It seems like a straightforward question — even as my mother’s instinct is screaming, “No, it’s not normal; something is wrong.”
However, it turns out the answer to this question depends on who you ask!
The popular baby books will tell you it is normal.
Like hair twirling, rocking, and other self-comforting activities, head banging is a way for your toddler to release pent-up energy and tension at the end of the day.
It can be pretty terrifying to watch, but this is not unusual for toddlers (and his skull is actually tougher than you think).
Many doctors will tell you it is normal (mine did!)
If your child is normal and healthy and only shows these behaviors during the night or at naptime, you should not be concerned — these are common ways for children to fall asleep. They are seen in many healthy infants and children beginning at an average of 6-9 months of age. These behaviors typically subside by age 2 or 3, and by age 5 are only still seen in 5 percent of normal, healthy children.
Although head banging appears alarming, the child seldom inflicts significant damage to the head. The physical examination in children who are head bangers is usually normal. Laboratory investigations are generally not indicated. The appropriate treatment of head banging is to offer the parents a supportive and reassuring explanation that brain damage is unlikely and that the child will outgrow the problem.
Many friends will tell you not to worry; it is normal (because their kids did it and are fine):
He would literally make his forehead bleed from hitting it hard enough, even on carpet. As painful as this was to watch, I learned that it was totally normal. And he learned too that some surfaces hurt more than others, though sometimes in a total meltdown, he’d forget that cement was especially painful and he’d end up with small marks on his forehead. Poor guy.
BUT . . . I have to interject!
Head banging is not normal, and for our family it was a huge red flag that everyone kept telling us to ignore.
Our family’s experience with head banging began when our daughter was around 14 months old. Unfortunately, this was not our first red flag. In the previous year she had colic, diarrhea, allergic shiners, w-sitting, and failure to thrive, to name a few. It was a just few weeks after her MMR vaccine, and we were instructed by a gastrointestinal doc that we needed to get her off my breast milk (he was confident that was the cause of all her issues), and put her on cow’s milk. Within a day of introducing two ounces of cow’s milk into her diet, she began the head-banging behavior. It was awful, absolutely horrendous to witness my child try to harm herself. I cried tears of agony and fear as I held her day after day in a bear hug as she thrashed, trying to keep her safe, attempting, in vain, to soothe and calm her. I made repeated calls to the doctor and was told: “It can’t be the milk,” “Head banging is normal,”and “She is nearing two, and that is what the ‘terrible twos’ looks like.” At the time, I hadn’t a clue what was going on in her little body, other than the growing sense that something was very wrong. We removed the milk from her diet, and slowly over the course of two weeks the head banging faded away. Fast forward to now, and I know so much more about what was more than likely was happening to our sweet baby girl. Today I share it with you in hopes that no other mom has to walk in my shoes.
Head banging is classified in the medical literature as a self-injurious behavior (SIB) and can also be classified as rhythmic movement disorder (RMD). One medical journal noted that “The impact force of SIBs as a percentage of body weights are near the low end of forces generated in boxing blows and karate hits.” Here are some things that head banging can indicate and why you should be concerned if your child is exhibiting this behavior.
Head banging can be associated with:
- Autism Spectrum Disorders: “A key area of concern in children with autism spectrum disorders (ASDs) are self-injurious behaviors (SIBs). These are behaviors that an individual engages in that may cause physical harm, such as head banging, or self-biting. SIBs are more common in children with ASD than those who are typically developing or have other neurodevelopmental disabilities.”
- Autism: “Motor stereotypies, including rocking, head banging, and toe walking, were observed. Difficulties in the domain of social interaction began to emerge during the second 6 months, including poor eye contact, failure to engage in imitative games, and lack of imitative vocal responses. By a little over 1 year of age, this infant met diagnostic criteria for autism based on the Autism Diagnostic Interview.”
- Seizures: “In this study specific limb and eye movements plus other ictal phenomena were catalogued from the neurologic literature on frontal lobe seizures. Ten patients were described who presented the clinical picture of frontal lobe seizures. Extreme self-injury in some brain-damaged persons was therefore regarded as involuntary, and need for recognition of this behavior as frontal lobe dysfunction, not a “behavior problem” under voluntary control, was noted.”
