I)epartment of Pediatrics, Harvard University and Massachusetts General Hospital, Boston, and
James Jackson Putnam Children’s Center, Roxbury, Massachusetts
T
HE SUCKING reflex of the infant assumiaesa volumitary aspect as it increases in its
importance to him. Extranimtritional simcking
which occurs imi infancy is often a source
of concern to paremits and to physicians. The importaiice of this kind of sucking as a soimrce of gratification has often been
over-looked. A more complete understanding of
what this activity means to the infant is
important iii providimig gratification of his
need for sucking, nutritional and
nonnutri-tional.
The nieciiamiislil for sucking is normally
instituted in fetal life. Hooker observed ac-tivity in the 17-week fetal infant which he
felt was a irecimrsor to sucking. Gesell2
placed the beginning of full swallowing and
suckimig at the 32- to 36-week fetal stage.
\Iaturatioti of this ability occurs in the last
2 months of fetal life. From birth onward, simcking activity becomes an expression of
the basic instinct of self-preservation.
Grati-fication of this primary instinct constantly
reinforces
tue
oral drive to suck. Freud3postulated that with oral gratification from
miimtritional sucking, the act itself assumed!
importance and became an associated goal.
Nonnutritional sucking then evoked
pleas-tire, eased tensions, and assumed an
impor-tance all its own. After the infant has
ex-perienced such gratification, interference with it may affect the feeding situation,4
or may affect emotional development in
other
A series of babies were cup fed from birth by Fredeen and no nutritional
suck-ing was allowed. These infants discontinued
sucking movements by the sixth week after
birth and did little or no sucking
there-after through infancy or in the second year.
This study was carried out in an attempt
ADDRESS: 51 Brattle Street, Canibridge, Massachusetts.
400
to prove that sucking was not an important source of gratification if the infant never ex1)erienced it as simcli. Sears and Wise7’ 8
pointed out that the frustration which an
infant showed when the sucking process
was interfered with, was directly propor-tional to the duration and amount of
grati-fication the infant had had in its feedings
prior to tue frustration. Hence, in the cup
fed babies of Fredeen, lack of
reinforce-ment of sucking activity simply deprived
these infants of any gratification in that area, and no interest in it was developed.
Most babies are fed by sucking methods,
and do learn to enjoy the process.
Extra-nutritional sucking nornially appears to in-crease in importance for
tue
infant up to 7 months if he is allowed to enjoy it, andthen spontaneously decreases in its
signifi-cance. It seems to be common in the first
year for babies to seek extra sucking, and
to enjoy it. It does not necessarily appear
to be a manifestation of unusual tension
or frustration. Spock#{176}refers to this sucking
as evidence of some unfulfilled need and urges mothers to examine their handling of
the infant when this occurs. As a result,
many conscientious young mothers feel guilty and bring their concerns to their physicians.
The present study was undertaken in an
effort to allay this concern and substantiate
the normality of extranutritional sucking.
PATIENT MATERIAL AND PROCEDURE
‘4..
90 80
70
60
50
40
30
20
10
I 2 3 4 5 6 T 8 9 10 II 12
WEEKS
FIG. 1.
SPECIAL
ARTICLE
:3 months or more amid were weaned gradkmally.
In an attempt to minimize the factor of cmi-vironmemital temision, they were selected with the following criteria : These were primiparas who seemed to enjoy their first babies, who had no overt problems with the babies or themselves, and who seemed permissive in
their approach to the feeding situatiomi and to
simcking. The feeding situation in each instance was felt to be a gratifying one on the whole for both mother and imifamit. The type of feed-imig, i.e., breast or bottle, was not an influence in the decisiomi to include them as a unit, as the above requirements were considered more important to this study. No attempt has been madle imi this study to correlate simcking with the type of feeding, as long as the feerling situation s’as a satisfactory one. The amount of simcking associated with each feeding varied from 15 to 40 mimiutes, and the mothers were urged to satisfy the babies’ simcking requirements with each feeding. Each infant varied imi his re-quired sucking time, and the mother was as-sisted in her evaluation of this requirement.
RESULTS
Of
these 70 babies, 61 manifested anap-preciable amount of extra sucking which
was not associated with feeding. This
ac-tivity was present at times that could miot
be attributed! to fatigue, hunger, or
discom-fort. It seemed to have purpose in itself.
The mothers’ spontaneous observations
were “She seemed to be sucking for the
pure pleasure of it,” or “He got too full if
he kept at the breast, so he seemerl to
know enough to stop and use his fist
iii-stead.” In 2 babies the ability to find the
fist was present from birth amid sucking started as a repeated!, patternedi activity
at 1 week. In 9 others sucking was repeated
volimntarily by 3 weeks, and all were sucking
their fists or fingers by 3 months (Fig. 1).
