Bed-Wetting

Bed-wetting (also called “nocturnal enuresis”) is not a “behavior problem” – rather it is a physical problem. There are many possible reasons for nighttime accidents, including:

  • Small bladder. If a child’s bladder isn’t fully developed, it may not be big enough to hold all the urine produced during the night.
  • Genetic factors. Parents who were bed-wetters themselves have a higher chance of having children who are bed-wetters. When nocturnal enuresis is genetically inherited, the problem can persist for longer than usual. For instance, it can be a family tendency that the kids still wet their beds past 7 or 8 years of age. Indeed, in some cases bed-wetting can continue right through adolescence (and even into adulthood). Medical treatments can usually provide significant relief.
  • Poor signals. The child fails to awaken when the bladder is full because the brain is not registering the “full” signal.
  • Slow or delayed nervous system development.

Bed-wetting may also be an indication of another medical problem, including sleep apnea, diabetes, urinary tract infection, problems with the urinary system, or constipation. If wet nights are consistent, talking to a doctor about the problem is recommended. Bed-wetting can also result from emotional stress such as occurs when parents are fighting frequently, someone in the family is ill, there are significant changes in the child’s life, he or she is being bullied or abused, a new baby is born into the family, or when any other form of stress is present in the child’s life.

Distinguishing between Normal and Not Normal Bed-Wetting
Bed-wetting is common in households with young children. At which age can parents expect bed-wetting to stop? How can parents tell if their child is going through a normal developmental phase or if their child has some sort of problem that requires professional attention?

Bed-wetting is common and normal for children under the age of 5. However, by the age of 6, bed-wetting should be a rare occurrence. If it is still happening twice per month in this age group, it can be considered a medical problem that should be attended to. Although the doctor may find that everything is perfectly normal and simply prescribe “patience,” it is important to rule out possible medical issues at this stage.

In addition, if a child starts wetting his bed after long periods of dry nights, or if he experiences pink or painful urination, unusual thirst, or snoring, he should be seen by a doctor.

Stopping Bed-Wetting
Bed-wetting in young children usually stops on it’s own so it’s best not to start any treatment until the child is six or seven years-old (although it is sometimes started earlier if the bed-wetting is damaging the child’s self-esteem and/or relationship with family/friends). Helpful treatments and techniques may include:

  • Bed-wetting alarms – these sound a loud tone when they sense moisture and can help by conditioning the child to wake up at the sensation of a full bladder
  • Decreasing the consumption of liquids before bedtime
  • Praising the child when he has a dry night
  • Avoiding punishments, reprimands and other signs of disapproval
  • Waking the child at night  to empty his bladder
  • Encouraging the child to go to the bathroom before bedtime
  • Diapers, pull-ups or absorbent underwear can be helpful in managing bed-wetting (and is especially helpful in avoiding embarrassment at sleepovers or similar activities)

Some medications such as anti-diuretic hormone nasal spray or tricyclic anti-depressants may also help. If the bed-wetting is occurring due to emotional stress, consulting a child or adolescent psychiatrist or psychologist can be helpful.

Obsessive-Compulsive Disorder (OCD)

Parents may wonder if their child has OCD when they notice that the child seems overly occupied with worries and strange behaviors. If the parent has seen something similar in another family member who has already been diagnosed with OCD, he or she may suspect that this child may also have the disorder.  Other parents have no such frame of reference and are simply perplexed by their youngster’s behavior.

Small children are often anxious and ritualistic – they want their parents to give them 10 kisses at bedtime and stay with them the whole night! It’s very difficult for a parent to know whether such behavior is just normal childish behavior or something that requires professional attention. However, when a child starts demanding 24 kisses – exactly 12 on one cheek and 12 on the other – a parent may become suspicious. It doesn’t “feel” or “sound” right to him or her. The only way to know if the child’s feelings and actions are within the normal range is to obtain a proper assessment.

A  diagnosis  of OCD can only be confirmed or dis-confirmed by a qualified mental health professional. If you are concerned about your child, talk to your family doctor or pediatrician – this person can refer you to a psychiatrist or clinical psychologist for an assessment. OCD will not normally be diagnosed unless the symptoms are causing the child significant distress or unless they are affecting the child’s school life, social life or home life adversely. Even if the child is diagnosed with OCD, there is much to be hopeful about: there are excellent behavioral treatments for OCD. People who receive treatment have a good recovery rate.

What is OCD?
OCD involves obsessions and compulsions (also called “rituals”). Obsessions are “sticky” thoughts – thoughts that just won’t go away (at least not by themselves). A teenager might obsess about whether she remembered to lock the door. Instead of just leaving the house like others do, she thinks about that door, asking herself over and over again if she remembered to lock it. Obsessions can also be sensations – a type of feeling. For instance, a child might pull his sock up over and over again until it hits a spot on the leg that feels “just right.” His mother might say that he is obsessed with getting just the right spot and she would be correct – the youngster cannot tolerate the feeling of the sock being at the wrong spot. Compulsions are actions that a person does that either “undoes” an obsession or ends it in some way. Spending lots of time arranging the socks is a compulsion. The teenager who is obsessing about whether or not she remembered to lock the door, may go back to the house 2, 3, or more times “to make sure.” The ritual of checking is called a compulsion.

