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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 1  |  Page : 42-46

Knowledge, attitude and practice of pediatricians towards digit sucking habit among children in Pune, India


Department of Pediatric and Preventive Dentistry, Dr D.Y. Patil Dental College and Hospital, Dr D.Y Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission17-Sep-2021
Date of Decision17-Oct-2021
Date of Acceptance01-Nov-2021
Date of Web Publication31-Dec-2021

Correspondence Address:
Samiksha Shivanand Shetty
Department of Pediatric and Preventive Dentistry, Dr D.Y. Patil Dental College and Hospital, Dr D.Y Patil Vidyapeeth, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_138_21

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  Abstract 


Introduction: Prolonged digit sucking habits can have deleterious effects on facial growth, oral function, occlusion and aesthetics, leading to dental and skeletal deformities. Early identification and intervention can result in a vast difference in treatment outcomes and avoid a complex, expensive, and time-consuming treatment in the future. Pediatricians are in a key position to identify these habits in children. The present study evaluated the knowledge, attitude and practice among pediatricians about digit sucking habits in children in Pune city, India. Materials and Methods: A pre-validated questionnaire was mailed to the study subjects. The filled 303 questionnaires were then statistically analyzed using descriptive statistics. Results: This study showed that although the number of pediatricians performing routine oral examinations was high (92.7%), the referral to dentists was low. 67.5% of pediatricians referred their patients to a dentist only when they had an explicit dental complaint. Only 20.5% of pediatricians referred children with digit sucking habits to a dentist. 95.7% of participants agreed that treatment of digit sucking is important, but only 7% of pediatricians recognized the use of habit-breaking appliances as a treatment modality. Conclusion: We found that although the pediatricians had sufficient knowledge regarding thumb-sucking habits in children, the involvement and collaboration with dentists was very low. The majority of pediatricians felt there was a need for more awareness programs on oral habits. We conclude that more collaborations should be encouraged between medical and dental professionals.

Keywords: Attitude, digit sucking, knowledge, pediatricians, practice


How to cite this article:
Shetty SS, Mathur A, Khan HA, Nankar MY. Knowledge, attitude and practice of pediatricians towards digit sucking habit among children in Pune, India. Adv Hum Biol 2022;12:42-6

How to cite this URL:
Shetty SS, Mathur A, Khan HA, Nankar MY. Knowledge, attitude and practice of pediatricians towards digit sucking habit among children in Pune, India. Adv Hum Biol [serial online] 2022 [cited 2022 Aug 15];12:42-6. Available from: https://www.aihbonline.com/text.asp?2022/12/1/42/334587




  Introduction Top


Digit sucking is a self-soothing habit that serves as an adaptive function and is thought to provide a child with a sense of security and comfort. Various studies have reported that sucking habits are frequently observed in children and more common in the first 2 years. The prevalence of this habit varies and depends on various factors such as the child's sex, age, socioeconomic status and ethnicity. Social background, older mothers, higher level of maternal education, working mothers, absence of older siblings have also been associated with prolonged non-nutritive sucking (NNS) habits.

According to a study by Nowak et al., at 6 months of age, 81% of children had NNS habits which declined to 59% by 20 months of age.[1] Over the first 5 years of life, Bishara et al. reported a decrease of pacifier use to 1% from 40%, and that of digit sucking to 12% in 4-year-old seven from 31% to 12 months of age.[2] A study conducted by Dhull et al. to assess the prevalence of deleterious habits among 3–5-year-old's showed a high prevalence of thumb sucking habits (12.8%). Digit sucking habits were more likely to be prolonged to 3–4 years of age or older compared to pacifier habits.[3] With a prolonged duration of the habit, the severity of developing a malocclusion increases proportionally. Thus, early identification of the habit and intervention at an appropriate time can result in the vast difference in treatment outcome and can avoid a complex, expensive and time-consuming treatment in future.