Of
the 9 babies in whom no extra smackingwas mioted in the first fev months, 5 were
quite placid and their mothers satisfied this
need by consciously offering aroumid 30
minutes of sticking with each feeding.10’ tt
Two others began finger sucking at 9
months, have continued with increasing in-tensity beyond
tue
first year and continueto be “problem suckers.”#{176} In tile other 2
0A “problem sucker” might be classified as one
who sucks his fingers beyond infancy to such ati
extent that it becomes a problem to his
I 2 3 4 5 6 7 8 9 10 II 12
MONTHS
FIG. 2.
4
3
2
in this group of non-suckers, motor
develop-ment was accelerated and the parents
consciously stimulated the infants’ attempts
to rrotor performance.
The extranimtritional sucking increased! in intensity from 3 months to 7 months when
it begami to lessen spontaneously, coincident
with mnotor accomplishments such as
creep-ing, crawling, sitting, and pulling up. In this periorl, the mothers observer! that suckimig was associated vith investigation of their hands, with teething discomforts amid
with frimstrations associated with
develop-mental progress. One mother reported that
her baby seemed to want to sit up, when lie
realized lie couldn’t accomplish it by
him-self, he looked around for her; not finding
her, he resorted to his thumb (Fig. 2).
By
9 months of age 45 babies and by 12nionths 57 babies had ceased extra sticking
except when they were tired, hungry or
unhappv.t2 I Four have continued to simck
their fingers rather intensively into the
second ‘ear; 2 of these have lessened in intensity
by
the age of 2 years, 2 have notand are “problem suckers.” Of the latter
pair, 1 was breast fed, 1 was formula fed,
and both have had unsatisfactory
environ-mental situations in the secomid year. These
2 are comparable in intensity to the former 2 who were not stickers in the first year.
All 4 of these “problem suckers” give imp
their thumbs in pleasurable sitimations bitt
quickly fall back with relatively minor
frustrations. These babies substantiate the
relationship between prolonged sucking and
tmnsatisfactory environmental relationships,
pointed out by various workers.tI_t
Intensity
Constitittional differences iii an infamit’s
muscular tone are apparent from birth. The
intensity of basic drive which demands
ex-pression varies from then on and affects
the infant’s response to such an activity as
sucking. NI. Fries17 believes that the
sponse to a sucking test in the immediate
neonatal period is an indication of the in-herent degree of this basic drive.
In babies who are constitutionally a
driv-imig and hypertonic type, extra sucking may
babies sttmdied were of tilis type and cried
pitifully as if in pain except when their
mouths were full. A pacifier at first, later
their own fists, satisfied their urgent need
for long periods and it seemed apparent
tilat extra simcking was an activity which
calmed them. They changed from unhappy,
“gassy” babies to more contented ones with
the introduction of a pacifier or the thumb.”’
The 9 babies who did little or no
extra-nutritional sticking were more placid types who were gratified in the oral area by the
relatively short intervals of sucking that they
got with meals. The other 56 babies fell
into neither group and seemed to need
vary-ing amounts of nonnimtritional mouthing and
sticking. The effect of the environment on
the intensity of this drive could not be fully
evaluated in this study. The intensity of
simcking varied from time to time in
mdi-vidual infants. Most often it could be
cor-related with tension in the infant from
within or vithoimt.
COMMENT
Extranutritional sucking is common in
healthy and contented babies in whom it is not inhibited. In babies whose feeding situa-tions are satisfying ones, gratification strengthens the sucking. This source of
grati-fication is carried over to extra periods
apart from feeding. Thus the infant may
learn to relive a pleasant, dependent
situa-tion independent of the parent figure by
re-producing the sucking. A resourceful baby
learns to alleviate his inner needs and
frustrations by substituting this pleasurable
act for situations where comfort depends upon the environment. Several authors have suggested that strengthening this activity
in infancy serves to encourage the growth
of inriependence in the infant.”” ““ 19
In this series of 70, only 4 might be
termed “problem suckers” in the second
year. Two of these were not sucking at the
earlier times in infancy and seem to have
resorted to it later. Thus, early gratification
of sucking was not a factor imi this
develop-ment. The other 2 have carried over their mieed for oral activity imito the second year
despite gratification imi earlier infamicy. In
59 infants, gratification of this oral drive
did not lead to prolonged
thumbsuck-ing.’6’
20, 21Frustration of such sucking is reported to
lead to difficulties in other areas, such as:
(1) accelerated motor development, as
re-ported by K. Wolf, which may not be
healthy;5 (2) infantile feeding disturbances;’
(3) sleep difficulties, nailbiting, anorexia,
I)ersistent thumbsuckimi g, enuresis,
tongue-sucking, as reported b’v others.”’6
The air-swallowing which occurs
coinci-(lent with such sticking in small infants can
easily be counteracted by occasional
offer-ings of flimid and “bubbling.” Permanent
dental arch deformity does not occur as a
resitlt of finger simcking in infancy, according
to Lewis,22 and others in the field of
ortho-dontia, and only results if the sucking
mains as a persistent habit until 5 or 6 years
of age.
