Nigerian Journal of Paediatrics 2011;38(2):73-77
ORIGINAL
Roland C. Ibekwe
Digit-Sucking Among Ibo Infants In
Ngozi S. Ibeziako
Bede C. Ibe
Eastern Nigeria
Mary-Ann U. Ibekwe
Received: 28 February 2011
Abstract
Background:
Digit-
The right fingers (66.5%) and the
Accepted: 24 June 2011
sucking is a common habit among
thumbs (42.25%) were the digits
infants and toddlers, it is a normal
most frequently sucked. The
adaptive process and attempts at
prevalence of digit-sucking do not
vary with sex ( χ = 1.17, p = 0.28)
2
Roland C. Ibekwe ( ) Mary-
stopping are discouraged before 2-
Ann U. Ibekwe
4 years of age. Prevalence varies
and infants' age ( χ
2
= 49.79, p =
Department Of Paediatrics
along racial lines. This study is
0.08).
Hunger (71.7%) was the
Ebonyi State University Teaching intended
to
document
the
most common condition in which
Hospital
prevalence and pattern of this habit
the infants suck their digits,
Abakaliki, Nigeria
among Ibo infants and also to
followed by anger (6.7%) and sleep
e
m
a
i
l
: determine maternal attitude and
(6.1%).
roland_ibekwe@yahoo.com
response to it
Most mothers (67.70%) had a
Tel: + 2348037875631
Method:
This is a crosssectional
negative perception to digit-
study on infant digit-sucking habit.
sucking and 69.59% of the mothers
Ngozi S. Ibeziako
Subjects were the mother/ infant
had attempted to stop the habit in
Bede C. Ibe
pairs that attended the well baby
their infants. Methods employed by
Department Of Paediatrics
clinics at the Institute of Child
the mothers include restraint
Univesity of Nigeria Teaching Health of the University of Nigeria
(78.21%), and topical application of
Hospital
Teaching
Hospital,
Enugu
bitter substances (23.04%) and
Enugu, Nigeria
(ICHUNTH), Mother of Christ
pepper (11.37%).
Specialist Hospital (MCSH),
Conclusion: - digit-sucking is a
Enugu and the Ebonyi State
common habit among Ibo infants
University Teaching Hospital
and most mothers have negative
(EBSUTH), Abakaliki, between
attitude towards it, majority of
March and May 2006.
which had attempted to stop this
Results:
One hundred and forty
habit in their infants using mostly
eight (30.8%) infants digit-suck.
deterrent methods.
Introduction
said to be more common among females and children
of higher socio-economic class.
5-7
Though common,
Digit-sucking is a common behavior in children and
parents are generally uncomfortable with it because
of its perceived medical and social consequences.
8,9
is thought to be a normal adaptive process during
infancy and toddling years, its prevalence is said to
The medical consequences of digit-sucking when it is
vary from 1 50%.
1-3
It is said to be more common in
chronic include dental malocclusion, finger
western countries and was thought to be uncommon
deformity, chronic paronychia and increased risk of
in Africa. Recent African studies have confirmed
digesting poisons, while socially it can lead to peer
that it is indeed a common condition; however its
non acceptance and dysfunctional family
prevalence varies along racial and ethnic divide. It is
4
relationship.
1-3,8,9
74
Regardless of the aforementioned risks associated
Subjects:
with chronic digit-sucking, it is very important that
the parents maintain a sympathetic, patient, and
These were mother with children aged 1 52 weeks
understanding attitude toward the child. Parental
and who brought by their infants for immunization
nagging, threats, and criticism can actually worsen
and growth monitoring at the clinics. Only mothers
the problem rather than improve it. The parent should
who gave informed consent were interviewed.
initially ignore the habit rather than force the child to
stop.Any attempts to cease the habit before the age of
2 years can create neurotic symptoms and personality
Study tool
problems. In spite of this, most studies report that
3
parents attempt to stop this habit. A Saudi study
The study tool was a structured pre-tested
reported that 48% of mothers did not like to see the
interviewer administered questionnaire on presence
habit at any age, and no mother accepted the habit
or otherwise of digit-sucking. Information on the
after the age of 4 years. Most mothers (86%) tried to
fingers sucked, conditions that lead to finger sucking,
stop their children digit-sucking. The most common
parental attempts at stopping the habit and what was
method used by these Saudi mothers to stop their
done by the parents to stop the habit were sought.
children sucking their digits was the application of a
Demographic information on maternal age, highest
bitter tasting lotion to the fingers (66%).
