with full answers to all questions. The response rate was 75.5% [Table 1].

Response to knowledge questions

Fifty-six percent of the respondents were aware of oral habits while 44% did not know about oral habits. 49% of study subjects knew about thumb sucking habit, 45% respondents replied “No” and 6% of the study subjects said they do not know about the digit sucking habit.

Among the participants, who knew about digit sucking habit, 55% were aware of its adverse effects on dentition, and 45% were unaware of its adverse effects.

Among the respondents who knew about adverse effects of digit sucking habit; 25% indicated unsightly appearance, 5% said mal-positioning of teeth, 14% subjects pointed psychological effect, and 11% of respondents expressed all of the above.

On asking the respondents about the etiology of thumb sucking habit 22% said psychological, 13% indicated inadequate parental care, 32% revealed habitual, and 34% respondents were unaware about its etiology.

About the methods adopted by respondents for treating thumb sucking habit; 15% mentioned do not know, 10% said bandage application, 9% specified bitter substance application on thumb, 8% opted for counseling the child, 7% pointed out counseling the parent, and 4% expressed referring to the dentist.

About 11% of respondents felt digit sucking habit is acceptable below 3 years, 14% expressed below 4 years, 14% said below 5 years, 15% indicated below 6 years, 14% opted it is not acceptable at any age, and 33% were unaware about at what age its acceptable.

About 24% of participants said digit sucking habit if not stopped early it leads to deep-rooted habit and difficult to stop the habit, 27% said “No,” and 49% were unaware.

Twenty-one percent of respondents said digit sucking habit should be stopped at 3 years, 19% said at 4 years, 18% said at 5 years, 19% said at 6 years, 12% said at 7 years, and 11% said at any age.

Majority (75%) of study participants did not know that sudden stoppage of digit sucking habit leads to tongue thrusting habit whereas 12% said “yes” and remaining 13% said it will not lead to tongue thrusting habit.

Twenty-two percent of respondents admitted that prolonged digit sucking habit leads to mal-positioning of teeth, while 24% participants replied “No” and majority of respondents (55%) were unaware that if digit sucking habit is prolonged it leads to malposition of teeth. Among the participants who knew about prolonged digit sucking habit leading to mal-positioning of teeth; 15% said it can happen below 3 years, 20% said at 4 years, 17% said at 5 years, 17% said at 6 years, 15% said at 7 years, and 15% said at any age [Table 2].
Table 2: Knowledge questions (n=302)

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Response to attitude questions

Twenty-four percent of respondents preferred that digit sucking child should be referred to the dentist for better management of the habit and associated malocclusion, 33% indicated No, remaining 43% said do not know.

Fourteen percent of pediatricians preferred to examine oral structures in a digit sucking child, remaining large percentage of respondents (86%) indicated “No”, 14% of study subjects expressed that oral examination should be done in a digit sucking child, 26% said “No” and majority (60%) of respondents indicated do not know, 41% of respondents noticed thumb sucking habit in child patient in their clinical practice, and remaining 59% did not notice.

Among the respondents, who have noticed digit sucking habit in child patients, the measures taken to stop the habit was as follows; 24% counseled mother for adequate care of the child, 20% counseled the child to stop the habit, 24% applied bitter substance on the thumb, 16% asked the mother to put long sleeves dress to the child, and 15% adopted other methods.

Among the respondents, who have not noticed digit sucking habit in child patients, the measures they could have taken to stop the digit sucking habit are as follows: 8% said they will do counseling the mother for adequate care of the child, 13% opted for counseling the child to stop the habit, 9% said they will apply bitter substance on the thumb, 35% will ask the mother to put long sleeves dress to the child, and 35% adopted other methods.

Thirty-seven percent of respondents noticed abnormal oral structures in digit sucking child, remaining 63% did not find any abnormality in oral structures. Among the respondents who have noticed abnormal oral structures in digit sucking child; 25% noticed forward placement of teeth, 24% found gap in teeth, 21% noticed deep palate, and 30% of them found all above abnormalities in digit sucking child.

Twenty-nine percent of respondents think that digit sucking child should be referred to the dentist for doing away with the habit and for correction of associated malocclusion whereas large proportion (71%) of respondents thought not to refer the digit sucking child to dentist.

Among the respondents who have preferred to refer the digit sucking child to dentist for better management, 22% of respondents referred to dentist all the times, 46% referred most of the times, while 24% referred rarely and 8% of them so far not referred any case.