There is an emergent focus on the role of the non-dental workforce in refining oral health outcomes in children worldwide.[4],[5] The World Health Organization (WHO) identifies oral health as important for interprofessional practice within the primary health sector.[6] Pediatricians are the first doctors to encounter children during their developing years and can play a key role in children's oral health. The recommendations for this role have included screening, anticipatory advice, and referral to dental services before the age of 12 months.[7],[8] Despite role identification, routine oral health screening and referral by pediatricians remains restrained.[9],[10],[11] Barriers to oral health practice include inadequate training and education, time constrictions in routine practice and lack of referral. Some authors have argued that the assimilation of oral health into medical schools, together with appropriate resources, would enhance access to dental care for all children.[9],[11]

Thus, strengthening the role of pediatricians in oral health by early identification and timely referral of NNS habits could prevent the complications associated with these habits. There is a limited number of studies conducted to assess the awareness of pediatricians towards oral habits in children. The present study is aimed to assess the knowledge, attitude and practice of pediatricians toward digit sucking habits in children in Pune city, India.


  Materials and Methods Top


Study design and population settings

This cross-sectional study was done among the pediatricians practising in Pune city, registered under the Indian Academy of Pediatrics Pune chapter (IAP, Pune). Prior to the study, permission to conduct the study was taken from the institutional scientific and ethics committee (DYPCH/IEC/120/61/19). STROBE guidelines were used to ensure accurate reporting of this observational study. The total number of pediatricians enrolled in the IAP, Pune city was 700. Using 700 as the universal sample, margin error of 5% and a confidence level of 95%, the desired sample size was calculated to be 249, after taking into consideration 10% dropouts using check market software. The study sample was selected using a random number generator from a list containing all pediatricians obtained from IAP, Pune chapter.

Questionnaire design

A questionnaire to investigate the knowledge, attitude and practices was developed for the purpose of this study. The questionnaire drew on previous research in this area by Kumar et al.,[12] Sharma et al.[13] and Ramroop et al.[14] and the required modifications were made. The pre-final questionnaire was then pre-tested and served to test the face validity of the questionnaire and determine how meaningful it was to the studied population. After discussion with participants, the variability in responses, understanding of items and ambiguity were evaluated. The questionnaire was then modified and used for this study. The final questionnaire consisted of 15 closed-ended questions, and the respondents were allowed to choose only one option.

Data collection

An electronic link was generated using google forms. The questionnaire was preceded by a consent section which explained the study's purpose, study objectives and voluntary participation. The questionnaire was then E-mailed to pediatricians registered under the IAP, Pune. Follow up reminders were sent every 2 weeks for 1 month. The duration of the study was 6 months, from 1st June 2020 to 30th November 2020. Half-filled or incompletely filled questionnaires were discarded. The completely filled questionnaires were taken up for statistical analysis, and a Chi-square test was performed. The response rate of the pediatricians was found to be 43.2%.


  Results Top


Out of the total 303 respondents, the mean age of the participants was 39.86 and 147 were females 156 were males. About 79.5% of the pediatricians considered the digit sucking habit to be normal in children, while 20.2% believed it to be an abnormal habit. 42.7% of pediatricians considered it to be acceptable till 3 years of age, 26.2% and 13.2% considered it to be acceptable till 4 years and 5 years of age, respectively. 6% were unsure, and 15.9% considered it to be unacceptable at any age. When asked about the aetiology of digit sucking, 16.2% believed the habit occurred due to psychological causes, 11.3% thought it occurred due to inadequate parental attention, 18.9% thought it was habitual. The majority of the respondents (52.3%) were of the opinion that it occurred due to all of the above reasons and about 1.3% of them were unsure of the aetiology. 94.4% of participants believed that prolonged digit sucking could have adverse effects on orofacial structure, 12.9% of the participants thought it led to malpositioning of teeth, 11.3% thought it led to skeletal changes in the orofacial region, 8.6% thought it led to psychological effects whereas the majority of the pediatricians 62.9% thought that it led to all of the above-mentioned effects [Table 1].
Table 1: Pediatricians response to knowledge - based questions

