Head Banging

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DESCRIPTION

  • A stereotypic movement disorder (SMD) which is a repeated, rhythmic, purposeless movement or activity; the behavior can cause self-injury or severely interfere with normal activities. Primary stereotypies occur in children of normal intelligence; secondary SMD can be seen in children with autism or other neurologic disorders.
  • Head banging (HB) is defined as the hitting of head on solid object such as a wall, side of crib, mattress, or floor.
  • Tendency to hit the front or side of the head
  • Usually lasts for 15 minutes but can go on for >1 hour
  • Regular rhythm of 60 to 80 bpm
  • Can be seen along with body rocking or head rolling

EPIDEMIOLOGY

  • Age
    • Average age of onset is 9 months; usually extinguished by 3 years of age
    • Older patients with HB 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 normally developing children
  • Estimated that 2–3% of kids with intellectual disability have SMD, such as HB, and 5% of kids with Tourette syndrome have SMD or HB

ETIOLOGY

  • The movement can be comforting and be 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 normally developing children as an expression of happiness or as a method of self-stimulation (sometimes secondary to sensory deprivation)
  • Can be part of a sleep rhythmic disorder called jactatio capitis nocturna (partial arousal during light, non-REM sleep); HB occurs when drowsy or falling asleep.
ALERT

It is important to rule out medical causes if HB occurs suddenly and is associated with other, nontypical symptoms.

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 disorder
    • Down syndrome
    • Lesch-Nyhan syndrome
    • Blindness
    • Deafness
  • Tic disorder/Tourette syndrome

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