SUMMARY
Sevemity healthy, apparently happy babies
were studied in an attempt to evaluate the
common occurrence of extranimtritional
simcking amid its importance. Sixty-one
mani-fested an appreciable amount of extra
suck-ing which seemed to be gratifying in itself
to the infant and which did not necessarily
represent fatigue, hunger or discomfort. The
onset of this varied from birth to 3 months
of age. Its intensity increased until 7 months
then began to decrease spontaneously,
co-incident with other motor accomplishments.
By 12 months all but 4 of these babies had
ceased to suck their hands except under
stress. Only 2 have continued beyond the
age of 2 years. The importance of
extra-nutritional sticking as a source of
gratifi-cation in infancy is pointed out. Its
occur-rence is normal amid its disappearance is
spontaneous in most infants when not
in-hibited.
ACKNOWLEDGMENTS
The aimthor wishes to express his
appre-ciation to Dr. Mariami C. Putnam and Dr.
Ralph A. Ross for their helpful suggestions
1942.
2. Gesell, A., and Amatruda, C.: Embryology
of Behavior. New York, Harper, 1945,
pp. 114, 126.
3. Freud, S.: Three Contributions to the
Theory of Sex. New York, Nerv. &
Ment. Dis. Monogr. Series, No. 7, 1930, p. 41.
4. Freud, A. : Infantile Feeding Disturbances,
Psychoanalytic Study of Child, Vol. II. New York, Internat. Univ. Press, 1946, p. 120.
5. Wolf, K. M. : Individual Tendencies in the
First Year, 6th Conf. New York, Macy,
1952, p. 130.
6. Fredeen, R. C. : Cup feeding of newborn
infants. PEDIATRICS, 2:544, 1948.
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and Brodnick, A. : Effects of cup, bottle
and breast feeding on oral activities of
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to dynamic theory of development of
thimmbsucking. Am.
J.
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& Pearce, Inc., 1945.
10. Levy, D. NI.: Fingersucking-etiology. Am.
1.
Psychiat., 7:881, 1928.of Infants. Philadelphia, Lippincott,
1937, pp. 16, 75.
13. Gesell, A., and Jig, F. : Infant and Child
in the Culture of Today. New York,
Harper, 1943, p. 306.
14. Bakwin, H. : Thumbsucking and
finger-sucking in children.
J.
Pediat., 32:99,1948.
15. Kaplan, M. : Psychological implications of
thumbsucking.
J.
Pediat., 37:555, 1950.16. Kiackenbush, C. : Thumbsucking and its
etiology. PEDIATRICS, 4:418, 1949.
17. Fries, M. E. : Psychosomatic relationships between mother and infant. Psychosom.
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18. Levine, M. I., and Bell, A. I. : Treatmemit of colic in infancy by the use of a
pacifier.
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Pediat., 37:750, 1950.19. Escalona, S.: Emotional Development in
the First Year of Life, 6th Conf. New
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20. Mead, M. : Contributions from the Study of Primitive Cultures, 1st Conf. New
York, Macy, 1947, p. 37.
21. Sullivan, A. \V. : Pathologic suckimig
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York State
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Med., 54:2474, 1954.22. Lewis, S.
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: Thumbsucking as a cause ofmalocclusion.
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Am. Dent. A., 17:1060, 1930.EFFECTS OF EXPERIMENTAL HYI’oTIIERtIIA ON \TITAL ORCANs, Phyllis Knocker.
(Lancet, 269 :837, October 22, 1955.)
This paper will be of particular interest to those concerned with the employment
of hypothermia as a technique for inducing a state of suspended animation perniitting
the shutting off of circulation during surgery upon tile heart. l)ogs were subjected to
a degree of hypothermia customarily employed in such operations and under
circum-stances intended to simulate the conditions employed. Pathologic changes were seen iii microscopic sections of the liver, kidneys, and adrenal glands. These were of such a degree as to make it seem likely that they might easily become irreversible. The changes resembled those which have been reported to occur as a result of various forms of stress, particularly tissue anoxia. The authors express skepticism that hy-pothermia should be considered as a state of suspended animation. They question