A common obsession has to do with the fear of becoming contaminated. This may involve a fear of germs. “I don’t want to touch the money because everyone else has touched the money and it probably is full of germs and germs are dangerous.” Equally common is the ritual of excessive washing in order to clean oneself of germs or contamination. “My daughter washes her hands until they bleed.” This is not normal washing that is meant to remove surface dirt; rather this is OCD washing that is meant to remove spiritual impurities that can harm a person. In fact, in order not to HAVE to wash oneself, OCD sufferers start to avoid being near problematic triggers. For instance, they might only handle money while wearing gloves (so their hands won’t touch the contaminated money and they will then not have to wash off the contamination). Or, they  may not open a door with their hand – they might use a foot or an elbow or ask someone else to open it. Avoidance actually contributes to the illness – the more a person avoids OCD triggers, the stronger the illness of OCD becomes. In fact, the major aspect of treating OCD involves teaching the sufferer to avoid avoidance! A child must be helped to confront and live with his or her worst fears.

Most obsessions center around issues of health, safety, goodness and cleanliness. As stated above, they can also center around certain “right” feelings (like the feeling of having a shoe lace tied up “just right”).

For instance, children and teens can obsess about the idea they have might have made a religious error. To “fix” it they might pray for hours on end (missing school in the process). Some people want to do things perfectly; a child may write something, erase it, write it again, erase it, write it again, over and over and over again – destroying the paper and taking hours to perform a task that other children are completing in minutes. Some people with OCD need to have everything in a certain order – for example, in order from biggest to smallest. Again, trying to get it that way can take painful hours; if the order is messed up by someone else, the person with OCD can become hysterical. These are just some of the common variations of OCD. There are many others and each person can have his or her own unique version of the disorder.

Treatment for a religious obsession might be insisting that the youngster DOES NOT pray for more than the normal few minutes that prayer takes a healthy person. In other words, the youngster must just live with the worry that perhaps she did something wrong. Instead of making that worry go away by praying excessively, she must just have the worry without doing anything to fix it or end it. This sort of treatment has the effect of stopping the worry altogether. Therefore, no more excessive praying is required. No obsession leads to no ritual which essentially is no OCD.

Obsessive-Compulsive Disorder (OCD)
People who suffer from OCD, even kids, usually know that their thoughts and actions are irrational, and they often feel distressed over their lack of control. The obsessions and compulsions, however, feel more powerful than a person’s will. The obsessive compulsive person is trapped in a vicious cycle; he or she needs to behave a certain way (perform a ritualistic behavior) to relive stress and anxiety, but the behavior itself creates more stress and anxiety. This can lead to intense attempts to avoid situations that will trigger the compulsion. For instance, if someone knows that touching a doorknob will create anxiety that can only be soothed by repeated washing of the hands, then he will try not to touch the doorknob. Instead, he might ask someone else to open the door, or he might open it with his elbow or he might wear gloves in order to open it. The time it takes to perform rituals can severely affect a person’s life and the difficulty of avoiding triggers can make a person function in a very odd way. OCD is thus very stressful. Attempts to manage OCD can sometimes lead to other mental health complications, such as clinical depression, other anxiety disorders, substance abuse and/or other impulse-control issues. OCD is sometimes found in people who have other clinical disorders like anorexia, Tourette’s Syndrome or ADD/ADHD.

What Causes  OCD?
Current thinking suggests that that OCD is a biologically- based condition, possibly the result of serotonin deficiency in the brain and other chemical conditions. It has been observed that OCD tends to run in families (that is, other family members have OCD or they may have other anxiety disorders) and therefore it is thought that a vulnerability for the condition is passed on through the genes.  OCD can also occur in a form called PANDAS  (pediatric autoimmune neuropsychiatric disorder) – when it suddenly appears following a streptococcal infection like strep throat. In this case it is believed that OCD is triggered by the same bacteria that causes scarlet fever and strep throat. Again, it might be that a person must have the vulnerable genes in order for the bacteria to have this effect.

