Self-Injurious Behavior

As child care providers, we have grown accustomed to children who sometimes act aggressively toward others. There may be times, however, when we observe young children who engage in self-injurious behavior. Self-injurious behavior is usually associated with temper tantrums experienced by children under three years of age. Self-injurious behavior is often exhibited as head-banging . . . although some children have been observed to hit, bite or even to scratch themselves. When we encounter young children who exhibit this type of behavior, our initial reaction may be one of shock and dismay, often followed by uncertainty regarding how to appropriately respond to this behavior.

Tantrums are a result of intense feelings of anger or frustration overwhelming children's capacity for self-control, leaving feelings to be expressed, or acted-out, through their behavior. While tantrums can be quite dramatic, these outbursts often lack focus or organization . . . what we might describe as a "meltdown". At times, tantrums may be directed toward individuals or objects in the immediate environment and exhibited as unsafe or aggressive behaviors. These behaviors might include hitting and biting or the destruction of property, such as turning over chairs or tearing the pages of a storybook. Occasionally, young children will express these strong feelings through self-injurious behavior.

Closely monitor children's behavior whenever tantrums occur. If children act to injure themselves or others, our immediate response must be to ensure safety. In the case of self-injurious behavior, this may require that the provider intervene with children during their tantrum using gentle, physical redirection. Our aim is not to provide physical control of children during this time of stress, but to avert an action where children attempt, for example, to scratch or bite themselves. In the case of headbanging, gently placing your hand on or under the child's head will help limit the force of the impact. Another alternative would be to introduce a soft item, such as a pillow or mat, on which children might direct their behavior.

I usually refrain from interacting with children during temper tantrums unless their behavior presents a threat to themselves or others. My goal is to provide for safety and not to reinforce inappropriate behavior with undue attention. Recognize, however, with aggressive or self-injurious behaviors any attempts by a care-giver to exert physical control over children may actually escalate the behavior. A firm, respectful and supportive approach is best during these turbulent times. At every other time, focus on developing children's social and emotional skills, as well as other developmental abilities. This includes helping children explore feelings or emotions, develop problem-solving skills and using language to express needs. These skills are fundamental in helping children express strong feelings and to regulate their behavior. As these skills develop, the frequency and intensity of tantrums and associated behaviors should diminish.

Most care-givers exposure to self-injurious behavior will be in terms of typically developing children. In some cases, however, self-injurious behavior may be associated with severe developmental delays or indicative of a mental health problem. Be aware of self-injurious behavior not associated with tantrums or that may appear rhythmic or repetitive. In addition, be aware of more subtle behaviors, such as when children frequently pick at their skin or pull at their hair. This behavior may indicate problems if it results in open wounds, sores or hair loss. In particular, if you observe children using objects to cut or pierce their skin, seek immediate assistance.