8
educational attainment, occupation, parity (those
There is scant report on the prevalence of this habit in
with 2 or more children were classified as
Nigeria. Uwaezuoke et al reported a prevalence of
4
'experienced' while those with only one were
23% among preschool children in Enugu. Their study
classified as 'inexperienced') and child's sex and age
was not limited to infants and involved a small
were also obtained.
sample size. This study was undertaken to determine
prevalence of digit-sucking among Ibo infants in
Eastern Nigeria, their socio-demographic
EthicalApproval
determinants and mothers' attitude towards it.
The Ethical Committees of the University of Nigeria
Teaching Hospital Enugu, the Ebonyi State
University Teaching Hospital Abakaliki, and the
Materials and Methods
authorities of the Mother of Christ Specialist
Study design
Hospital Enugu, approved the study.
This cross-sectional study was carried out between
March and May 2006 among mother-infant pairs
StatisticalAnalysis
attending the well baby clinics at the Institute of
Child Health of University of Nigeria Teaching
Analysis was done using SPSS statistical package
Hospital, Mother of Christ Specialist Hospital, both
version 11.0 using tables and percentages. Means and
in Enugu, and the Ebonyi State University Teaching
standard deviations were determined as appropriate
Hospital, Abakaliki. These centers were chosen
and differences in proportions were tested for
because they enjoy large patronage and the authors
statistical significance using the chi square test.
have working interest in them. Enugu is the capital
Logistic regression was used to determine factors
city of Enugu State while Abakaliki is the capital of
that were predictive of digit-sucking. Significance
Ebonyi State, both in South-East of Nigeria. The
level was set at p < 0.05, with 95% confidence level.
populations of Enugu and Abakaliki are 308,200 and
235,000 respectively. The inhabitants are mainly
Ibos.
Result
Sample size and sampling technique
Demographic characteristics
4
Based on the prevalence of digit-sucking of 23%,
The mother/infant pairs were recruited consecutively
and using the formula for sample size determination
as they attended clinics at the 3 sites until the sample
(N = Z PQ/d ), a sample size of 165 was obtained.
2
2
size was obtained. The 3 sites contributed 215,
This was increased to 500 to improve validity and
171and 114 from ICH-UNTH, MCSH, and
accommodate for attrition.
EBSUTH respectively. Four hundred and eighty
mother/infant pairs were analyzed. Twenty were not
included in the analysis due to incomplete data.
Table 1 shows the demographic characteristics of the
75
mothers and infants that participated in this study.
Substances on the digit 24 (23.04%), application of
Three hundred and twenty eight mothers were aged
pepper on the digit 11 (11.37%), and bandaging of the
between 21 and 30 years while the age of 115 mothers
digit 9 (9.31%), some mothers had tried more than one
was between 31 and 40, the two age categories
method. The decision to attempt to stop digit sucking
habit did not vary according mothers' education ( χ =
2
constituted 92.7% of the mothers. Three hundred and
0.91, p = 0.82), mothers' age ( χ
2
ninety five (83.2%) mothers had at least secondary
=7.27, p = 0.20),
mothers' experience ( χ = 0.23, p = 0.63), infants' age
2
education. Petty trading and fulltime home-making
were the two most common occupations among the
( χ = 30.24, p = 0.22) and infants' sex ( χ = 0.41, p =
2
2
mothers. Two hundred and ninety three mothers
0.52). Table 4 highlights that on logistic regression
(61.3%) reported their parity. The mean number of
analysis none of the above variables had predictive
deliveries per mother was 3.29 + 1.61. Of these, 26
influence on Ibo mothers attempt at stopping digit-
(8.9%) were primipara, others had two or more
sucking.
infants. Thus 267 (91.1%) of the mothers were
experienced.