What is the Treatment for OCD?
OCD is best treated with CBT – Cognitive Behavioral Therapy. Although some teens and adults can relieve their own symptoms with self-help by reading books on OCD (see for instance, “Overcoming Compulsive Washing” or “Overcoming Compulsive Checking” by Dr. Munford), most people will have the best results by consulting a qualified mental health professional who specializes in the diagnosis and treatment of OCD. Ask your doctor for a referral. Parents should read up on OCD and get professional counseling to know how to best help their child. Uninformed parents often accidently worsen OCD by helping the child AVOID triggers. As we saw above, EXPOSURE to the frightening element is curative – NOT avoidance! Parents need to know exactly how to help their child or teen in the home setting. The earlier OCD is treated, the easier it is to treat. On the other hand, the more one lets OCD fester, the more they will experience its symptoms. It is possible that intense stress causes certain physical conditions in the brain that then trigger the dynamics of OCD. Relieving stress may make it easier to treat the OCD. Therefore, psychotherapy may play a role in helping ease OCD by reducing overall stress and anxiety in the system (much like medication does) so that CBT can be effective.

Natural Treatment for Stress Relief

Bach Flower Remedies are one-ounce bottles of specially prepared water (see below for details). Although they are only water, they can affect the way people feel emotionally. In fact, they can help balance emotions so that a person can release stress, upset, hurt, anger, fear, sadness, irritation, jealousy, impatience  and any other distressed emotion. Indeed,  many people report that they have successfully used Bach Flower Remedies to feel calmer, sleep better, worry less, recover faster from upset and heartache, handle parenting stress and work stress better and so on. Many have also reported that they were able to see a reduction in their child’s tantrums, aggressive behaviors, moodiness  or fears because of the use of the remedies.

But the remedies can do even more than help a transitory bad feeling : they can also help correct the tendency to fall into those feelings in the first place. When the remedies are used to treat a chronic emotional issue (like a tendency to be stubborn or a tendency to be explosive), they might actually be assisting in a processes now referred to as  “epigentic healing” – the healing of the gene that leads one to experience chronically negative emotional states. We now know that genes can be turned on and off and this is what appears to be happening when someone takes a long course of Bach Flower Therapy. This means that a child who tends to be very shy can take the remedies over time to reduce the shy tendency altogether. The Bach Flowers do not change personality, however. What they do is enable a person to be their own best self. A very strong-willed, obstinate child will retain his strength of character but instead of just being difficult to live with he will be his best self: a born leader, a confident person, one who can take appropriate action. When the Flower Remedies help a childhood overcome chronic separation anxiety, they leave the child’s personality intact: it is the same youngster without debilitating fear blocking the expression of his true self.

It’s hard to believe that these little remedies can work and it’s best not to even TRY to believe that they will; rather, just try the remedies yourself and observe how you feel while taking them. Or, offer a remedy to your child and observe the child’s behavior over the next days and weeks to see if there is any difference. Bach Flowers sometimes seem to have a dramatically positive effect on both behavior and mood and other times seem to make little difference. (Of course, there is no medical or psychological treatment either that works equally well for every single person who employs it.) In the latter case, it might be that the wrong mix of remedies is being used, but it can also be that a longer period is necessary before change will occur or even that a particular person is not responsive to the remedies at the particular time that they are being offered (i.e. this could change in the future). It can also be that while the Bach Flowers are having some positive effect, a complete treatment  requires other interventions as well including strategies like nutritional support, exercise, psychotherapy and/or medicine.

How are Bach Flowers Prepared and Used?
Dr. Edward Bach, a prominent physician in Britain who died in 1935, was interested in preventative medicine. In his search for something that could boost the immune system to ward off disease or to help the body recover more quickly and thoroughly from illness, he discovered a water-based method of healing that became known as “Bach Flower Therapy.” Modern physicists use principles of quantum physics to explain how water remedies can affect human emotions. Dr. Bach, however, understood the remedies on a purely intuitive level. He felt their effects and he could see what they were able to do to effectively relieve stress and emotional distress.

Bach Flower Remedies are prepared by taking the head of a certain flowering plant and placing it in a clear bowl of pure water. The water is heated in sunlight or on a stove for several hours (depending on which flower is being used) and then the flower is removed. The water is the remedy. It is bottled (and preserved with a bit of grape alcholol) and – in our times – sold in health food stores throughout the world as well as on-line.

Bach Fower Remedies are a form of vibrational medicine, not herbal medicine. They are NOT medicinal. They do not act on the body at all. They don’t interact with other medicines or foods or health conditions or anything. They are the same as water is to the system. However, if someone cannot have even a minute amount of alcohol in their system, they should look for the newer remedies that are made using glycerin instead. In general, however, anyone can safely use Bach Flower Remedies – babies, children, teens and adults, pregnant women and elderly people. Even plants and animals respond well to the Bach Flowers!

How Does One Take Bach Flowers?
If a person is using only one of the 38 remedies, they can take 2 drops from the remedy bottle in a small amount of liquid. They should do so 4 times a day – morning, mid-day, afternoon and evening.

