Should I Worry About Head Banging?

It’s not uncommon for pediatricians to hear the fear in a mother’s voice when describing her two-year-old’s newest pastime: head banging. Is this normal? Will my child’s brain be injured? Is this a sign of autism?

First, you shouldn’t drive yourself crazy with worry. According to the Journal of the American Academy of Child Psychiatry (JAACP), close to 20 percent of all healthy toddlers will go through a period of head banging.

Head banging occurs when a child’s head is rhythmically hit against a solid surface. In children who are developmentally normal, an episode usually lasts less than 15 minutes but in some extreme cases can last for a few hours. A high frequency of up to 60-80 hits per minute is common. This behavior occurs three times more often in boys than girls and peaks between 18-24 months. It may last several months to years, although most children outgrow the behavior by 3 years old.

According to the JAACP, head banging can be a way for the child to relieve tension and can become a self-soothing ritual to help fall asleep, especially in children who are easily overstimulated. In some cases, the onset of head banging has been associated with teething or otitis media. Some researchers suspect it acts as a pain reliever. Head banging is usually during a temper tantrum but also associated with attention-seeking behavior when the child is upset.

Mild forms of repetitive childhood behaviors such as head banging, thumbsucking, nail-biting, teeth grinding, and rocking or rhythmic movements that do not interfere with normal daily activities are not typically caused by an underlying disease. However, when the child has a hard time functioning in normal activities because of constant head banging, other diagnoses should be considered. According to recent guidelines from the Centers for Disease Control and Prevention, if head banging is also associated with worrisome signs such as not responding to being addressed by name, not pointing at objects, not making eye contact, or not engaging in pretend to play with objects by 18 months old, the child should be evaluated for autism spectrum disorders or other developmental problems.

It’s important for parents to remember that isolated head banging is rarely associated with autism or other developmental problems and typically does not cause serious head injuries. As with most attention-seeking behaviors, the more openly concerned the parent becomes, the more frequently it occurs. If the child does not get a strong reaction from the parent, the behavior usually ends sooner than if the parent overreacts each time the head banging occurs. By waiting patiently, this unnerving behavior will likely soon be gone for good.

Sources:

• Journal of the American Academy of Child Psychiatry, Vol
• 22, Issue 4, pages 329-336, July 1983.
  Centers for Disease Control and Prevention
• Autism Spectrum Disorders.
  Medscape
• Childhood Habit Behaviors and Stereotypic Movement Disorder.

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