“He just will not quit biting his nails no matter how much I yell at him!”

Complaints such as these are quite common. Sometimes it feels tricky to decipher between which habits are typical and can be ignored and which should not. Plus, even if it’s best to just ignore the habit, it is always much easier said than done.

Thumbsucking, nose picking, fingernail biting, and hair twirling are usually much more distressing to us as parents than to the kids themselves. In this article, I will cover some of the most common childhood habits, potential associated issues and some tips for you to manage these behaviors.

1.Thumbsucking is probably the most common childhood habit. It usually starts at some point during infancy and diminishes as children grow older. Typically, older children will limit this to when they are at home, while watching TV or when stressed. Frequently, it is also accompanied by cuddling a lovey like a stuffed animal or blanket. Usually, thumbsucking will diminish on its own, and if it does not by age 5, it usually will soon thereafter thanks to the magic of peer pressure. Plus, once kids are about 6 years old they naturally will tend to develop more self-control of their own behaviors, making it easier for them to quit this habit on their own.

Some problems that might arise if thumbsucking lasts too long include dental issues (such as an overbite) or even finger infections. Even so, this is a good example of a habit that I don’t want you to call too much attention to. In young children, it is perfectly acceptable to ignore it, since there is a very good chance it will go away by itself. In older children, try your hardest to keep a calm, nonchalant tone when working with them to break this habit.

2.Nose picking is the next famously annoying habit. Almost every child goes through this phase at some point - even possibly wiping the results on something nearby… or even (shudder) eating it. During pre-school years it’s good to teach your child not to pick their nose in public and to dispose of the contents into a tissue. Just like for thumbsucking, it’s best to keep your cool. Avoid saying “Eww” or “Yucky” since that could have a shaming effect on children or, in some cases, encourage it even more! Sometimes nose pickers can end up with minor cuts or scrapes inside the nose since the skin there is so thin and delicate. Try to keep your child’s nails short to avoid any damage or infections. If you’re having difficulties with dryness, try running a humidifier or vaporizer in their room at night, apply some petroleum jelly to the tip of their nose at night or spray some nasal saline into their nostrils before bed to moisturize it.

3.Next on the list of bad habits is body rocking. Many people don’t realize that some children will normally engage in body-rocking; especially before bed. This usually occurs when these children are settling themselves to sleep and can sometimes be rough enough to shake the entire bed. There is often no need to intervene. On the contrary, if your child is missing developmental milestones and is engaging in body rocking, head banging, unusual hand movements or other similar behaviors this is something I would discuss with your pediatrician.

4.Fingernail biting is also very common. It typically starts during school age years and can last even into adulthood. This can lead to extremely short fingernails and sometimes infections of the nails, damage to teeth and even gingivitis. As with other habits, positively reinforcing behaviors and ignoring the biting can help your child quit. There are also clear, bitter-tasting nail polishes available over the counter that you can apply to help with this process; although to be honest, the success with using these polishes alone is pretty minimal.

5.Last but not least is hair tugging or pulling. There are two types of hair-pulling: one you can ignore and one you shouldn’t. Many young children will tug on or twirl their hair while sucking their thumb. Sometimes this can even cause some hairs to fall out. This behavior is not of concern and usually stops once the thumbsucking stops. In young children, it’s best to ignore this behavior, or turn your efforts toward eliminating the thumbsucking habit.

The other type of hair pulling is called Trichotillomania and is seen usually in older children. Trichotillomania is the irresistible urge to pull one’s hair. This typically will lead to bald spots on a child’s head. Sometimes this can be linked to underlying stresses, depression or OCD (obsessive-compulsive disorder). If you are concerned about your child’s hair pulling, talk to your pediatrician because counseling can be very helpful in these cases.

Why do kids tend to have these bad habits?

The truth is, we really don’t know; but, it seems that many of these behaviors tend to have a calming effect for children. Many people notice that habits tend to ebb and flow – and tend to increase especially during times of stress. Most often it seems these habits will relieve anxiety, boredom or stress; however, some children catch on to our irritation and engage in these annoying behaviors to get a reaction out of their parents.

When does a habit become more than just that?

There are actually a few bad habits that I don’t want you to ignore. Trichotillomania, as mentioned above, is when an older child pulls on their hair so much that bald patches will occur. This usually requires counseling by a trained mental health professional. Another one is pica. Pica is when a person eats objects which are not food and this is often be associated with anemia. So, if your child is commonly trying to eat non-food items, talk to your pediatrician.

Lastly, cutting or self-injury in adolescence. Any self-injurious behavior is a sign that needs professional attention; I strongly recommend that you talk about this with your pediatrician right away.

When it comes down to it, most bad habits are an annoying phase that kids will go through. Unfortunately, most children will go through at least a few of these phases at some point. As annoying as they often may be, for the most part it is simply best to stay calm and positive.

As always, if you have concerns, run it by your pediatrician.

What if you then found out that you had been lied to about that day care’s license?

In fact, they didn’t have a license at all.

Fortunately cases like this are rare.

But what about a more common case where your child is bitten once or a few times at day care? What if your child is the one who is biting?

I reviewed the Texas Department of Family and Protective Services Minimum Standards for Child-Care Centers. Here is what I found:

• Parents should be notified about minor injuries when the child is picked up from day care (biting is included in this category).
• Relevant ongoing education is required for employees (and specifically mentions biting).
• Decisions about child/caregiver ratio must take into account situations where there are tricky situations. For biting, it suggests that a caregiver be assigned with training in redirection or that an extra caregiver be assigned.
• Biting is specifically prohibited as a means of discipline for a child (day care workers cannot use the old “just bite them back” techniques for biting).