However, most people take anywhere from 2 to 7 remedies that have been mixed together in a “mixing bottle.” To prepare a mixing bottle, one places water in a glass bottle with a glass dropper – generally a  30 ml  (1oz.) amber bottle. (These bottles are sold wherever Bach Flower Remedies are sold and they are called Bach Mixing Bottles.) Then one adds 2 drops from each desired remedy bottle. If a person was using 7 remedies, they would be adding 14 Bach Remedy drops to their mixing bottle. To ensure that bacteria does not grow inside of the mixing bottle, a teaspoon of brandy or apple cider vinegar should be added to the bottle.

This Bach Flower Remedy Mixture is then taken, 4 drops at a time, in hot or cold liquid, with or without food. Ideally, these 4 drops are taken 4 times a day, for a total of 16 drops daily. A person takes them in the morning, mid-day, afternoon and evening.

Adults can put 4 drops of their Bach Flower mixture into coffee, tea, water, juice, soup or any other liquid. Children can take their drops in water, chocolate milk, juice, cereal or any other beverage.

A person takes their mixture until they start forgetting to take it and they no longer need it. (Or, parents give a mixture to a child until the child’s behavior or mood issues have resolved to the point where the parent is now forgetting to give it to the child)  If symptoms return (and they most likely will), the person starts taking the remedy again. In fact a person may end up using the remedy off and on for a year or two (less time in children) before the problematic tendency  disappears completely.

How Does One Know Which Remedies to Use?
Dr. Bach wanted to keep his healing method very simply. A person should be able to read the description of the 38 remedies and decide which ones he needs. Of course, some people feel that they need all 38! However, no more than 7 should be used at a time.

A person could pick up a book on Bach Flower Remedies and decide which flowers they need based on the description of who the remedy is for and what it can do. Also, most health food stores have a pamphlet that explain what the remedies can too. Alternatively, a person can make an appointment with a Bach Flower Practitioner who will be pleased to help them design a remedy for themselves or their child.

Arranging Everything Just So

Some children are fussy about their things. They like everything in it’s place. Others care so little about this that their parents struggle with them for two decades to clear a path to their beds! And yet, despite the obvious benefits of being very neat and organized, this trait can sometimes be problematic. The basic question is, when is it too much?

If your child has to have everything “just so,” consider the following tips:

Monkey See, Monkey Do
If you or your spouse also like everything “just so,” it may simply be that your child is copying your style. Sometimes, the child’s copy is more intense than the parent’s original, but if it is in the same department, it may be nothing more than a learned behavior. As long as none of  you gets overly distressed when something is out of place, there is nothing to be concerned about. However, if any of you become extremely agitated when something is missing or not in exactly the right position or angle, then things are not quite as they should be. In that case consider the information below.

Nervous Habits
Arranging things “just so” can help calm inner feelings of tension and mild anxiety. Tension might be barely perceptible, not even conscious. However, straightening things up can bring a pleasant sense of order to an inner chaotic state, even when the person is not even aware of the inner chaos. In other cases, the person IS aware of feeling uptight or bothered and knows full well that cleaning, straightening, organizing or adjusting things helps calm him or her down.  Even when it accomplishes this, however, the inner tension has not been properly dealt with. There are much better ways of handling stress, such as using mindfulness meditation to see what exactly the stress is and to clear it out of the system, or some other strategy like EFT (emotional freedom technique) or Focusing (a technique for paying direct attention to the stress in the body to ‘meet and greet’ it and release it).

Consider an Anxiety Disorder
An intense need to have everything “just so” can also be part of the anxiety disorder called “obsessive-compulsive disorder” (OCD). The same psychological dynamics are at play in OCD as described above for normal stress and tension. However, in the case of OCD, the brain itself gets “hooked” or addicted to the behavior that releases the stress (in this case, arranging things just so). Once the brain is hooked, failing to be able to arrange things just so can cause an intense withdrawal reaction, including feelings of panic, rage, overwhelm, extreme irritation, and more. OCD is a physical disorder, a condition of the brain itself. Fortunately, the brain can be rewired to become “un-addicted” – but this may take some professional cognitive-behavioral therapy (and in some rare cases, the help of medication). Parents need to know how to help their compulsive child because ignorance not only fails to help, but it can actually worsen the child’s brain condition. In other words, when parents respond appropriately to their child’s need to arrange things just so, they can help re-wire the child’s brain, but when they respond inappropriately, they can actually help wire it in the WRONG direction! Therefore, if you suspect that your child may be suffering from OCD or OCD-like behavior, arrange for a consultation with a child psychologist or other mental health professional for a proper assessment and, if necessary, treatment plan.

Over and Over Again

When a child or teen repeats actions for no obvious reason, there is often a reason! In fact, there are many reasons why young people might repeat movements or actions. Let’s look at the more common ones.

