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PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Head Banging Toddlers: Not your Average Heavy Metal Concert.

“Hey Mr. DJ, put a record on. I wanna dance with my baby.” – Madonna, “Music”

I know I’m dating myself, but whenever I get a request for a post about a specific topic, that song comes up in my head. It’s a good one with a great beat.

This week on the blog my subject choice comes straight up from one of my online #smartmommas who asked me to talk about head banging in kids. And not heavy metal music loving, black eyeliner wearing teenagers either. In this entry we’re gonna talk about those young kids, often babies older than 6-8 months old and toddlers, who look like they are purposely trying to injure themselves by slamming their heads into a wall or on the ground or against the side of a crib, most often related to falling asleep. Around 1 in 5 healthy children will do this at some point before age 4, and it’s seen more commonly in boys than girls. Another related phenomenon is body rocking in children, where kids will sway back and forth. Less dramatic, but similar.

I’ve seen many a parent bring in their 14 month old to acute care at 9:45PM on a Wednesday because they are concerned that their otherwise healthy child is banging their head routinely and might:

  1. Have autism, or
  2. Have seizures, or
  3. Be causing brain damage.

I get the concern.

Looking at a child who is having a head banging “moment” can be quite scary: it looks rhythmic, automatized, and forceful. It can last for 15 minutes, even, which feels like an eternity. If you’re not sure exactly what I’m talking about, I promise it really is self explanatory: a child will simply rock back and forth, beating his/her head against a firm surface, usually when falling asleep or upset. What’s unusual is that the child doesn’t appear to be in pain (although this may occur in the middle of a temper tantrum so the child may be angry), and in fact seems quite purposeful about it, relaxed even. Some children will simply rock back and forth without the head banging component, usually on all fours.

So I’ll get this out there right away: Rhythmic rocking and head banging in otherwise healthy children who are developing on track is nearly-always harmless, does not cause brain damage, or indicate seizures or autism. 

Most developmentally on track children who bang their heads or rock their heads against a hard surface are doing so when they are overstimulated (to calm down) or understimulated (boredom), or as they are falling asleep. It’s a form of “rocking” that is thought to be self-soothing (even though it doesn’t seem so) or even a way to let emotions out. Some theories suggest that the rocking component calls up similar motion sensations from when the child was in utero, and for a toddler this may have a calming effect.

child crying in crib

So what should you do if you have an otherwise healthy, developmentally on-track rocker or head banger?

Welp. A whole lotta nothing, or as we say in medicine, “benign neglect” (25 cents!) is usually all that’s needed. The majority of children will grow out of this phase all on their own. For some kids, it can be a way to get attention, especially around sleep time, so be careful that you’re not inadvertently giving your child the signal that if she does this it gets you to step in and disrupt any routine you’re trying to set. Don’t worry about adding any extra pillows or bumpers into the crib- that’s not a safe sleep practice and it doesn’t typically help anyway.

For head banging during a temper tantrum, I really encourage all caregivers not to make a big deal about it. Being as low energy as possible is the best recipe for extinguishing the behavior as rapidly as possible. If there’s an underlying reason for all the emotion, address that for sure, but not the head banging as an expression of that emotion. Children under 3 really don’t generate enough force to truly injure themselves, so real injury shouldn’t be a factor.

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When SHOULD you be concerned about head banging or rhythmic rocking?

A few red flags worth knowing about:

  1. If your child isn’t attaining standard developmental milestones, or is regressing in speech or motor movement, then it’s time to talk to your pediatrician about your child’s overall development and include this as part of the discussion. It still may be completely harmless, but it’s reasonable to include.
  2. If your child seems “in a daze” or not responsive to voice during these movements, or you are concerned about seizures, then immediate medical care should be sought.
  3. If you feel that your child’s sleep pattern is being regularly disrupted, talk to your pediatrician especially if snoring is associated, in case this is part of an overall primary sleep disturbance.

After reading this, I hope that we all will breathe a little easier the next time we are in Target and see a mad toddler in the middle of aisle 5 having a fit and pounding her head against the floor. She’s gonna be ok, and so will her #momma. Let’s all resolve to be supportive and non-judgmental about this all-too-frequent occurrence, now that we understand it a little better.

 

 

 

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