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In the latest episode of Here Comes Honey Boo Boo, Alana Thompson’s family must make a scary medical decision about their youngest member, baby Kaitlyn.

As we already know, Anna’s daughter, Kaitlyn, was born with two thumbs on one of her hands.

Now that Kaitlyn is one year old, it’s time to consider removing it.

As Honey Boo Boo explains, she isn’t the only family member with an interesting body part. Mama June has forklift foot, Sugar Bear has his inside parts reversed (his heart is on the wrong side), Anna’s got a weird skinny gene, Jessica’s got shark teeth, and Uncle Poodle’s got nine toes.

Honey Boo Boo’s niece, Kaitlyn, was born with two thumbs on one of her hands

Honey Boo Boo’s niece, Kaitlyn, was born with two thumbs on one of her hands

They’ve got two options: leave the thumb there and she grows up with it or remove it. Problem is, Anna wants her baby to have the surgery and Mama June is against it.

June Shannon is afraid that the surgery could go wrong and it could paralyze Kaitlyn’s remaining thumb. She also is fearful of putting such a little baby under anesthesia. But Anna is worried about it being the butt of jokes or the reason Kaitlyn is teased as she grows older.

That doesn’t mean she’s not worried about the procedure. Anna cries knowing that her daughter has to go through surgery and the possibility something might go wrong. The issue becomes a real source of tension between Mama June and her eldest daughter. But Anna doesn’t back down asserting that the decision is ultimately up to her.

After a visit with the doctor, Anna decides to wait a year.

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Honey Boo Boo and her family posed for a photoshoot in the hilarious season finale of reality show Here Comes Honey Boo Boo to air on Wednesday night.

Things don’t quite go to plan as the gang take part in a family portrait, with the 101°F heat causing tempers to flair as Honey Boo Boo smudges her make-up off and ends up resembling “a football player”.

The action kicks off with the Thompson crew dressing up for what is meant to be some fun in the sun, including the pageant hopeful sporting a pink floral frock and gold clips in her blonde hair.

Mother June Shannon even turns a little philosophical as she is seen telling the camera: “Beauty comes from within. If you’ve got a great personality and everything, then it shines through to the outside.

“It doesn’t matter. Big, small, little… beauty is in the eye of the beholder. Skinny, fat, it don’t matter.”

Honey Boo Boo smudges make-up as family portrait turns sour in season finale

Honey Boo Boo smudges make-up as family portrait turns sour in season finale

Father Mike “Sugar Bear” Thompson then muses over his choice of outfit, oblivious to the comedic deadpan delivery, saying: “I just went casual, I’m not the dress-up type – unless it’s a funeral.”

However, things soon take a turn for the worse as the soaring heat fails to impress anyone.

Precocious Honey Boo Boo, real name Alana Thompson, is seen pinching a water bottle from her mother while June Shannon is still drinking, with the cheeky child claiming she thought the family matriarch had finished sipping.

The seven-year-old then grows irritable and very tetchy, bemoaning “the heat drains me”, before rubbing her eyes and being told she resembles “a football player” after her eye make-up smudges.

June Shannon also rather unattractively says: “Man, I’m taking a bath in my own sweat.”

Another drama to unfold in the episode sees Honey Boo Boo gearing up for a big pageant, before plans change as sister Anna Chickadee goes into labor, and the arrival of baby Kaitlyn is captured on camera.

The season finale of Here Comes Honey Boo Boo airs on Wednesday at 10:00 p.m. ET/PT on TLC.