Table: 1
There were 246 males (51.3%) and 233 females
Distribution of Maternal and Infant Demographics
(48.6%), M: F=1:1.06. The mean age of the infants
Frequ
was 14.29 weeks + 12.82 and 313 (65.2%) of them
Maternal Age
ency
Percentage
were aged 1- 12 weeks.
16 –20
21
4.4
20 –30
328
68.3
Prevalence of digit-sucking
31 –40
115
24.0
> 40
4
0.8
One hundred and forty eight mothers (30.8%)
No Response
12
2.5
reported that their infants sucked their digits. Table 2
Total
480
100.0
Maternal Educational
highlights the distribution of the fingers sucked by the
Attainment.
infants; six mothers (4.05%) did not report the digits
U niversity/Polytechnic
44.8
their infants sucked. Of the 142 mothers that reported
215
the fingers their infants sucked, 95 (66.5%) sucked
Secondary Education
180
37.5
the right fingers while 47 (33.10%) sucked the left
Primary Education
73
15.2
fingers. The thumbs were the most sucked fingers 60
No Formal Education
7
1.5
(42.25%), while some infants sucked more than one
No Response
5
1.0
fingers 29 (20.42%) out of which 3 children (0.6%)
Total
480
100
sucked all 5 fingers.
Maternal Occupations
Hunger was the conditions mothers felt that most
Senior C ivil Servant
84
17.5
predisposes their infants to suck their digits 129
Junior C ivil Servant
53
11.04
(71.7%), followed by anger 12 (6.7%) and sleeping
Petty Trader
103
21.5
11 (6.1%). Other conditions including boredom were
House Wife
120
25.0
responsible in 19 (10.6%) infants. Digit-sucking
Student
20
4.16
habit did not vary significantly due to sex ( χ = 1.17, p
2
Self employed
78
16.3
= 0.28), infants' age ( χ = 49.79, p = 0.08), mothers'
2
C orporate office
5
10
age ( χ = 4.58, p = 0.47), maternal experience ( χ =
2
2
No response
17
3.5
0.89, p = 0.35), maternal education ( χ
2
= 2.55, p =
Total
480
100
0.47). Table 3 shows that on logistic regression, none
Number of D elivery by
of the above variables had a predictive influence on
Mothers
1.
26
5.4
digit-sucking among Ibo infants.
1 – 4
194
40.4
> 5
73
15.2
Mothers' perception and response to infant' digit-
No response
187
39.0
sucking
Total
480
100
Age of Infant (Wks)
1 –12
314
65.4
Three hundred and twenty five (67.70%) mothers felt
13 –24
70
14.6
that digit-sucking were abnormal habit; this
25 –36
66
13.8
perception was more among mothers whose infants
37- 52
29
6.0
were not digit-sucking 242 (72.89%) compared to
No response
1
0.2
those whose infants' digit-suck 83 (56.08%). This
Total
480
100.0
difference in perception was statistically significant
Sex of Infants
( χ
2
= 13.64, p < 0.001).One hundred and three
Male
246
51.3
mothers (69.59%) had attempted to stop the habit in
Female
233
48.5
their infants. Methods Used to stop this habit include:
No response
1
0.2
- restraint 81(78.27%), applying bitter
Total
480
100.0
76
Table: 2
Discussion
Pattern of Distribution fingers sucked by Ibo infants
in Eastern Nigeria
Though the prevalence of digit-sucking among Ibo
Fingers
Right N (%)
Left N (%)
Total N (%)
infants of 30% is similar to previous report of 23% by
Uwaezuoke et al in Eastern Nigeria, and the 1-50%
4
Thumb
42 (29.58)
18(12.68)
60(42.25)
reported from studies in Western countries, these
studies were however conducted among pre school
children.
