When young kids scratch, bite or hit themselves

A child might rock on hands and knees, bang their head on the pillow, mattress or crib, roll their head side to side, or hum in time with the movement.

Body-rocking may start around 6 months and head-banging around 9 months. Most children stop by age 5.

Head slapping can be a way of saying “I’m frustrated,” “I want that,” or “Please stop asking me.” Slapping the ears or banging the head can also be a sign of pain or discomfort.

Hand biting may help a child cope with anxiety or excitement. For some children, a safe thing to bite on instead can help.

Scratching and pinching are among the ways children may self-injure. If it keeps happening, mention it to your child’s doctor.

Many young children twirl or pull their hair, and many stop as they get older. Hair pulling can happen when a child feels frustrated, stressed or bored.

Nail-biting is one of the most common childhood habits. Occasional nail biting or skin picking is usually just a habit. It’s worth getting help if it causes sores, infection or distress.

The most common idea is that rhythmic movements are self-soothing, perhaps copying the feeling of being held or rocked. They often happen at naps or at night.

A child who can’t yet explain what they need may show it with their body. Self-injury can be a way of showing needs, wants or feelings when there’s no other way to communicate.

Feeling unheard, being told off, having little choice, or hearing arguments can all set it off.

Ear slapping or head-banging may be a child’s way of showing discomfort or pain. Behaviour that started because of pain can later continue as a way to get out of hard situations.

Bothersome sounds, smells or uncomfortable clothes can be too much for some children. Others may be seeking strong sensations, and activities like jumping or swinging can meet that need in a safer way.

Too much time awake in bed before falling asleep may lead to more rocking and head-banging. Snoring or tiredness in the morning could point to a sleep problem, like obstructive sleep apnoea, that the doctor can check.

Habits usually give a child something in return. Some children use them for attention or to get a reaction from parents.

At bedtime, if rocking keeps a parent nearby, a child may do it more.

You usually don’t need to be concerned if your child is healthy and developing well during the day, and rocks or head-bangs only as a way to settle. Most children need no treatment.

Head-banging may cause red marks, slight bruising or thickened skin, but for most children it doesn’t cause serious or lasting injury.

• It happens during the day too
• It’s causing injuries, or you fear it could
• It’s disturbing sleep, or your child snores or seems tired and hard to wake
• It gets worse when your child is stressed or irritable
• Your child seems anxious or unhappy
• You notice delays in speech, movement or eye contact
• You wonder if it could be a seizure

• Bald patches, or a lot of hair on the pillow or floor
• Infected nails or fingers, or sores that keep coming back
• Signs of swallowing hair, like vomiting, belly pain or loss of appetite
• The habit is causing teasing or getting in the way of daily life
• Your child seems anxious, low, or driven by worried thoughts

Scolding, punishment or teasing can make habits like hair pulling or nail biting worse. Calmly saying what you’d like instead, and praising self-control, works better.

Lots of attention on the behaviour can raise a child’s anxiety. Praise for using a coping skill is usually more helpful than nagging.

For a child in a bed, remove bedside tables and other hard surfaces and move the bed away from walls, or put the mattress on the floor.

For babies under 1, don’t add bumpers or pillows to the crib. See the bedtime section below.

If a task seems too hard or overwhelming, pause it and come back when your child is calmer.

The American Academy of Pediatrics advises placing babies on their back for every sleep, on a firm, flat surface with only a fitted sheet. Keep pillows, blankets, bumpers, toys and other soft items out of the sleep area.

• Bed sharing is not recommended
• Don’t use weighted blankets, sleepers or swaddles
• Share a room, with baby in their own sleep space, for at least the first 6 months
• These rules apply until age 1

Think about how long your child is in bed before falling asleep, since a lot of time awake in bed may lead to more rocking. Avoid giving the behaviour lots of attention.

If you’re concerned, take a video of the behaviour so your child’s doctor or nurse can see exactly what happens.

Some children pull hair without noticing, often while absorbed in something like TV. Simple cues, like tying hair back or wearing a jingly bracelet, can help them notice the urge.

Offer something to keep hands busy, like a squeeze ball, a beaded bracelet, drawing or play dough. Suggest a replacement, like wiggling fingers, and offer distractions.

Ask your child whether they want to stop and what might help. Praise and small rewards for self-control work better than reminders, and it takes time.

Healthy food, active play, enough sleep, relaxation and things they enjoy can all help, because stress can make hair pulling worse.

Habit reversal training, a type of behaviour therapy, helps children spot when and why the habit happens and practise something incompatible, like squeezing a ball. Most of these more persistent patterns start later, in late childhood or the teen years.

If habits seem driven by worried or “stuck” thoughts, mention this to your child’s doctor. The “OCD in children & teens” guide has more.

Visual supports, like pictures of body parts or pain symbols, help a child show pain, discomfort or needs. Tell your child what to do instead in simple words and pictures, and praise them when they switch.

A predictable daily routine can reduce anxiety. Include a mix of activities to limit boredom, and plan ahead for transitions.

Activities like trampoline jumping or swinging can meet a similar sensory need. For hand or arm biting, a safe item to bite on may help.

Reward calm periods and helpful behaviour straight away, and say clearly what you’re praising. Some children don’t enjoy social attention, so a favourite activity or toy may work better than words.