Child hitting themselves when upset

It’s a jarring experience for any parent the first time that their adorable and sweet baby reaches up and hits them. It’s even more confusing for parents to see their toddler turn their anger inward, and hit themselves. Children who have never been physically disciplined may still hit themselves, scratch themselves, or pound their head against walls or the floor when they’re frustrated. Why do toddlers do this? What can parents do to stop it, and when do you know whether you might need to seek further professional guidance if your child has this problem?

Dr. Patricia Kurtz, the director of neurobehavioral outpatient services at the Kennedy Krieger Institute’s Department of Behavioral Psychology, has done extensive research on this type of behavior in young children. Her research has found that self-injurious behavior usually emerges before the age of 1. Very young children who can’t effectively communicate may use self-injurious behavior as a method of communicating their distress or frustration to their caregivers. Since toddlers are also interested in experiencing new sensations, some toddlers may experiment with hitting or pinching themselves just out of curiosity — the same reason that they grab a set of keys off the table and put it in their mouths. Dr. Kurtz has found that there are at least 1 of 5 common risk factors among families where the self-injurious behavior persists beyond a brief stage: parenting practices, child communication, caregiver depression, caregiver stress, and lack of social support. Children who have trouble communicating with their caregivers in typical ways but who have caregivers who respond swiftly to self-injurious behavior may fall into a pattern of repeating that behavior to get their caregiver’s attention.

Watching their children harm themselves can be scary for parents, and make them want to rush in stop the behavior immediately. However, a big reaction can inadvertently make the behavior more attractive to a child. Janet Lansbury, a parent educator, recommends that parents try to stay very calm. For a child who is banging her head against the floor, Lansbury recommends slipping a thin pillow under her head instead of trying to physically restrain the behavior. For a child who is biting himself, she suggests saying something like “Yeah, ooh. You wanna bite yourself. Here’s something you can bite,” and offering the child a teething ring or another safe toy.

When is self-injurious behavior a sign of autism or other developmental delays?

Researchers at the Department of Educational Psychology at The University of Minnesota studied a group of 149 children at ages 1, 2, and 3 who had older siblings who were autistic and to help determine the relationship between self-injurious behavior and autism. Their research found that while nearly 40% of children displayed self-injurious behavior at age 1, that figure had dropped to less than 25% for 3-year-old children. Children with autism, however, were 4 times as likely as other children to injure themselves. Autistic children may display other behavior including poor eye contact, difficulty maintaining conversations, and may exhibit restrictive or repetitive patterns of behavior. If your child’s self-injurious behavior consistently continues after the age of 1 or seems to increase in duration or severity, it’s a good idea to talk to their pediatrician to determine if it might be a sign of developmental delay or other condition.

Though many children may get over their phase of self-injurious behavior without any interventions, it’s important for parents to pay attention to what seems to trigger the behavior. Keeping a record of when the behavior started, when it appears, and whether it is getting more or less severe can help your child’s pediatrician and other professionals effectively treat the behavior. The options for treatment are different if a child self-injures in response to pain (a toddler with an earache may bang their head to distract themselves from the pain in the ear) versus a child who is using self-injurious behavior to try to communicate. For older children whose self-injurious behavior is in response to their struggle to communicate, sign language or a communication board can help mitigate some of the frustration that causes the urge to self-harm. In some cases, a doctor may prescribe medication or suggest other alternatives to try to lessen the behavior.

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