Head Banging

Basics

Description

  • 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 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 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 HB 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); HB 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.

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