What can you do?

Three tips if your child is being bit:

1. If it’s a one-time thing, try your best to let it go. I know this is hard but biting does happen and can happen in the blink of an eye even in very closely supervised environments.
2. If you start to notice bites over time, mention your concerns and assess what the day care is doing to prevent the issue.
3. If the bites are severe or very frequent, I would feel very confident suggesting that your child’s day care follow the steps as outlined in the Child Care Guidelines. This might mean that the day care needs a specialized or extra caregiver for the “problem” room.

Three tips if your child is the biter:

1. Do not feel guilty. Sometimes the day care will make it seem like your parenting is the problem. The reality is that you cannot do anything at home to teach a toddler to not bite at day care. Discipline in the toddler age does not work that way.
2. Discuss your child’s triggers with the day care. Biting usually occurs in predictable situations for children. You might be able to help them prevent biting in the first place.
3. Learn what works to distract your child. Children need to be distracted when they are biting. It’s clear from studies that direct punishment does not work well with toddlers. Teach the day care what strategies they can use.

While the increase in self-injuries may not seem that extreme, Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, said the study does not tell the entire story. Sometimes the degree of cutting, for example, may not be severe enough to receive medical attention.

Elliott presents to schools, churches and community organizations on the issue of teens and self-harm injuries. She also treats patients in her practice.

“It can be difficult to determine the prevalence of these types of injuries accurately due to the secretive nature of self-harm prevalence,” Elliott said.

Elliott says that the most accurate numbers show that 20 to 23 percent of teens engage in some type of self-injury. The age of self-harm abuse typically begins between the ages of 12 to 14 years old.

Research shows that gender differences appear only to be associated with method of self-injury. Females are more likely to use cutting. Both genders use burning and self-battery. Caucasians are significantly more likely to engage in self-injury than non-Caucasians.

Methods of self-harm include:

• Cutting (70 percent of self-injuries)
• Carving
• Scratching/biting
• Burning/abrasions/branding
• Hitting themselves
• Picking/pulling skin and hair
• Head banging
• Tattooing
• Excessive body piercing

Injuries are most commonly found on arms, hands, wrists, thighs and stomach.

"This is something we see quite often, mainly in female teenagers, and it has increased dramatically in the last several years once it became a 'thing' that teenagers do and have seen or heard about," said Corwin Warmink, assistant medical director in the Emergency Department at Cook Children's. "It is a response to stress and anxiety and gives the performer a sense of control and eases their anxiety. It is not a suicidal behavior, but some studies have shown people who perform self-injury are more likely to commit suicide than people who do not. It also can be indicative of a more serious mental disorder."

So why do kids harm themselves?

“Kids who repeat self-harm injuries are often trying to ease some type of intense, overwhelming negative emotion such as anger, pain, anxiety or frustration,” Elliott said. “That’s the most common reason, but the second most common reason is self-punishment. They are expressing anger at themselves. This is strongly connected to self-derogation and criticism.”

Other reasons for self-harm include:

• Interpersonal influence – as a means to garner affection/caring from others, to identify/connect with others who have self-injured, to “belong” or fit in with a peer group.
• Stress management.
• To feel a sense of control over their own body, feelings or life situations.
• To provide a distraction from painful emotions through physical pain.

Kids who engage in self-harm behavior are more likely to tell and seek help from a peer their own age than tell a parent. Usually, adults only become involved if that peer tells a grownup and asks for help for his or her friend. Other times, a teacher or coach hears talk among other teens and steps in to help.

Elliott offers these tips to identify if your child is involved in self-harming behavior:

• Dressing in long sleeve shirts/hoodies even in hot weather.
• Wearing concealing outfits.
• Avoiding activities such as sports and swimming.
• Making excuses for having cuts, marks, wounds on body.
• Finding razors, scissors, lighters, knives in unusual places such as under the bed.
• Spending long periods of time locked up in bedroom or bathroom.

For more information

To schedule an appointment or refer a patient to Behavioral Health Services, please call 682-885-3917. To have Lisa Elliott speak more on this topic at your school, church or community organization, click here.

One of the biggest stories centers around the suspension of Luis Suarez for biting an Italian defender.  It’s not the first time he has done it either.

I usually tell families that their kids will outgrow this problem, but I guess if you’re a world-class soccer player, that’s not always true.

What do we do when our child is the biter?

First off, this happens ALL THE TIME…

Your child is not the first child who has bitten and won’t be the last so let’s be calm.

There’s really just a few things you can and need to do in these situations …

When the bite has already happened

Separate biter and the bitten child.  This helps the “victim” feel safer and diffuses whatever frustration caused the biting in the first place.

Try to talk it out.  Often you are dealing with a pre-verbal child, but it is still important to try and talk about the situation that led up to the biting.  Usually the child who bit is just as scared as the child who was bitten.  You are typically dealing with young toddlers with limited verbal skills, but talking with them about their frustration/anger that led up to the biting can help them understand that there is a better way to express these emotions.

Preventing the Problem

The ultimate goal in helping with biting is to prevent the situation that leads to biting in the first place.  The key to this is: distraction, distraction and distraction.  Keep the frequent biters from their trigger situations or be prepared to intervene quickly before the frustration levels begin to rise.

Or, Just Bite Them Back

Of course, everyone has had a family member or someone tell them that this is the best way to get a biter to stop and while it may have worked for them in the past, I feel that this strategy is simply modeling the behavior you are trying to extinguish.  Toddlers learn best through seeing their parents’ actions and having your parent bite you only makes you think that is appropriate behavior.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his three young children, exercising, reading and writing about parenting and pediatric health issues.He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.