  • Pervasive Developmental Disorders (PPD): Some mental health disorders like autism, Asperger’s Disorder and PPDNOS (pervasive developmental disorder not otherwise specified) may have repetitive behaviors as part of their symptom picture. For instance, there may be rocking or rhythmic movements, hand flapping or twirling. Such behaviors in and of themselves do not indicate the presence of a pervasive developmental disorder – many other symptoms must be present for a diagnosis to be made. Behavioral Therapy may help reduce these kinds of repetitive behaviors.
  • Simple Nervous Habits. Some children kick their legs back and forth when seated or rock back and forth, or twirl their hair or even crack their knuckles.  This sort of repetitive behavior may just be a discharge of “nervous energy.” Unless these behaviors interfere with functioning or cause distress, there is no need to treat them. However, some people find that giving their children Bach Flower Remedies (try “Agrimony”) may help reduce nervous habits. Consult a Bach Flower Practitioner for an individually designed remedy most appropriate for your child’s needs.
  • Tourettes Syndrome. Tic disorders are, by definition, repetitive behaviors. SImple Tic Disorders such as Transient Tic Disorder (common in 7 – 9 year old children) may consist of one repetitive behavior such as blinking or twitching a shoulder or clearing the throat. In simple Tic disorders, the particular behavior may change from time to time, or, there may be more than one movement or sound involved. These sorts of tics usually disappear on their own within a year or so, although in some children they can last years or right into adulthood. In Tourette’s Syndrome, the child has BOTH repetitive movement and repetitive vocalization occuring, and there can be more than one of each kind. Bach Flower Remedies have helped people with Tic Disorders. There are also medications that your doctor can presecribe. In addition, there are behavioral therapies that can help bring tics under control.
  • Obsessive Compulsive Disorder (OCD)When a child feels compelled to repeat certain behaviors and very anxious if he is prevented from doing so, he may be suffering from OCD. OCD is an anxiety disorder that consists of worries (obsessions) and rituals (repeated behaviors). Sometimes the child is aware of the worry (i.e. he is afraid that someone in his family will become sick) and sometimes he just feels anxious without knowing why. In either case, he discovers a series of repetitive actions that makes him feel temporarily calmer. For instance, he may count numbers in his head, or take a certain number of steps forward and backward, or wash his hands a certain number of times or write and rewrite and rewrite his schoolwork. There are many variations of repetitive behaviors that those who have OCD may perform. If the child’s behavior interferes with his functioning at home or school or if he is very distressed by having to do them, it is highly possible that OCD is the culprit. However, only a professional child psychologist or psychiatrist can make an accurate diagnosis and prescribe an appropriate treatment plan (usually consisting of cognitive behavioral therapy -CBT and sometimes, medication as well).
  • Physical Disorders and Medications. Occasionally repetitive behaviors can be symptomatic of a medical condition or a reaction to medication. Your pediatrician or GP can do an assessment for you.

Habits

What’s the difference between a bad habit, a nervous habit and a compulsive habit? When should a parent be concerned about a child’s habit?

Bad Habits
Everyone has bad habits. Leaving one’s dish on the table is a bad habit – one that many kids (and adults!) have. Calling a sibling “stupid” or some other insulting name can be a bad habit. Slamming the car door too hard can also be a bad habit. A bad habit is any repetitive behavior that needs improvement. That behavior can be a small, annoying behavior or it can be a more serious problematic behavior. For instance, a teen might have a bad habit of calling home past midnight to say that he’ll be out later than expected, or, he might have a really bad habit of forgetting to call home at all and just showing up at 3 in the morning.

Parents can help their children overcome bad habits by using normal parenting techniques like teaching, rewarding and disciplining. If the child’s bad habit is interfering with his health or functioning, however, then professional intervention is a good idea. For instance, a child who is chronically sleep-deprived due to going to bed too late or who is doing poorly in school due to chronically getting up too late, may benefit from counseling or other appropriate therapy.

Nervous Habits
Nervous habits are bodily behaviors that aim to discharge stress or tension. Twirling one’s hair, biting one’s nails, rocking back and forth, shaking one’s feet while seated – all these actions are examples of nervous habits. Talking rapidly, running to the bathroom urgently, gulping down food, giggling inappropriately – these, too, can be nervous habits.

If a child has a nervous habit he or she may benefit from learning better techniques for stress reduction. There are children’s classes and groups for yoga and mindfulness meditation that can be helpful. Alternative therapies can also help. For instance, herbal medicine can come the system down and Bach Flower Therapy can relieve stress and tension. Parental nagging to stop the nervous habit, on the other hand, does not help at all – if anything, it might increase the nervous habit. If the habit is bothering the child or parent, a consultation with a mental health professional may be helpful.

Compulsive Habits
While bad habits and nervous habits occur to some extent in almost everyone, compulsive habits occur only in those who have various mental health disorders. Eating disorders often involve compulsive activities like weighing oneself or cutting food into tiny bits. Certain kinds of psychotic disorders also have compulsive symptoms.

