What are self-injurious behaviours?
Self-injurious behaviours can be defined as any actions or behaviours through which a child causes harm to themselves. This might include but is not limited to: head banging or shaking; biting of the limbs; face or head slapping; hair pulling and skin picking. These behaviours can understandably cause alarm for staff supporting young children.
Why might children engage in self-injurious behaviours?
There are a few reasons why a child might engage in behaviours that cause themselves harm and it is important for adults working with young children to consider the possible functions of the behaviour.
Considering the functions of the behaviour will help in deciding how best to support the child. The child is likely to be communicating a need through their behaviour. This may include:
- a physical need, such as feeling hungry, thirsty, tired, wet or unwell
- a sensory need, including feeling over stimulated (e.g. too much noise, too much light, specific smells, too cold, too warm ) or under-stimulated (leading to sensory seeking). The behaviour may provide the child with sensory feedback that they find satisfying
- expressing an emotion, such as feeling excited, worried, scared or frustrated or
- expressing that they want or do not want something (e.g. a toy, game or activity).
Reducing the occurrence of self-injurious behaviours
- Explore the function of the child’s behaviour by completing structured observations (see ABC Charts or the STAR approach in the appendix).
- Work closely with the child’s family to explore when/where the behaviour occurs outside of the setting to better understand patterns and the function of the behaviour.
- Increase structure and routine – establishing clear and consistent routines and structure can help to reduce Provide additional support around transitions throughout the day through use of visual timetables, now and next boards and objects of reference to reduce anxiety.
- Consider the sensory demands of the environment – create small, contained, break-out spaces for the child to access at planned times. (See appendix for guidance on how to create a sensory space.)
- Provide opportunities for alternative sensory experiences throughout the day that could meet the same need for the child (e.g. jumping on a trampoline, swinging, or biting on soft/edible items).
- Provide a range of sensory experiences that could support children to get the feedback they are seeking e.g. weighted or pressure clothing, hats and sunglasses, messy play such as shaving foam, gloop, flour and water, water and sand play and sensory tubs which can also support fine and gross motor development.
- Support communication with visuals – try to give the child other ways to communicate what they want or need (e.g. objects of reference, pictures of different items or body parts, symbols, emotions fans, communication grids and AAC devices) to help children communicate their emotions.
- Offer praise that is sensitive to the child’s individual preferences (e.g. not too overwhelming if a child struggles with praise) and provide meaningful rewards for the behaviour that you want to see.
How to help when the behaviour occurs
Reduce any demands on the child – if they have been given an activity or an instruction, come back to this when they are calm.
- Reduce uncomfortable physical or sensory stimuli where possible.
- Give the child plenty of space.
- Keep responses low key – it is important to respond very calmly, reduce your language and speak in a consistent tone.
- Do not ask or tell the child to stop engaging in the behaviour. If it is safe to do so, you can give the child clear instructions to redirect their behaviour towards what you want them to do (e.g. ‘Jack, hands down’). This could be supported with a visual prompt.
- Keep the child safe – create a barrier between the child and what is causing them harm. For example, provide a soft mat between a child’s head and a wall, or a pillow between the child’s head and hand. Offer replacement items such as a soft item to bite on.
- Gently redirect the child’s attention if it is safe to do so (e.g. towards a favoured toy or activity.)
Signposting and further information
It can be helpful to discuss a child’s self-injurious behaviour within a multiagency group. Contact your SENCO for support in the first instance.
Specialist Learning Disability Nurses can offer support to develop individualised plans for children, based on a robust understanding of the function of the behaviour (what need it is meeting or expressing for the child).
Out Of Sync Child Website includes links to books, articles and resources around sensory processing difficulties.
Examples of sensory checklists are available online e.g. environmental-sensory-checklist.docx [1.67Mb].