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53.3% of the pediatricians strongly agreed that they have an important role in identifying oral habits, 46.4% agreed to this statement, and 0.3% were unsure about the same. Fifty-six percent of pediatricians agreed to the fact that routine oral examination of children is important during their visit to the pediatrician, 43% strongly agreed to this statement, whereas 0.3% disagreed with this and 0.7% were unsure. The majority of the pediatricians, 61.3% agreed that treatment of prolonged digit sucking habit is important, 34.4% strongly agreed to this while 2.6% disagreed with this statement, and 1.7% were unsure. 16.9% of the participants strongly agreed with the statement that the child with digit sucking habit should be referred to a dentist, while 61.9% agreed, 10.3% disagreed, and 10.9% were unsure about this statement. The bulk of pediatricians, 63.9%, agreed, and 33.1% strongly agreed that awareness programmes should be initiated to enhance pediatricians' knowledge on deleterious oral habits, whereas 0.7% disagreed and 2.3% of pediatricians were unsure [Table 2].
Table 2: Pediatricians response to attitude - based questions

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The majority, 92.7%, routinely performed the oral examination in a digit sucking child, while 7.3% did not follow the same practice. 67.5% only referred their patients to a dentist for a routine dental check-up only when their patients had an explicit dental complaint, whereas 28.8% frequently referred their patients, and 3.6% did not refer to a dentist for a routine check-up. 68.2% of the respondents stated that they encounter such cases sometimes, and 28.1% come across such patients most of the time, whereas 3.6% rarely do so [Table 3].
Table 3: Pediatricians response to practice - based questions

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  Discussion Top


Identification of deleterious oral habits forms an integral part of anticipatory guidance and pediatric care. Early detection of oral habits and prospective dental abnormalities through a comprehensive but concise examination of the oral cavity could lead to timely management of their associated complications and improved quality of life.

There has been a budding focus on the role of other healthcare workers in refining oral health outcomes in children throughout the world.[4],[5] The WHO identifies oral health as important for interprofessional practice within the primary health sector.[6] Pediatricians are the first doctors to encounter children during their developing years and can play a key role in children's oral health. The recommendations for this role have included screening, anticipatory advice, and referral to dental services before the age of 12 months.[7],[8]

The pediatricians have the unique ability to meet the child and their caregivers several times within the 1st year of life itself. Thus, they are in an ideal position to instruct the parents/caregivers about the effects of oral habits and the prevention of malocclusion.

A high percentage of pediatricians responded positively when asked about the aetiology and adverse effects of prolonged digit sucking habits in children. Although pediatricians performing routine oral examination was also high in our study, but we found that the referral to a dentist was considerably low. Most of the pediatricians did not seek the dentist's opinion about digit sucking habits in children. This indicates a definitive lack of awareness among pediatricians regarding the management of thumb-sucking habits.

A similar study was conducted in the year 2019 by Kumar et al., wherein 70% of the pediatricians did not refer the child with digit sucking habit to a dentist, although they noticed abnormal oral features. In this study, a high number of participants preferred not to examine oral features of a child indulging in the habit, which was in contrast to our study where 92.7% of participants responded that they routinely perform oral examination.[12] Similar results were obtained by Sharma et al. in the year 2016 in a questionnaire study to assess the knowledge attitude and practice of pediatricians regarding malocclusions in Haryana. The authors found that the knowledge of pediatricians and referral to the dentist was poor.[13] Contradictory to the above studies, the knowledge of pediatricians regarding digit sucking habits in our study was found to be satisfactory.

Studies conducted on the awareness of oral health care practices have documented similar limitations in dental knowledge amongst pediatricians. Indira et al. and Gupta et al. stated that there was a lack of awareness about oral health practices among pediatricians. The authors found that although the majority of the pediatricians agreed that they are an extremely valuable resource in promoting the oral health of children and that both medical and dental professionals together are responsible for the oral healthcare in children, the referral to the dentist was low.[15],[16]

A vast majority of pediatricians in our study agreed that awareness programmes should be initiated to enhance the pediatrician's knowledge of oral habits. Pediatricians should be motivated to refer children with prolonged thumb sucking habits to the dentist in general and pedodontist in particular for effective and timely management of digit sucking habits and their associated malocclusion. Collaboration among medical and dental health care workers is essential for achieving the goal of integrated oral and general health in children. Awareness programs and continuing medical/dental education workshops should be conducted on a regular basis.