Compulsive habits are most characteristic of the anxiety disorder called obsessive-compulsive disorder (OCD). This sort of habit is more ritualistic than the habits we’ve discussed so far. For instance, someone with a “nervous” habit might tap her feet while waiting in a long line. However, someone with a compulsive habit might tap her feet exactly 13 times – not because she is tense, but because she is attempting to reduce truly anxious, troubling feelings. Tapping exactly 13 times – not one less or one more -is a compulsion. A compulsion is a specific action whose purpose is to calm the anxiety associated with troubling obsessions (thoughts or sensations). There are many, many types of compulsive habits. Washing one’s hands a certain number of times is a common compulsive habit that often results in red, chapped, even bleeding skin. Counting steps, saying certain words or numbers, checking things repeatedly, praying in a specified way not characteristic for others who practice the same religion – all of these can be compulsive habits. The child who engages in these or other compulsive habits is a slave to the habit – he or she MUST perform the action or else suffers overwhelming anxiety.

Compulsive habits do not tend to go away by themselves. Instead, they get worse and worse over time and spread into more and more styles of compulsive habits. The sooner a child receives professional treatment for compulsive habits, the sooner the child will be able to lead a normal, healthy, compulsion-free life. If you think that your child’s habits may be compulsive in nature, arrange for an assessment with a mental health professional (psychologist or psychiatrist). Treatment can help!

Head-Banging

Seeing one’s child banging his or her head against the wall or a wooden bed is alarming for parents, especially if the child is a baby or toddler. Parents are not only concerned about the possible pain and injury that may result from such an activity – they are also worried about the child’s psychological well-being. “Is something wrong with my baby?” is a reasonable question for parents to ask when their child deliberately harms himself.

In fact, in most cases, a child’s head-banging is caused by a normal desire for stimulation or soothing (as we will discuss below) — not by underlying mental health issues. Additionally, young kids rarely hurt themselves during head banging enough to cause considerable pain or head damage. Head-banging may also occur in certain developmental syndromes such as autism. In these cases, there will be other neurological and behavioral symptoms besides head banging. In an otherwise healthy child, head-banging is not a matter for intense concern.

What’s Behind Head-Banging?
Head banging can be a way for kids to get stimulation. The habit can relieve the discomfort of boredom or stress. Remember that during the toddler years, kids are in the process of understanding and appreciating different body sensations such as sights, sounds and  even feelings of pain and discomfort. The sensation that comes when we bang our heads against a hard surface is new and foreign to a child, and understandably, the child is curious about it. Thus he may repeat head-banging so that he can explore the sensation better.

It’s also possible for children to head-bang in order to soothe themselves when they are anxious, in discomfort or otherwise distressed. In these cases, head banging is no different from thumb sucking or nail biting. It’s ironic, but it’s possible that children find the pain of head banging a distraction for their current discomfort or unease. Some kids may also find the rhythm of soft head banging comforting, in the same way that a slow and steady drum beat can be soothing, rhythmic head banging can be reassuring to a child.

What can Parents Do?
Safety is always a primary concern. Even if head-banging is usually harmless, there’s nothing wrong with taking a few extra precautions. As much as possible, keep young children away from hard surfaces like walls or bed posts. If there’s a risk that they will run into a hard surface, protect your child by putting a soft pillow or foam padding as insulation. If you can make it impossible for your child to head-bang against something hard, then you can worry less about head-banging behavior.

It may also help to provide your child with stimulation and soothing when you feel that he or she needs it. Toys of different shapes and colors, as well as materials of varying comfortable textures and temperatures can provide stimulation to a child. Rocking, singing a lullaby or a soft massage are also positive ways to provide soothing.

When parents suspect that unease, discomfort or stress is causing the head-banging behavior, they can offer their child the Bach Flower Remedy Agrimony. Two drops in liquid four times a day can be used until the banging diminishes. Or, for a more complete treatment, call a Bach Flower Practitioner. You can find more information about the Bach Remedies online and throughout this site.

Older children who are banging their heads may need more than Bach Remedies (although these should be tried first). Stress reduction through professional psychological counseling may be very helpful. If very young children are stressed, family counseling may be preferable. Parents may be able to make environmental changes that put the child more at ease.

When Should Parents be Concerned?
While head-banging is generally normal and harmless, there are occasions of head-banging behavior when parents need to provide their children with stronger interventions and/or professional help.

One situation is when kids use head banging as a way to get negative attention, punish themselves or release anger and frustration. When head banging is a deliberate action to achieve an end, parents should arrange a consultation with a child psychologist. The psychologist may help the parents intervene in more appropriate ways or he or she may work with the child directly in order to reduce underlying tensions.

