My Toddler Head Bangs — Should I Worry?
By Glenn Jennings, M.D.
A: Repetitive and ritualistic behaviors become developmentally necessary in children, normally at age 2-1/2. Previously easygoing toddlers will quickly begin to expect things to be done in certain routines and ways. They are trying to create their own sense of security and to think out ways of self-control.
During this phase of development, children do not tolerate interruptions and changes very well. Prior to age 2-1/2, the repetition of actions allows children to learn activities and how to behave. Afterward, the rituals become a source of social and emotional sense of competence and reward. Order, consistency and predictability for the surrounding world become represented by these internal repetitions, and children learn how to prevent future harm, as well as how to establish self-control and emotional regulation. Between ages 2 and 4, children demand and depend upon this type of repetition learning for development to proceed. By age 4, they become less dependent upon the sense of completion of repetitions and rituals in learning, so that social learning can then follow.
These intentional driven repetitions and rituals most often simply decrease anxiety or sustain arousal. Head banging; self-hitting and biting; rocking; and skin picking are most often temporary, developmental fixations or stages that resolve as more constructive development begins. Studies have demonstrated that such toddler fixations are not the cause or course of more serious neurological, psychological or developmental disorders. More serious disorders always have other symptoms and findings in addition to head banging, even if the head banging causes harm or disruption.
Your recognition of a problem and concern for your son is a positive predictor that head banging will stop; however, excessive worry may delay and divert your child from resolving the behavior. It is most helpful for parents to have confident expectations that they can stop the behavior ritual themselves at any specific time, while their patience and wisdom allow the child to learn this for himself with your help.
You should be confident that your son is free of more serious disorders, according to the check-up by your doctor. Because your son’s head banging has started before age 2-1/2, I would predict that he is advanced in his overall course of development. He appears to already have overdetermined expectations and become bored, even about how long it takes to learn or to make things happen. As he has no past behaviors that predict injury will become more severe, having only a bruise is an indicator that the head banging is developmentally appropriate. If your son has days when he has no head banging, you may have more confidence that he can cease all head banging. By regulating angry emotions and feeling more security and self-control, he will become more sophisticated in resolving his feelings during times of distress.
You may fear that the helmet and crib might reinforce or substitute other negative behaviors. If you choose not to use that method, consider the following techniques until he reaches a place developmentally where he stops head banging himself. Try using a method you may have used to stop other patterns of behavior such as pacifier sucking. Relieve your child’s boredom with additional home learning activities. Or, if you feel the environment is overstimulating, try calming it down. Know what the triggers or circumstances are that prompt head banging — this allows role modeling and talking out other responses. Do and talk about activities that revolve around taking care of the head, such as hair combing and tooth brushing. This can displace the frustration and fixation of head banging and provide interest and esteem.
Our face and head are most often our first point of contact with the outer world. The brain has many of its nerves devoted to representing the face and head. Not banging the head makes much more sense than just cushioning the banging. Big boys have much greater proportions of growth occurring in the trunk and extremities, as the head and face are relatively already big in proportion to the rest of the body starting out in life. Play activities involving these other body parts, such as hide and seek or catching/kicking the ball. This not only distracts the focus from head banging, but also promote ritualized group play that sparks new developmental interest and accomplishment. Then you look back together and ask “Why did I even bang my head at all?”
Medical Director, Child and Adolescent Inpatient Services, Moses Cone Behavioral Health