Q: My client constantly bites her lower lip until it swells and bleeds. She is highly intelligent, five years old, hypertonic, and has vision difficulties. Do you have suggestions?

I have never faced this situation, but I believe that the principles of helping a child stop any oral habit would apply. You have to help the child recognize what she is doing, help her understand the problems it causes, help her develop a goal for stopping, set up a reward system for achieving certain levels of stopping, identify and alleviate factors which may be perpetuating the problem (e.g., stress in the home), design activities for sitting with “quiet lips” during increasing periods of time, etc.

This could be viewed as a family problem, not just the child’s problem. Therefore you will have to assess how much the family is invested in stopping this behavior. If they are unwilling to be a part of this, or don’t care, or can’t get it together to help, then probably the most you will be able to do is to help her stop at school or in therapy, wherever you see her.

However, if the child sees this as something she wants to stop, she can do this without parental involvement. Most kids aren’t aware of their oral habits, so simply learning about it sometimes will cause them to want to diminish it, especially if they come to realize that they are getting bigger and “big girls” don’t do these things.

You are riding a fine line between helping her become aware of the problem yet avoiding shaming her about it. Please keep in mind that the client also may need psychological intervention.

I hope this helps you think this through. My book called How to Stop Thumbsucking addresses the basics of eliminating any oral habit. It is easy to read and appropriate for therapists, educators, and parents.