But a second situation is when parents suspect an underlying medical or psychological condition behind the head banging behavior. If head banging is seen alongside symptoms of social withdrawal, delayed speech and motor development, and inability to empathize, parents should consider consult their pediatrician. A referral to a mental health professional for assessment can confirm or rule out a diagnosis of autism or pervasive developmental disorder. Head banging that seems beyond a child’s control may be a symptom of Tourette’s Syndrome. Various seizure disorders may also account for head banging behavior. To be certain, it’s best to get a child diagnosed by the appropriate medical or mental health professional.

Rocking and Shaking

Babies often rock back and forth in their cribs starting around 6 months of age and are usually growing out of it by around a year and a half. The motion of their own bodies is soothing; babies love the sensation of being rocked by themselves or others.

Some children (and adults!)  also use rhythmic movements to “calm their nerves.” Rocking back and forth or shaking their legs helps to relieve stress. The behavior may be done almost subconsciously (without conscious intention or awareness) – it just seems to happen on its own. In other words, the child or teen does not actively think to him or herself, “I’ll rock now” or “I’ll shake my legs now.” While the child is sitting in a chair working or talking, the movements occur. Other people can interrupt the process by pointing it out: “Stop shaking your legs!” At that point, the child becomes aware that he or she was moving his legs. However, just a few minutes after stopping the movement, it usually starts again.

If your child is a “mover and shaker,” consider the following tips:

Rhythmic Movements are Usually Harmless
In otherwise normal children and teens, rocking and/or shaking is a harmless “nervous habit.” However, like other nervous habits, it can become socially unacceptable. Excessive movements disturb other people, even though they don’t seem to bother the rocker/shaker. There is an annoyance factor when someone keeps moving his or her body. If your child’s teacher reports negative peer reactions or other disturbances in school as a result of rocking or shaking, it’s time to help your child lose this habit and find more appropriate ways to self-soothe. When rocking and other rhythmic behaviors occur in a child who has other neurological or behavioral abnormalities, be sure to get a complete medical or psychiatric assessment. In these cases, the rocking may be part of a medical syndrome that requires attention.

Nagging Doesn’t Help
Telling a child to stop rocking or shaking is not an effective way of curing the habit. Although the child may stop for a moment or two, he or she will start again. Since the behavior is out of the child’s awareness, he or she is not exactly aware of when it begins or even that it is happening and therefore, has no effective way to interrupt it on a regular basis. It is annoying for the child to be told repeatedly to stop moving. Since this strategy causes tension between parent and child and does not effectively treat the problem, it cannot be recommended!

Stress Reduction May Help
Anything that helps the child relax his or her nervous system will help both directly and indirectly. The direct form of help is that it may relieve the tension and therefore the need to self-soothe. The indirect form is that it may make it easier for the child to successfully apply behavioral strategies. Herbal remedies or Bach Flower Remedies that calm the body and mind can be very helpful in both regards. See a professional herbalist or naturopath to assess your child and make up the appropriate herbal remedies. Alow time to see the results. Similarly, see a Bach Flower Practitioner to make up an individually tailored treament bottle for your child. Consider remedies like Agrimony and Impatiens and others that address your child’s personality. A homeopath or other natural healer may be able to help as well. In addition, it may be possible to teach the child stress reduction techniques like yoga or even breath-based meditations (or, for teens, mindfulness meditation). In some cases, regular, intense exercise will be helpful. Of course, reducing stress in the house is always helpful so anything you can do to keep calm, enhance your marriage and de-stress yourself, will help as well.

Behavioral Therapy
When rocking becomes dysfunctional (excessive, bothersome, embarrassing or otherwise disturbing), consult a behavioral therapist – someone who is experienced and skilled in the treatment of habits. There are also habit removal workbooks (i.e. The Habit Change Workbook by Pedrick) that you may be able to work through with your child or that your older child or teen can work through indepedently.

Picking at Skin

There are different ways to pick at one’s skin.  Some people, including children and teens, pick at the skin around the nails of the hand. Others pick at little scabs or sores that may be anywhere on the body (such as insect bites, blemishes, or injuries). Some create little sores by scratching themselves or irritating normal surface “bumps” on the skin and then, they pick at the newly formed sore. Some pick at their scalp. “Dermatillomania” is one name for this condition, although each type of picking has its own distinct name.

Lack of Control
Picking at the skin is an impulse control disorder. It has been compared to trichotillomania – a condition in which one pulls out one’s own hair from the eyebrows, or the eyelashes or from the scalp. It has also been likened to OCD (obsessive-compulsive disorder), a disorder in which a person performs ritualistic behaviors in order to reduce anxiety. Dermatillomania has also been considered to be a sub-category of Tourette’s Syndrome – a condition in which a person has compulsive tics (movements and sounds that just MUST be made, even though they serve no constructive purpose. No matter which way we categorize skin picking, it is always seen as a behavior that is related to tension release.

