Odd But True: Headbanging in Kids

Odd But True: Headbanging in KidsPositive Bullwinkle sign, is what we called it. When our oldest was an infant, he would take his hand, with fingers and thumb in full extension, and would frequently bonk the right side of his head (always the right) in the minutes before he corked off to sleep. The whole thing made him look like a wee, one-antlered moose, and it was his thing, his ritual, his habit. And it was pretty weird.

In my travels since as a parent and a pediatrician, I’ve come to see that my son’s pre-sleep actions were a variation on a phenomena called headbanging, that causes amusement, curiosity, or frank worry on the part of parents. Can it cause injury? (almost never) What causes it? (good question) What should one do? (read on!)

Headbanging is startlingly common–occurring in up to 1 in 5 healthy infants and toddlers at some point– and is considered a normal habit behavior in healthy children.  Habits like headbanging are known in psychiatric circles as repetitive movement disorders, and they may be described as  behaviors that range from innocuous and quirky, to annoying, and on occasion, causing injury.  Most habits are the stuff that drives grandparents crazy: throat clearing, nailbiting, and teethgrinding. And, then there’s the headbangers.

Headbanging  appears in children after six months of age. It occurs in boys three times more often than in girls.  The textbook case usually goes something like this: Parents may notice that their infants or toddlers tendency to gently wap their head in a facedown position onto a pillow, mattress or blanket as they drift off to sleep. The frequency of these movements can be pretty brisk, occurring about once a second, and can last up to 10-15 minutes until a child falls asleep. In lesser cases, children thump their head or pull on their hair as sleep takes them. Headbanging diminishes and disappears in about 97% of children by their third birthday.  In older kids, who may tap the headboard or wall as they go through these motions, it can make quite a racket.

In children with known neurological issues, developmental delay, autism, hearing or visual impairments, and for children who are institutionalized or neglected, headbanging can be much more prevalent, and may be associated with other repetitive behaviors, such as rocking, or humming. And, some of these kids may continue to headbang into their adolescence and beyond.

Odd But True: Headbanging in Kids

No, not that kind of headbanging...

What is going on here?

For all those children who headbang, the exact source of the drive of the behavior is not entirely understood. There appears to be something about the gentle, repeating movement that allows the child to relax and organize themselves for sleep, much in the same way perhaps, that a sucking on a binky does for a newborn. Headbanging in children with neurodevelopmental issues, it may provide a source of dealing with overstimulation, or boredom and loneliness.

From a primary care provider’s perspective, I’ll consider each case individually, with an eye to each child’s medical and developmental history followed by a thorough exam. For children without neurologic or developmental concerns, getting a sense of how long a child has been headbanging is important (minutes? weeks? months?), and helps discern if something painful is afoot, such as a bump to the noggin, ear infection or discomfort from teething.  What’s more, it is helpful to establish that these behaviors only occur when going to sleep, and do not carry over into the daytime, and/or occur with movements of other extremities (tapping of the feet, or tics of facial muscles).

In older children, banging one’s head on the floor during a meltdown can be a supreme means of  getting parental attentions.  For parents who encounter episodes of headthumping during tantrums, the best approach is to minimize attention to the outburst.  Make sure a child is safe, but retreat to a distance. Responding repeatedly may actually reinforce the behavior. While headbanging may cause bruises, bumps, calluses, and the occasional scrape, severe injuries are blessedly rare in the vast majority of children.

And what to do? Parents understandably ask if any special preparations should be made for their child when they bang their head at bedtime.  In short, not much past common sense is the best approach. For infants and toddlers, I do not recommend putting bumpers or extra pillows in the child’s crib. There isn’t much danger to begin with, they’re not terribly effective, and the soft objects may pose a hazard to a little one in their bedspace.   For older children, it may be preferable to have the bed moved away from the wall, to avoid the noisy tattoo of head-on-wall.  Otherwise, checking that the bed or crib is secure should do the trick.  All that, and, it’s probably a good idea to tell the grandparents or babysitter so they don’t have a cow when the bedtime rituals begin.

It is absolutely appropriate to see a child’s health care provider if:

  • the behavior is causing stress in the household
  • there is any difficulty with breathing(such as pronounced snoring or gasping for breath),
  • there are concerns for seizures, unrecognized developmental delays, or a risk of injury
  • Or, if people are worried.

If warranted, a consultation with a psychiatrist, neurologist, or developmental pediatrician would be just the ticket.

Perhaps, as your charges sleep in their cribs or their beds, there’ll be a half-Bullwinkle,  or someone tip-tapping Night Night in Morse Code. Following the rhythm and the ritual, sleep will come. For most families, headbanging is a funky but benign interlude in their child’s journey. May this lessen your worry. Sweet dreams.

Photo 1 by Alessandro Zangrilli at http://commons.wikimedia.org/wiki/File:A_child_sleeping.jpg

Photo 2 by Lilly M at http://upload.wikimedia.org/wikipedia/commons/9/96/Metalmania_2008_Vader_Maurycy_Mauser_Stefanowicz_01.jpg

Cartoon below by me.Odd But True: Headbanging in Kids

Jack Maypole, MD has plenty of material to work from. He is director of Pediatrics at the South End Community Health Center and he is director of the Comprehensive Care Program at Boston Medical Cent ...read more


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