How can I keep my toddler from scratching himself when he is upset?

Question

Whenever my toddler gets very upset or throws a fit, he has a tendency to rake his fingernails very hard across his face, often drawing blood. Currently one side of his face is covered with scratches and scabs from this behavior. How can we encourage him to stop?

The first, most obvious idea is to simply trim his nails very short, but I'm worried that might just displace his frustration and cause him to start pulling out hair or something similar.

Edit: Two years after I originally asked this question, our child was formally diagnosed with autism. I add this here because it seems like an important point for people to keep in mind. An extreme inability to deal with ordinary stresses, including self-harming behaviors, may be an indicator of problems beyond simple toddler obstinacy.

Answer 1

I have worked with many children who are self abusive and this is a perplexing problem for parents and caregivers. Head banging, self-biting, clawing/scratching, and hair pulling are all self-injurious behaviors sometimes exhibited.

A very important question to ask is what is triggering this unique acting-out behavior. Toddlers are often frustrated when events do not meet their expectations. Learning self-regulating behavior is often a challenge. When their sensory systems reach overload, they often respond with crying or tantruming. After a few moments, the intensity usually passes with or without intervention and they self-regulate and return to a state of "normalization" where they can once again engage with their world. Being very tired or sick can extend their out of sync behavior.

Usually; however, the very act of crying and tantruming provides the body with the opportunity to calm. Crying/tantrums requires deep breathing, tensing of muscles and even falling onto the floor or kicking or hitting. All of these behavior result in calming the nervous system and returning it to normal. Even as adults deep breathing, deep tension alternated with relaxation, deep pressure, punching a pillow and even a good cry help us to "feel better" and self-regulate to a more calmed state.

Self-injurious behavior may indicate that a child's sensory system is not integrated and they escalate to what we consider the pain level to increase sensory stimuli in an effort to achieve self-regulation. Of course, the response of parents gives them intense attention that adds a behavioral component to the sensory based issue.

Intervention may best be focused on providing the intense sensory stimulation that his body is seeking. Grasping him in a deep bear hug, rocking him aggressively while speaking at an intensity that matches his and gradually modulating your voice as a model for him to follow may all assist him. Of course, identifying triggers and providing distraction or other calming interventions before the abusive behaviors begin is even better.

I recommend reading information on Sensory Integration Disorders or Sensory Processing Disorders as a reference for strategies that are calming. I am NOT implying that you child has this disorder. I believe that understanding sensory integration and sensory processing is invaluable to all parents and the strategies used with these children benefit all children.

Of course, keeping the nails short may prevent the most severe damage.

Answer 2

Actually, trimming his nails is a good solution, and what I'd have recommended. If your child's nails are long enough to draw blood, then they need to be shortened. Even if it means trimming them twice a week. - This is a must.
I'd rather stop the obviously damaging behaviour at the risk of whatever might take its place, than continue to tolerate the damaging behaviour.

As for the tantrums themselves, there are a number of good suggestions about that on the site. Do a search for [tantrums], and perhaps Marie's answer here would also inspire you.

Answer 3

Self-harm in toddlers can be hard to pin down.

It's very common with autistic children and children with sensory disorders -- they can block out overload or frustration with something easy to do that shuts out whatever they're having trouble ignoring. If you already suspect autism or a sensory disorder for other reasons, I'd look doubly hard at the possibility now. If not, then there are other causes to consider:

Some toddlers self-harm simply because it's something they can control in a world that is almost completely out of their control. The best way to discover if this is the case is to increase opportunities for your child to be in control of things and see if the self-harm abates. Some ways to do this are:

• Encouraging the child to make simple either/or choices as part of your everyday routines, such as picking out his own clothes each day from two choices you have offered
• Making sure that you and everyone in your family is very consistent in how you react to your toddler's behavior -- if he knows that behavior X always results in an immediate time out and behavior Y gets consistent praise, he feels like he knows how his world works, but if X is tolerated without reaction until you get really annoyed and blow up, he has no idea what happened and feels like it was just random, which is very frightening.
• Making sure you provide your toddler with a stable routine, so he/she can predict what is happening next, or how common events (a haircut, cleaning his room, meal time, etc.) will work.

Some toddlers self-harm because they don't know how to handle feelings of frustration or anger. Helping your child communicate more effectively (absolutely teach and use sign language if verbal communication is difficult for him!), and helping him learn what is appropriate to do to vent those feelings will help stop the self-harm if this is the case.

Some toddlers self-harm because they've learned that it gets really intense reactions from grown-ups.

Finally, some toddlers self-harm as the result of abuse. The answer is to get the abuser out of the child's life immediately and permanently, and understand that it will take time for the child to adjust to his new world and phase out the self-harm.

There may be other reasons, but these are all the ones I've dealt with. Whatever the cause, cutting the fingernails only helps so much; a child with even very short nails can often draw blood anyway, and if not there's always head banging, hair-rending and so on.

While you work on figuring out and dealing with the cause, try restraining your child when he begins to self-harm. Do it calmly, and don't give any huge reaction or try to reason with the child about it. At least in my experience, self-harm is a self-reinforcing behavior -- the more you allow him to do it, the more he will want to do it.