- Developmental Disorders, Tourette’s, and OCD: “We present a 7-year-old boy with a developmental disorder presenting with severe head banging. Clinical evolution was consistent with diagnosis of autistic spectrum disorder, obsessive compulsive disorder, stuttering, and Tourette’s syndrome.”
- Intellectual Disability: “Self-injurious behavior is a serious problem that is not uncommon among individuals with mental retardation. Medical and developmental characteristics of 97 children, adolescents, and young adults (age range 11 months to 21 years, 11 months) assessed and treated for self-injurious behavior in a specialized, interdisciplinary inpatient unit between 1980 and 1988 were reviewed. Severe or profound mental retardation was present in 82.5% of our patients. Associated disabilities represented at greater than expected frequencies included pervasive developmental disorders, visual impairment, and a history of infantile spasms. Most patients (81.4%) engaged in more than one type of self-injurious behavior. The most common topographies were head banging, biting, head hitting, body hitting, and scratching.”
- Nutritional Deficiency (Scurvy): “We report an unusual clinical presentation of scurvy in a one and half year old child. The child presented with abrupt onset of peri-orbital ecchymoses and scalp hemorrhage following head injury. The child also had a history of temper tantrums and head banging. Our case did not have any of the typical clinical features of scurvy.”
- Ear Infections (Otitis Media): “The author presents two case reports of peripubertal boys with severe and chronic head-banging parasomnias, or rhythmic movement disorders (RMDs), which started de novo whilst they were suffering from recurrent and severe otitis media in toddlerhood.”
My question to you, Thinking Mom, is how do you know your child is not suffering from one of the underlying conditions above if you are told it is normal and you ignore it without further investigation, testing or attempt to intervene? Can you tell if your child has an uderlying neurologic, psychiatric, or cellular condition just by looking at him or her? No!
Even this article that maintains that head banging is a normal activity for some children says that underlying pathology should be ruled out before “reassuring” the parents:
Headbanging is a rhythmic motor activity that may occur in normal infants and young children, as well as in children with underlying psychiatric or neurologic disease. Once underlying pathology has been excluded (emphasis mine), parents should be reassured about the benign nature of the activity.
What can you do about it?
Express your concern to a doctor. If you are told it is normal, bring information substantiating your concerns (linked above). If your doctor will not look into it further, find a doctor who will and ask that things like ear infection, seizures, deficiencies and developmental delays be investigated and ruled out as the cause, especially if the behavior continues or worsens.
If there have been vaccinations given in the preceding hours, days, or weeks (up to three to six months) prior to the onset of any self-injurious behavior, encephalopathy should be ruled out, especially if there was a sudden onset of the behavior.
Keep a journal, and note when the symptoms started. Note when the child was last vaccinated, had any new antibiotics or medication, and what new foods were introduced. Do a trial elimination of a specific food that you feel may be suspect (e.g., milk or wheat) to see if the behavior lessens or worsens.
If the behavior worsens or intensifies and you fear for your child’s safety and health, do not hesitate to take your child to an emergency room and request an MRI. If your child is experiencing any type of encephalopathy, this may be the only way to verify and record that information while it is occurring.
Keep in mind every behavior is a form of communication for pre-verbal or marginally verbal children, so head banging cannot be just dismissed as “attention seeking.” If you had no language and your head hurt intensely, what might you do to communicate this to those around you in order to get help?
Consider what veterinarians are telling pet owners to do when their dogs and cats do this behavior they call “head pressing,” and what it means:
The term “head pressing” is actually pretty descriptive—the affected pet stands close to a wall or other hard surface (furniture, the corner, etc) and literally presses the top of her head against it. It almost always signifies significant illness.
Many diseases can have head pressing as a clinical sign, but most often we associate it with hepatic encephalopathy, a condition that occurs in pets with liver disease. The liver is meant to remove toxins from the blood stream. When it doesn’t function properly, ammonia and other toxins build up and create this neurologic syndrome of head pressing.
What do you think it means when your toddler does it? I recommend seeking medical attention ASAP.
For more by Beaker, click here.