1-3
Index finger
18(12.68)
9(6.34)
27(19.01)
There are no African studies that we are
aware of on the prevalence of digit-sucking among
Middle finger 12(8.45)
5(3.52)
17(11.97)
infants but Western studies reports a much higher
value of 50 -70% with progressive decline to about
Ring finger
3(2.11)
2(1.41)
5(3.52)
12% at 4 years and 2% by 12 years. The finding in this
6
study site seems to support the postulation that for
Little finger
3(2.11)
1(0.70)
4(2.82)
unknown reason digit-sucking is less prevalent
among African than in Caucasians.
2,3
Combination 17(11.97)
12(8.45)
29(20.42)
The review of
3
of fingers
digit-sucking by Ekatrina Polyakov,
and earlier
Total
95(66.90)
47(33.10
142(100.0)
studies reported that digit-sucking was more common
among females and infants from higher socio-
economic setting; this is at variance with the finding
5,6
Table: 3
of this study where the prevalence did not vary
Logistic regression analysis of variables with
between sexes and maternal educational attainment.
predictive influence of digit-sucking among Ibo
Davidson on the other hand observed that like in this
2
infants
report there were no sex differences but noted that
females appear to find it more difficult to stop the
Variables
B
S.
Wald
R
Exp
P
E.
(B)
habit.
Mothers Age
-0.08
0.15
0.25
0.00
0.93
0.61
The earlier reported preference for the right fingers
and the thumbs is also confirmed in this study.
6,7,
Maternal
-0.49
0.47
1.11
0.00
0.61
0.29
It has
Experience
been noted that this marked preference for the right
Mothers
0.14
0.16
0.61
0.00
1.15
0.44
thumb is present as early as 15 weeks of intra uterine
Educational
life.
10
Status
This question the conventional belief that after
Age Categories
-0.19
0.01
2.71
-0.05
0.98
0.10
birth a certain level of physical and brain maturity is
(Weeks)
required before hand preference can manifest. Unlike
Sex
0.22
0.27
0.67
0.00
1.25
0.41
in previous studies where infants were noted to digit-
Constant
0.05
1.55
0.00
0.98
suck mainly while sleeping,
3,6,7
it was reported that
hunger was the major conditions that aggravates this
habit in this environment, the reason for this
difference is not very clear but the fact that this study
Table: 4
was not an observational study but based on maternal
Logistic regression analysis of variables with
recall would limit the reliability of this finding.
predictive influence on mothers attempt to stop
Majority of Ibo Mothers (68%) had a negative
digit-sucking
perception of digit-sucking even among infants; this
is much higher than the 48% reported among Saudi
mothers. Not surprisingly about 70% of mothers
8
Variables
B
S.
Wald
R
Exp
P
whose infants had this habits had attempted to stop the
E.
(B)
habit. This attempt at stopping this habit in such an
Mothers Age
0.26
0.28
0.85
0.00
0.77
0.36
early age has been found to be counter productive and
is discouraged by Pediatricians and Dentists. Most of
3
Maternal
-0.31
0.79
0.15
0.00
0.73
0.69
Experience
the methods used by mothers in stopping this habit are
Mothers
0.29
0.35
0.68
0.00
1.33
0.41
punitive and are non productive, some of them can
even harm the child.
11,12
Educational Status
It is worrisome that the
Age Categories
-0.01
0.02
0.12
0.00
0.99
0.73
attempt to stop this habit also involves very young
(Weeks)
infants and Mothers who were relatively well
Sex
-0.17
0.46
0.13
0.00
0.85
0.72
educated also tried to stop the habit among their
Constant
0.38
2.60
0.02
0.88
infants.
8
77
In conclusion
In their infants and the methods they adopted were
mostly deterrent. There is need to enlighten Ibo
digit-sucking is a common habit among Ibo infants
mothers that digit-sucking is a normal adaptive
and the right thumb is the digit most commonly
process and that most children stop this habit
sucked. Ibo Mothers have a negative attitude towards
spontaneously, it is also counter productive to try to
it, majority of which had attempted to stop this habit
stop the habit before 2 years of age.
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