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What to do about a toddler head banger
D New York City
Head banging is one of the most puzzling things that some young children do. The behavior is so bizarre and frightening that it is impossible to witness it, especially to hear it, without thinking there is something drastically wrong. Sometimes there is. Children with autism display this behavior frequently. And children living in orphanages or other institutions may engage in it.

In the case of the orphanage children it appears that lack of stimulation in their isolated world is the explanation. Banging produces both auditory and kinesthetic stimulation. I suppose that if you hear or see little in your isolated world, even slight pain is a plus. But that doesn’t explain the not infrequent appearance of such behavior in perfectly normal children growing up in well-functioning homes with plenty of love and stimulation.

Sometimes the banging is against a wall or headboard of the bed and is so hard that lumps are raised on the child’s head. When that happens, parents worry about brain damage. In other instances it is more a gentle rocking on all fours that sometimes hits a stationary object, producing noise only occasionally. As your son bangs against a pillow, you have probably not experienced the frightening sound I am describing.

Once my husband and I lived in an apartment that was next door to an apartment with a head banger. Believe it or not, the banging was so loud it would wake us up. It stopped, incidentally, when her parents taped a pillow to the wall above her bed so that she was unable to get whatever satisfaction she got from the physical contact with the wall or from the sound she produced.

There have been a number of surveys trying to determine just how common the behavior is, with some suggesting that up to 20 percent of young children will engage in head banging at some time during the first four years of life. Other surveys, which probably defined banging in a slightly different way, find that number too high. Even so, it is probably more common than you imagine. It’s not the sort of thing parents like to talk about, so probably none of your friends with children of similar ages has mentioned experiencing the problem. Even so, it’s a good guess that one or more of them will have had the same worries at some time or other.

As for what to do about it, the answer of most experts would be “as little as possible.” That is, try not to let the behavior bring too much attention to the child. For example, if a bout of head banging brings Mommy or Daddy scurrying back into the bedroom for extra attention, the behavior has been reinforced. Try not to let that happen.

I would suggest that there are two main approaches you should take. One, make certain that your son can’t hurt himself. As he bangs on a pillow, it doesn’t sound as though that is likely. You also want to make sure that he couldn’t get his head caught between the rails of his crib.

Two, try to change his bedtime routine so that the behavior is less likely to have a chance to occur. Head banging is almost always accompanied by rocking movements. In this context it is good to remember that, throughout prenatal life, babies experience gentle rocking while living in the mother’s uterus. And after birth there are few things they enjoy more than being rocked. So think of some things you can do to re-create some of that sensation. Even though he is getting big, rock him a while before putting him down. And keep him up a bit later so he is more likely to fall asleep immediately.

This kind of routine should help eliminate the behavior. If it hasn’t stopped by the time he’s 3½, ask his pediatrician to reconsider his opinion and help you look for other options.

Dr. Bettye M. Caldwell Ph.D. Professor of Pediatrics in Child Development and Education