Stress and Dermatillomania
Skin picking occurs more frequently when a person feels stressed. It also decreases when a person is feeling more relaxed and in-control of their lives. Therefore, treatments aim to reduce tension and build emotional stability. Skin pickers often do not have healthy ways of handling their stressful emotions. Psychotherapy may be helpful – especially with teens and adults. Children may benefit from art therapy. Techniques like EFT (emotional freedom technique) can sometimes be helpful. Meditation and relaxation training, as well as hypnosis, have all been helpful in addressing this disorder. For adolescents and adults, there are also support groups that can be helpful. The workbook “The Habit Change Workbook” by Claiborn and Pedrick, takes a cognitive behavioral self-help approach that can also make a positive difference. Psychotropic medications like anti-depressants are sometimes used as part of the treatment. Each person who picks at his or skin has different psychological needs and therefore treatment is individualized to address those needs.

Getting Help
Skin picking can make a person feel out-of-control and ashamed. It is often done in hiding and it is rarely spoken about. People are embarrassed and therefore don’t even talk to their doctor about it. Therefore, people don’t get the help that is available for this highly treatable disorder. If you think that your child may have this disorder, or even if you are just concerned about seeing picking behaviors on occasion, do consider arranging for a mental health assessment. A professional will let you know whether treatment is necessary or not and if so, help design a treatment program that can help way beyond stopping this symptom.

Pulls Out Hair

Hair-pulling in children and adolescents may be perceived as a harmless habit. After all, if your child likes to pull, say 3-5 strands of hair a day, it shouldn’t make much difference to his or her scalp and hair health. The amount of hair that falls off naturally probably exceeds the couple of strands kids and teens pull for fun anyways. When should hair pulling become a concern?

Hair-pulling behavior can range in severity from mild to severe. There are those who ritualize hair-pulling for aesthetic purposes, e.g. getting rid daily of the strands that don’t fall obediently with the rest, or hair considered as “dead”. There are others who pull hair strands when they’re frustrated or upset. And then there are those who suffer from an impulse control disorder called trichotillomania – compulsive hair-pulling that can be so bad, sufferers end up with permanent patches of baldness.

What’s Behind Compulsive Hair-Pulling?
Like many impulse control disorders, compulsive hair-pulling is caused by a feeling of incredible tension and anxiety. For some reason, hair-pulling relieves the tension and anxiety. Once the hair-pulling is done, the child or teen with trichotillomania feels an immediate sense of release, gratification and even pleasure. This dynamic of “tension-behavior-relief” is what makes hair-pulling addictive, progressive and after a while, very difficult to resist.

Hair-pulling in trichotillomania is often concentrated on the hair on the head, although sufferers may also focus on eyelashes, eyebrows, moustache and beard, and hair from other places of the body. Hair-pulling can be of individual strands, although more serious versions of the illness have patients pulling clumps at a time.

Are There Serious Health Effects?
At first, hair-pulling may not cause any physical harm to hair follicles and the scalp. If compulsive hair-pulling can be stopped early, hair growth resumes normally. But in severe cases, repeated hair-pulling can irreversibly damage hair follicles, inhibiting the ability of hair to grow, resulting in permanent baldness.

How can Parents Help Kids and Teens with Hair-Pulling Problems?
There are many ways parents can assist their children with compulsive hair-pulling.

First, it helps to understand that compulsive hair-pulling behavior is an impulse control disorder. This means that it won’t go away by simply telling your child to stop. In fact, unless your child is too young to understand the impact of his or her condition, your child likely already wants to stop — except that he or she can’t seem to quit.

What parents can do is address the tension and anxiety that causes hair-pulling behavior. Hair-pulling is essentially a coping mechanism, a way to get relief from stress. This is not as irrational as it sounds, and may have a biological basis. When our bodies feel pain, such as after the hurt caused by hair-pulling, our brain releases natural pain relievers that makes us feel good. It’s this feeling that people with trichotillomania like and chase, not the act of pulling hair. Although reducing stress will help the child have less intense episodes of hair-pulling, it will not cure the condition. A cure generally requires therapy. However, parents can reduce stress by being careful not to yell at the child or use harsh discipline, help manage the child’s academic load by consulting with teachers as necessary, limit the amount of marital conflict they display in front of their child and so on. In addition, they can teach their child healthy ways to release stress such as through exercise, the use of natural remedies like Bach Flower Remedies (consult a practitioner for best results), use of aromatherapy (consult a book or a practitioner for ideas), use of yoga, breathing techniques, EFT (emotional freedom technique) and other self-help strategies.

It’s best if parents can see professional help for their child who is pulling hair. Professionals can set up a cognitive-behavioral therapy to help decrease hair-pulling.

At the end of the day, compulsive hair pulling is not really about hair, nor about beauty and appearance. It’s about internal regulation and emotional management. If symptoms persist or worsen despite the interventions listed above, then parents are recommended to consult a psychologist or psychiatrist.