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Child Caring

Nervous habits often reflect a developmental need

By Barbara F. Meltz
Globe Columnist / July 30, 1998

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As a child, Susan Swedo bit her fingernails so much that her parents made a deal with her. If she stopped biting for a month, they'd take her to the movies, a treat in rural Iowa.

``I didn't make it,'' she says.

Now a mother of three and a pediatrician who, perhaps not so coincidentally, researches children's nervous habits, she understands how much her biting must have bugged her parents. She also understands why they were never able to get her to stop. It turns out that nail or cuticle biting is one of the hardest habits for children to break; 20 percent of those who do it, like Swedo, will still be picking or biting as adults.

Luckily, most of the habits our children engage in go away on their own. While they last, though, any one of them -- from hair twirling to lip picking, thumb sucking to shirt sucking, finger tapping to knuckle cracking -- can make you crazy. And therein lies the rub. Just because a habit bothers you doesn't mean it bothers your child. Indeed, most children pick, bite, or suck without even realizing it. Not only that, but most of the time, the habit serves an important purpose and a developmental need, usually for comfort.

``We call them nervous habits but more commonly it's about being overtired, out of control, or trying to concentrate,'' says clinical psychologist Laura Gutermuth Foster, who researches developmental disorders at the University of Maryland at Baltimore.

It's easy to see that the baby who sucks his thumb is trying to comfort himself. It's also easy to connect it to a primitive suckling reflex. It's harder to make the connection with a 9-year-old who one day starts to suck on his shirt-sleeve but Foster says it's the same need. In fact, she says many kids migrate from one form of oral gratification to another, typically pacifier to thumb to pencil chewing to shirt sucking.

Even infants have habits. Body rocking on all fours or head banging are considered habits, even though they can be scary to watch; one is fueled by a need to strengthen muscles pre-walking, the other by unexpended energy. They tend to disappear by 18 months but residual rocking in a seated position or at bedtime may continue into adulthood and still be normal, says experimental psychologist Gershon Berkson, a professor at the University of Illinois at Chicago.

Prime time for the onset of habits is between 2 and 5. A 2-year-old rubs her ear lobe with her finger or her blankie against her lip, a 3-year-old twirls her hair. Or you may see something more ritualistic: a 4-year-old who insists on the same orange shirt every day or who refuses to eat a broken cracker.

A source of security

``This is all about wanting to exert control over your world,'' says Foster. It may feel like rigidity to you, but it's a source of security to a child. ``Let it roll off your back,'' says Foster. ``It'll disappear faster.''

Not all habits begin out of a need for self-comfort. Hair twirling, most common among fifth- and sixth-grade girls, calms a child so she can concentrate. Finger or foot tapping starts as a way to expend unused energy. The genesis for nail biting and knuckle cracking is tactile.

``You pick a finger because there's a rough spot or a hangnail. You crack your knuckle because you get a sensation of tightness in your finger. Some boys start because they think it's macho,'' says Swedo, who is chief of pediatrics for the National Institute of Mental Health.

Soon, it takes on a life of its own. ``You do one finger, you check the next, and pretty soon you're into a pattern of doing them all,'' she says. ``Once you start, you have to do it to completion.''

And, yes, sometimes something that makes a child nervous -- bedtime, a test, the first day of school -- is what brings a habit on. ``Going to sleep is one of the most anxious periods of the day,'' says Swedo. ``You're separating from the family and facing fears of the dark. Sucking your thumb, rubbing your blankie, rocking, even the sequence of events are calming.''

Parental strategies

With any habit, the task for a parent is to be alert to teasing by peers or to potential medical issues. Otherwise, there's no reason to try to make a child stop, says Foster.

In the preschool years, teasing is unlikely; distracting her with another activity or ignoring the habit is your best strategy. Whatever you do, at this or any age, don't shame a child, says child psychiatrist Stuart Goldman of Children's Hospital. ``Saying, `I'm surprised a boy your age does this,' or, `Your little sister doesn't do that,' '' is humiliating,'' he says.

In the school-age years, it's a different story; peers will notice a habit that is socially uncool, like nose picking or sucking a thumb at school. It can be important, indeed critical, for a child to be aware of what she's doing and able to control herself. Point the habit out, talk about how peers might react, and label it as something to be done in private. Avoid nagging.

``If he's trying to self-calm, nagging makes him more anxious. You increase his need,'' says Foster.

The key to getting a child habit-free, no matter what the habit, is that she herself wants to stop. What typically will push her to that point is being teased or seeing the habit annoy her best friend. Even if you warn her this might happen, she likely won't believe you; she has to figure this out herself. Start by pointing out, ``When I was a kid, someone who picked his lip would be teased. Does that happen to you?'' Offer support -- ``Do you want me to point out to you when you do it?'' -- and a way for him to gain control, for instance, a substitute behavior like chewing gum. You can also suggest, ``How 'bout if you carry paper in your pocket and every time you notice someone noticing you picking your lip, you mark it on the paper. Then you can decide for yourself if this is a problem.''

When to stay involved

Once you've done that, back off. There are a few exceptions, however, when more is called for:

- If you really can't stand it. If he cracks his knuckles at the table or picks his nose, send him to his room, says Swedo. ``Tell him, `It ruins our meal and I know you can control it enough not to do it at dinner. Please stop or leave.' '' Don't be punitive, just matter-of-fact.

- If it could have a medical component. Hair twirling can turn into hair pulling, which is a serious medical problem. Picked fingers can get infected. Offer a substitute behavior that gets her need met: a smooth stone in her pocket for touching or a small ball to squeeze.

- If it interferes with her ability to function. Habits can cross a line and become rituals or obsessions, says child psychiatrist Henrietta Leonard of Brown University. A 5-year-old who taps his fingers during story time has a habit that may be disturbing to others, but that's all it is. (Give him options for acceptable substitute behaviors.) But if he interrupts his play to rush to a spot in the room to tap on the floor, he could be moving along a continuum. ``Get it checked out,'' says Leonard. She is coauthor, with Swedo, of ``Is It Just a Phase?'' due out in October (Golden Books).

- If it's a tic. Throat clearning, sighing, coughing, or sniffing when there isn't a cold or allergy are common verbal tics; motor tics include repetitive eye blinking, facial grimaces, and head shrugs. Unlike habits, kids are aware of these and feel self-conscious, but they're unable to stop. If it lasts more than three weeks, contact your pediatrician, advises Leonard.

When a child wants to rid himself of a habit, star charts and other mild behavioral modification can help. For instance, says Goldman, ``Take a baseline of how many times a day you observe it, say five, and set a goal together of anything less than five being worthy of special time with you. Then work down from there. The key is not to set unrealistic expectations.''

Perhaps of any parent, Swedo is best prepared to be sympathetic to a child's nervous habits. So far, though, her three daughters haven't had any, not even a hint of nail biting.

SUGGESTIONS FOR PARENTS

- A nervous habit doesn't automatically mean a child is nervous, unhappy, or poorly adjusted.

- At the onset of a habit that you know could be troubling, the first time you notice it is the time to have a conversation: ``This is the kind of thing kids tease about.''

- Habits can appear overnight. In a school-age child, look for a catalyst. There may be a stress she needs help with.

- You can point out potential bad consequences from a habit -- braces from sucking, infection from picking -- but don't expect them to faze a child. He can't project into the future.

- Superstitions are normal, a kind of magical thinking (``If I do this nothing bad/something good will happen'') and not cause for concern. Don't belittle your child for having one.

- If your child is too old to have a blankie and likely to get teased at sleep-overs, cut it into small pieces. It will be less offensive, and there's always a spare.

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