Related to question about to which dental specialty digit sucking habit child should be referred most of them referred to any other dental specialty and 20% referred to orthodontist and 21% referred to pedodontist [Table 3].
Table 3: Attitude questions (n=302)

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   Discussion Top


Many studies have been carried out to evaluate mothers knowledge and attitude toward digit sucking habit in children, but no studies have been done to assess knowledge and attitude of pediatricians who are the first professionals dealing with health care of the children. This study focused on pediatrician's knowledge and attitude toward digit sucking habits in children.

There are several negative outcomes associated with thumb sucking habit. The most frequent concern related to chronic thumb sucking habit is the development of malocclusion, increased overjet, crossbite and anterior open bite. These problems may not self-correct if thumb sucking persists beyond 4 years of age.[4]

Oral health-care knowledge of pediatricians is different when compared to the dental practitioners. Even though they are qualified in the medical faculty, their knowledge about oral health, pernicious oral habits, and relationship of oral health with systemic diseases is very limited. Since the association of pernicious oral habits of children with adverse outcomes have been well established, it is very essential for pediatricians to be aware of risk factors for timely intervention and prevention.

In our study, the majority of the pediatricians employed similar methods in trying to stop the digit sucking habit in a child.

This study showed that most of the respondents were unaware that oral habits could be responsible for malocclusion.

A high percentage of respondents preferred not to examine oral features in digit sucking child which is a major concern. Medical practitioners should be encouraged to carry out oral examination in every patient as a part of the general examination. Among the etiological factor that may contribute to digit sucking habit in a child most of the respondents expressed that habitual, psychological and inadequate parental care is the causative factor. Most of the participants answered that parental and child counseling is essential to stop the habit.

Majority of respondents said that digit sucking habit is not acceptable at any age.

Although most of the respondents noticed abnormal oral features in digit sucking child, 70% of the respondents did not refer the digit sucking child to the dentist. And further, many of pediatricians were unaware about the very important role of orthodontists and pedodontists in managing digit sucking habit and its associated malocclusion.

As per our study, the level of knowledge among pediatricians about digit sucking habit in children is quite low. Many studies have been carried out to assess oral health behavior among medical professionals. There is no single study about the assessment of knowledge among pediatricians about digit sucking habit in children. With regard to knowledge about general oral health behavior among medical practitioners and pediatricians our present study is in agreement with the Chitta et al. (2015),[10] Sezer et al.[11] and Giuseppe et al.[12]

Chitta et al. (2015) conducted a study on oral health awareness among medical doctors and found that oral health awareness among medical doctors was very low.[10]

Sezer et al. assessed the oral health and dental knowledge among pediatrican's in Turkey and found that lack of dental knowledge and training in residency limits the pediatrician's role in promoting children's oral health in daily practice.[11]

Giuseppe et al. determined knowledge and attitude and practices regarding the prevention of oral diseases among pediatrician's in Italy and found that pediatricians lacked knowledge although they believed that they had an important responsibility in preventing oral disease among children.[12]

In our study, around 70% of respondents did not refer digit sucking habit child to dentist this in agreement with the study done by Sharma et al. in 2016.[13]

Sharma et al. in 2016 carried out study on knowledge and attitude and practices of pediatricians regarding malocclusion in Haryana state India, they offered many questions to pediatricians with respect to malocclusion and oral care and they found that pediatricians knowledge was very poor and further in relation to question about referring thumb sucking habits to dentist, 70% of pediatrician's did not refer digit sucking child to dentist.[13]

Oral habits such as digit sucking, thumb sucking, and pacifier usage are common in childhood. The intervention of oral habits is recommended at the age of 4 years.[14] Surprisingly, in our study, many pediatricians were not aware about the age of acceptability of digit sucking habit in the child which is also a major concern. The pediatricians should insist parents to consult dentist if the child is involved in oral habit beyond 4 years of age.

The important finding of our study was the need for continuing dental education for pediatricians and also inclusion of oral health care in the curriculum of pediatrics so that we can increase oral health awareness among pediatricians and also the role of each dental specialty in the management of particular kind of oral problems. Eke et al. in 2015 carried out a study about pediatricians perception of oral health care of children in Nigeria, they found that majority of pediatricians had limited knowledge about oral health knowledge, and their study stressed the inclusion of basic oral health-care knowledge in the curriculum of pediatrics.[15]

In our study, most of the pediatricians had not sought out advice about child's digit sucking habit from a dentist. This observation in our study highlights the deficiency of oral habits awareness and its management among pediatricians. Pediatricians should be instructed and motivated to seek out advice from the dentist in general and orthodontist or pedodontist in particular for management of digit sucking habit and its associated malocclusion. Further research should be carried out to assess knowledge and awareness level of pediatricians with respect to digit sucking habit in children.

