Head Banging Concerns

Dear Melissa, 
My 3½ year old son has some mild developmental delays, which we are addressing and making progress with through various therapies. However, I am really concerned that he bangs his head against the wall as he is falling asleep at night and has been banging his head more during the day when he is upset. I am worried that he will hurt himself. Can you help me?

Head Banging Concerns

In my years of working with little ones who have developmental delays, I have had this question come up numerous times. Unfortunately, the treatment for head banging is somewhat illusive. Some people say, “Don’t worry, they will grow out of it.” And you will discover as you keep reading, that this answer is partially true. Others say, “Put a helmet on the child.” But, if the head banging is based on the need for sensory input, this often makes the head banging even worse. I had this question posed to me again recently, by a colleague. Instead of offering just my guesses and personal treatments that I have used over the years, I decided to go to the literature.

However, there is really not much research done on this topic. Whether you search the Journal of Pediatrics or use old “Dr. Google”, the research is sparse at best. What you find upon searching usually just discusses which individuals are more likely to engage in head banging, and not how to actually help them stop.

In addition, I find the dates and titles of these articles pertaining to head banging quite fascinating. Once you filter out all of the “head banging” pertaining to heavy metal bands (which totally made me giggle), you will find tons of articles from the late 1960’s and early 1970’s discussing head banging in “schizophrenic children”, the majority of whom were institutionalized. Now, I work in the health care professional field, and in my 12 years of experience, I have not seen a single child (under the age of approximately 16 years) diagnosed with schizophrenia. However, I have a whole caseload of kiddos diagnosed with autism. These articles are just more evidence supporting the well-documented premise that children with autism have always been among us (or, unfortunately, in institutions). In the past, it was diagnosed as “childhood schizophrenia”, and now it is diagnosed as autism.

Back to the posed question, let us define the behavior: What is head banging?
According to an article published in 2013 by Dr. Shailesh Jain, in Current Psychiatry, “head banging” is:

• Rhythmic movement of the head against a solid object, marked by compulsive repetitiveness
• Usually seen in normal, healthy, well-cared-for children
• More common in boys than girls
• Usually starts around 18 months and goes away on its own by age 4 years
• Seen in 5-15% of healthy children
• More likely in children who are blind, deaf, have significant cognitive delays, or are on the autism spectrum
• Often occurs before sleep, lasting a few minutes to an hour
• Is rarely harmful, even though it might leave marks, calluses or bruises

When to Contact Your Pediatrician:
According to the Cleveland Clinic, you should discuss your head banging concerns with the pediatrician when:

• There is injury associated with the head banging
• The noise of the head banging is keeping family members up at night
• You feel like there are other sleep disorders such as snoring, sleep apnea, etc.
• You are concerned about the overall development of your child
• You worry that your child might also have seizures

How to stop head banging:
OK, here is where I will personally weigh in. Since there is very limited research out there on how to help parents address worrisome head banging concerns, let me offer up my suggestions. While it is true that there is no real way to “fix” head banging, it is important for parents to do a little “detective work” to help determine the causes for the head banging, in order to determine a solution for it.

• Is it migraines? I did have a kiddo, many years ago, who was frequently screaming and banging his head at 3 years of age, to the point that doctors told the parents to consider institutionalization. Because this little boy had a language delay, he couldn’t communicate that he was banging his head due to the pain of migraines. Once this was discovered (with the help of a neurologist), and the child was put on proper medication, he became a now healthy, happy, “normal” pre-teen. Watch for squinting eyes and rubbing of the head associated with the head banging to determine whether migraines could be the source. Also, look for the head banging to occur in the middle of the day, and at both predictable (such as with bright lights) and random (as in not associated with a tantrum) times. If you suspect migraines in your child, discuss it with your pediatrician, or a pediatric neurologist.
• Is it sensory seeking? Is your child a “crasher” into everything? Does your child seem to not feel pain easily? Does your child like to jump, swing, spin, climb, fall? If so, your child may just be sensory seeking. If this is the case, provide a significant amount of more appropriate sensory input. If you simply try to get a sensory seeking child to stop an undesired behavior (such as head banging), then they will often replace it with something even worse. Provide lots of opportunity for running, jumping, swinging, spinning, climbing, snuggling, squeezing and wrestling, throughout the day. For more ideas on providing sensory input, see the link to my Star Sensory Handout.
• Is it behavior? Does your child bang his head when he wants something? When he is upset? When you take something away? If your answer is, “Yes”, then it is likely behavior-related. This one might be the trickiest and most difficult. You don’t want to simply ignore this negative behavior. However, you don’t want to provide the attention the child craves by acknowledging the head banging. The best way to deal with this is to praise the child like crazy when he is being “good” and provide lots of positive attention when he is not engaging in head banging. However, when he does become upset and bangs his head, walk away if he is in a safe place (such as banging his head on plush carpet). If you fear he might hurt himself, simply pick him up and place him in a carpeted “safe” room. Don’t make eye contact. Don’t talk to him. Don’t give the attention to the head banging. Simply move him as if you were moving a piece of furniture. The good news is that most children who engage in head banging for attention seeking have appropriate pain neuro-receptors, and therefore, will not bang their heads hard enough to cause injury.

Because there is not much research available to us, let’s share our own solutions. If you have a child who has engaged in head banging either now or in the past, please let us know. Share your tips here!

Resources:
Jain, Shailesh. (2013). Head Banging: Cause for Worry or Normal Child Development? Current Psychiatry, 59.
Head Banging and Rocking, Cleveland Clinic, accessed December 2015.