Limitations

The findings of the study cannot be generalized as it was conducted among pediatricians practising in urban settings, and many of the respondents were also attached to academic institutes, which might have led to a potential bias. Thus, a study with a larger sample size covering subjects from various backgrounds is needed.


  Conclusion Top


We found that although the pediatricians had sufficient knowledge regarding thumb-sucking habits in children, the involvement and collaboration with dentists was very low. The majority of pediatricians felt there was a need for more awareness programs on oral habits. We conclude that more collaborations should be encouraged between medical and dental professionals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nowak AJ, Levy SM, Kiritsy MC, Slager SL. Patterns of nutritive/non-nutritive sucking at 20 months. J Dent Res 1996;75:1683.  Back to cited text no. 1
    
2.
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. 2
    
3.
Dhull SK, Verma T, Dutta B. Prevalence of deleterious oral habits among 3 to 5-year-old preschool children in Bhubaneswar, Odisha, India. Int J Clin Pediatr Dent 2018;11:210-3.  Back to cited text no. 3
    
4.
Daly B, Batchelor P, Treasure E, Watt R. Essential Dental Public Health. Oxford: Oxford University Press; 2013.  Back to cited text no. 4
    
5.
Herndon JB, Tomar SL, Lossius MN, Catalanotto FA. Preventive oral health care in early childhood: Knowledge, confidence, and practices of pediatricians and family physicians in Florida. J Pediatr 2010;157:1018-24.e1.  Back to cited text no. 5
    
6.
WHO. Expert Consultation on Public Health Intervention against Early Childhood Caries: Report of a Meeting, Bangkok, Thailand, 2016. Geneva: World Health Organization; 2017.  Back to cited text no. 6
    
7.
US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville: Executive Summary US Department of Health and Human Services National Institute of Dental and Craniofacial Research National Institutes of Health; 2000.  Back to cited text no. 7
    
8.
Section on Pediatric Dentistry and Oral Health. Preventive oral health intervention for pediatricians. Pediatrics 2008;122:1387-94.  Back to cited text no. 8
    
9.
Lewis CW, Boulter S, Keels MA, Krol DM, Mouradian WE, O'Connor KG, et al. Oral health and pediatricians: Results of a national survey. Acad Pediatr 2009;9:457-61.  Back to cited text no. 9
    
10.
Lewis CW, Cantrell DC, Domoto PK. Oral health in the pediatric practice setting: A survey of Washington state pediatricians. J Public Health Dent 2004;64:111-4.  Back to cited text no. 10
    
11.
Lewis CW, Grossman DC, Domoto PK, Deyo RA. The role of the pediatrician in the oral health of children: A national survey. Pediatrics 2000;106:E84.  Back to cited text no. 11
    
12.
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.  Back to cited text no. 12
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13.
Sharma R, Kumar S, Singla A, Kumar D, Chowdhary S. Knowledge, attitude and practices of pediatricians regarding malocclusion in Haryana, India. J Indian Assoc Public Health Dent 2016;14:197-201.  Back to cited text no. 13
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14.
Ramroop V, Kowlessar A, Ramcharitar-Maharaj V, Morris L, Naidu R. Knowledge, attitudes and behaviour towards preventive oral care in early childhood among pediatricians in Trinidad and Tobago: Findings of a national survey. Int Dent J 2019;69:67-76.  Back to cited text no. 14
    
15.
Indira MD, Dhull KS, Nandlal B. Knowledge, attitude and practice toward infant oral healthcare among the pediatricians of Mysore: A questionnaire survey. Int J Clin Pediatr Dent 2015;8:211-4.  Back to cited text no. 15
    
16.
Gupta SK, Gupta S, Gojanur S, Kour G, Singh K, Rani P. Pediatricians' view on early childhood caries and oral health in a north region of India: A cross-sectional study. J Family Med Prim Care 2019;8:220-4.  Back to cited text no. 16
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