Limitations of the study

  • Sample size is small
  • Distribution of sample size is uneven
  • Sometimes the responses to the questionnaire by individual participant might be associated with bias due to, psychological, cultural or geographical factors which may be determinants in the responses of the study participants.



   Conclusion Top


As per our study, we found that the pediatricians lack the knowledge and attitudes about digit sucking habit in child and its management. It is necessary that pediatricians should keep their knowledge updated. Basic oral health care should be included in the curriculum of pediatrics. Further with the combined efforts of pediatricians and dental practitioners, we can conduct continuing dental education programs and symposiums to refresh and enhance the knowledge levels of pediatricians about prevention and better management of pernicious oral habits in a child.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Meghalhaes LN, Rodrigues MJ, Heimer MV, Alencar AS. Prevalence of non-nutritive sucking habits and its relation with anterior open bite in children seen in Odonto pediatric clinic of the University of Pernambuco. Dent Press J Orthod 2012;17:119-23.  Back to cited text no. 1
    
2.
Leite-Cavalcanti A, Medeiros-Bezerra PK, Moura C. Breast-feeding, bottle-feeding, sucking habits and malocclusion in Brazilian preschool children. Rev Salud Publica (Bogota) 2007;9:194-204.  Back to cited text no. 2
    
3.
Amaral CO, Mussoline JB, Silva RO. Study of methods for removal of harmful habits in a dental occlusion in pediatric dentistry. Colloquium Vitae 2009;1:123-9.  Back to cited text no. 3
    
4.
Byrd MR, Nelson EM, Manthey LM. Oral-digital habits of childhood: Thumb sucking. In: Fischer JE, O'Donohue WT, editors. Practitioners Guide to Evidence Based Psychotherapy. New York; Springer Publishing Company; 2006. p. 718-25.  Back to cited text no. 4
    
5.
Bishara SE, Warren JJ, Broffitt B, Levy SM. Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life. Am J Orthod Dentofacial Orthop 2006;130:31-6.  Back to cited text no. 5
    
6.
Duncan K, McNamara C, Ireland AJ, Sandy JR. Sucking habits in childhood and the effects on the primary dentition: Findings of the Avon longitudinal study of pregnancy and childhood. Int J Paediatr Dent 2008;18:178-88.  Back to cited text no. 6
    
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Ovsenik M. Incorrect orofacial functions until 5 years of age and their association with posterior crossbite. Am J Orthod Dentofacial Orthop 2009;136:375-81.  Back to cited text no. 7
    
8.
Sarmah HK, Hazarika BB. Determination of reliability and validity measures of questionnaire. Indian J Educ Inf Manage 2012;1:508-17.  Back to cited text no. 8
    
9.
Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ 2011;2:53-5.  Back to cited text no. 9
    
10.
Chitta H, Chaitanya NCSK, Lavanya R, Reddy MP, Subramanyam I. Awareness of medical doctors on oral health: A cross sectional study. OHDM 2015;14:424-8.  Back to cited text no. 10
    
11.
Sezer RG, Paketci C, Bozaykut A. Paediatricians' awareness of children's oral health: Knowledge, training, attitudes and practices among Turkish paediatricians. Paediatr Child Health 2013;18:e15-9.  Back to cited text no. 11
    
12.
Di Giuseppe G, Nobile CG, Marinelli A, Angelillo IF. Knowledge, attitude and practices of pediatricians regarding the prevention of oral diseases in Italy. BMC Public Health 2006;6:176.  Back to cited text no. 12
    
13.
Sharma R, Kumar S, Singla A, Kumar D, Chowdhary S. Knowledge, attitude and practices of pediatricians regarding malocclusion in Hryana, India. J Indian Assoc Public Health Dent 2016;14:197-201.  Back to cited text no. 13
  [Full text]  
14.
Green M, Palfrey JS, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 2nd ed. Arlington, VA; National Center for Education in Maternal and Child Health; 2002.  Back to cited text no. 14
    
15.
Eke CB, Akaji EA, Ukoha OM, Muoneke VU, Ikefuna AN, Onwuasigwe CN, et al. Paediatricians' perception about oral healthcare of children in Nigeria. BMC Oral Health 2015;15:164.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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