Head Banging, Pediatric

Head banging (HB) is defined as the hitting of head on solid object such as a wall, side of crib, mattress, or floor.

Tend to hit the front or side of the head

Usually last for 15 minutes but can go on for >1 hour

Regular rhythm of 60-80 bpm

Can be seen along with body rocking or head rolling

Epidemiology

Average age of onset is 9 months; usually extinguished by 3 years of age. Older patients with head banging are more likely to have a developmental delay or other medical problems

More common in boys than girls (3:1)

Occurs in 3-15% of typically developing children

Estimated that 2-3% of kids with intellectual disability have stereotypic movement disorder (SMD) (HB) and 5% of kids with Tourette syndrome have SMD (HB)

Etiology

Can be comforting and be a part of other self-soothing activities such as body rocking or head rolling

Can be seen during a temper tantrum secondary to frustration or anger

Can be seen with typically developing children as an expression of happiness or as a method of self-stimulation (sometimes secondary to sensory deprivation)

Need to rule out medical causes specifically if head banging occurs suddenly and is associated with other symptoms

Can be part of a sleep rhythmic disorder called Jactatio capitis nocturna (partial arousal during light, non-REM sleep); head banging occurs when drowsy or falling asleep.

Can be described as SMD, which is a repeated, rhythmic, purposeless movement or activity; these usually cause self-injury or severely interfere with normal activities. These are most prevalent in adolescence and tend to occur in clusters of symptoms. Diagnosis requires 4 weeks of duration.

Commonly Associated Conditions

Medical causes: teething (pain), ear infection, seizures, meningitis, headaches, drug use (cocaine, amphetamines)

SMD associated with cerebral palsy, intellectual disability, schizophrenia, autism spectrum disorders, Down syndrome, Lesch-Nyhan syndrome, blindness, deafness

Tic disorder or Tourette syndrome

Rule out child abuse if significant scalp laceration, skull fracture, or intracerebral or subdural hemorrhage

Diagnosis

Dependent on multiple factors

Determine factors associated with behavior, including age of child, degree of parental concern, location of behavior, associated behaviors, motivations of the child, benefits to the child, etc.

Determine if a medical cause exists, particularly if sudden onset.

Determine if psychological factors are involved.

Diagnostic Tests & Interpretation

Usually, no laboratory testing is needed for diagnosis.

Physical examination to look for bruising, swelling, scratches, or minor lacerations.

If swelling or blood loss is involved, brain imaging may be necessary to rule out damage.

If severe and persistent head banging is reported, an ophthalmology exam is warranted to rule out complications.

Developmental screening to rule out possible developmental delay

If developmental delay is suspected, formal psychoeducational testing can be recommended.

Treatment

Typically, developing children will outgrow the habit by age 3 years.

Older children may need psychological/developmental follow-up to determine delay/cognition status and to determine if behavioral modification therapy could be beneficial in decreasing symptomatology.

If severe, head banging can lead to ophthalmologic complications, including cataracts, glaucoma, or retinal detachment. Referral to ophthalmologist is recommended.

For patients with particularly violent movements of Jactatio capitis nocturna, trials with clonazepam and citalopram have shown some success.

For patients with stereotypic movement disorder, medications may help, including antipsychotics, tricyclic antidepressants, SSRIs, and benzodiazepines. These should be closely monitored.

Ongoing Care

Prognosis

Normally disappears by age 3-4 years

Jactatio capitis nocturna is usually benign and resolves by age 5 years.

Stereotypic movement disorder usually peaks in adolescence and then declines.

Additional Reading

Harris KM, Mahone EM, Singer HS. Nonautistic motor stereotypes: clinical features and longitudinal follow-up. Pediatr Neurol. 2008;38(4):267-272. [View Abstract]

Leekam S, Tandos J, McConachie H, et al. Repetitive behaviours in typically developing 2-year-olds. J Child Psychol Psychiatry. 2007;48(11):1131-1138. [View Abstract]

Miller JM, Singer HS, Bridges DD, et al. Behavioral therapy for treatment of stereotypic movements in nonautistic children. J Child Neurol. 2006;21(2):119-125. [View Abstract]

Sallustro F, Atwell CW. Body rocking, head banging, and head rolling in normal children. J Pediatr. 1978;93(4):704-708. [View Abstract]

Vinston R, Gelinas-Sorrell D. Head banging in young children. Am Fam Phys. 1991;43(5):1625-1628. [View Abstract]

Codes

ICD09

307.3 Stereotypic movement disorder

780.58 Sleep related movement disorder, unspecified

ICD10

F98.4 Stereotyped movement disorders

G47.69 Other sleep related movement disorders

SNOMED

43954004 Head-banging (finding)

40083003 Stereotypic movement disorder with self-injurious behavior (disorder)

284706008 Banging own head against object (finding)

230497000 Sleep-related head banging (disorder)

FAQ

Q: Can head banging lead to serious head injury or neurologic damage?

A: Typically, developing children rarely bang their heads hard enough to cause bleeding or fracture.

Q: What can a parent do to prevent injury or diminish head banging behavior?

A: Remove sharp or breakable objects from child's environment to avoid accidental injury.

Place a rubber pad on the floor or a thick rug.

Secure the crib to the wall to decrease noise and vestibular input to the child.

Pad crib with bumpers.

If behavior occurs during temper tantrums, ignore the behavior once safety is established. Reward the child for appropriate behaviors.