head banging , biting and pulling hair out and eating it.

[helga]

My sixteen month old baby has over the last few months began to bang his head on the floor, wall or nearby object whenever he is annoyed or frustrated.   In addition to this he bites or attempts to bite either myself or other children if he is angry or if I say no.  As if this wasnt worrying enough he also pulls out his hair and eats it.  He has been doing this since he was about 8 months old.  His development seems to be largely in line with what is expected at his age and his milestones have been acheived at the normal times.  However my son was born with a number of dysmorphic features including nasolacrimal duct fistula, simian crease, and horseshoe kidneys.  He also appears to have some abnormality to his sternum which has a small central concavity.  As i have worked with learning disabled and developmentally delayed people for almost 17 years I know that head banging and some of these dysmorphic features are often associated with developmental delay, however my instinct is telling me that developmentally hes doing o.k.  

he has always been a very contented and happy baby with a sunny personality, and it is very distressing to watch him bang his head so hard on the floor.  I would be grateful for any advice you could give me in respect of any of these behaviours.

Thank you

Helen Whicker

[helga]

Thanks for taking the trouble to answer my question.  I hope the behaviour is related to the frustrations of being a toddler, rather than a pervasive development disorder.  This had crossed my mind too, although I have noticed that his language development is very good for his age, despite the fact that he is tongue tied.  Also he is very sociable and enjoys being around other children.  I am hoping that this is a good sign.  The system in the U.K. would make it very difficult to get him assessed by a developmental paediatritian - as this would need referal via my G.P. - who feels that at this stage theres nothing to worry about.  This is quite frustrating as in my work I frequently come across children with obvious developmental problems who are not diagnosed until they are three or four and valuable time has been lost.  

I will get his hair cut short, distract him from the head banging and try and reduce the triggers (i.e. saying no)so that he  is less likely to bang his head.  I will try also to ignore him as far as it is safe and practical.

Thanks again for your very frank and helpful response.

[Kevin Kennedy, Ph.D.]

Dear Ms. Whicker,

You are correct in observing that, at times, the types of behaviors you describe can be signs of developmentally-based problems. However, it is an optimistic sign that your child seems to be generally developing well.

There are some forms of Pervasive Developmental Disorder in which development seems to progress well during and after the first year or so, and then problems begin to display themselves.
Only time will tell if any such thing is occurring with your child.

The dysmorphic features certainly make him vulnerable to neuro-behavioral or neuro-integrative disorders, so this needs to be watched. What might make sense at this early stage is to have your child examined by a developmental pediatrician or team of developmental clinicians. Hopefully what you are witnessing is his version of learning to cope with the frustrations that can be so hard to manage for a toddler. If so, as he matures and develops, his capacity for managing frustration will improve.

As a specific intervention for now around his pulling and eating his hair, I would suggest you cut his hair so this is not easy to do. This intervention can be helpful in curbing what can turn out to be a habit pattern.