Nail Biting, Skin Picking and Other Hard-To-Stop Children’s Habits

They’re annoying and sometimes unhealthy. Dr. Saltz reveals how parents can get kids to break these all-too-common habits. (Hint: Positive reinforcement works better than finger-wagging.)

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Episode Transcript

Speaker 1 (00:05):
These are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm Dr
Gale Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,

(00:27):
hopefully with understanding, insight and advice. Do you find yourself
worrying about your child's nail biding? Don't? Many children, at
some point or another, develop what you feel is a
bad habit, and your impulse may be to feel concerned
it will harm them physically or socially, and that it

(00:50):
will never go away. Today, I'm answering your question that
a listener has about a habit their child is developed
that really concerns them. The most common childhood habits develop
as a child's method of coping with emotional states of
anxiety and stress, or boredom and even feeling tired. They

(01:14):
may find the habits soothing, which provides the kind of
positive reinforcement to keep it going. Some children are more
prone to certain kinds of habits than others, because picking
at things on one's body and Nail biting tends to
run in families, and because a child will often witness

(01:36):
their parents doing something like nail biting and then imitate it.
The most common childhood habits are thumbsucking, nail biting, nose picking,
skin or lip picking, hair twirling or pulling, and masturbating.

(01:56):
A parent's tendency is to want to scold a child
for doing something that they consider to be themselves yucky behavior. Unfortunately, attention,
even negative attention, may actually increase the behavior. Children may
even get a rise out of your exasperation and this

(02:17):
will surely spur them on. Expressing disgust can also have
the added negative outcome of making a child feel ashamed
of their body in some way, and that can have
lasting emotional consequences. The American Academy of Pediatrics has actually

(02:37):
just announced that children and teens are having a mental
health crisis, meaning the number of children struggling with high stress, anxiety,
and depression has risen substantially in the setting of the pandemic,
and more children are in need of support. When a

(02:59):
child feels dressed, any behavior that has a soothing component
to it, even if it's hard for you to understand
how this would be soothing is likely to increase. Picking, touching,
twirling are all repetitive behaviors that do have a satisfying

(03:19):
component that then gets reinforced by the good feeling the
child gets, which makes them want to do it more
and makes it hard to stop. Many of these behaviors
become automatic, such that the child doesn't even realize they're
doing it when they are. This makes it especially hard

(03:42):
to stop. With that, let's turn to my listeners question
and ask how can I help, dear Doctor Souls. My
eight year old son has started biting his nails. I
used to bite my nails as a kid, but I
managed to stop. I feel like, especially now with such

(04:05):
an emphasis on handwashing and diseases like COVID being transmitted
by putting dirty hands in your mouth, that it really
bothers me. He has started doing this now. I've told
him it's a problem and he has to stop, but
I see he is still doing it. I don't know

(04:26):
what to do to help him stop. I've noticed it's
really mostly a few fingernails, not all of them, but
these nails get really low and frankly, it looks like
it hurts. But he's still doing it anyway? What can
I do to get him to stop? It? Has been

(04:47):
an especially stressful year for many kids and adults, and
of course our children pick up on our own stress
as well. Nail biting may or may not be directly
related to stress. That you were also a neo biter
as a kid may point to the possibility that the

(05:09):
potential for picking and biting behaviors runs in your family,
and so he has a propensity to develop this habit anyway,
but perhaps especially so at stressful times. To help him
to stop the biting, he needs to feel on board
with the idea of quitting. It can't just be a

(05:32):
battle with him wanting to and you not wanting him to.
In order to get him on board, this has to
have two components, making him aware that he does it
and where he has a tendency to do it, so
he can increase his general awareness about it and increase
his awareness of the urge to do it. The urge

(05:56):
is the feeling just before he starts biting it, a
feeling of wanting to or needing to do it. It's
important to make this conscious for him because it is
the urge moment beforehand where he actually has the chance
to intervene. How can I help with Dr Gail Salts

(06:18):
will be back after the short break. The other part
is that he feels he has a desire or incentive
to stop doing it. Explaining why it's worth it and
worth stopping will be very helpful. For example, it's healthier

(06:42):
to keep your hands out of your mouth, since you
can't really and shouldn't really be washing your hands all
the time to avoid colds and other illnesses. But also
that over time his hands are appearing chewed up and
they will hurt, and this isn't really something he likely wants.

(07:02):
Do this, however, without shaming him or referring to any
part of it as disgusting, but rather more factually, you
can tell him you understand how hard it is to stop,
because indeed you do. You can also tell him that

(07:23):
once he has stopped for a while, it will be
much much easier to not do it than it is
at the beginning. You may need to try and aid
to make him aware when he is doing it, and
rather than it be you telling him, which can turn
into a nagfest of you saying now now stop now.

(07:47):
Try a nail polish designed to taste bitter as a
means of awareness that he just started, and as a deterrent.
There are numerous brands. Give him something else to fidget
with his hands at stressful times. So if you know
something is going to be stressful, or it's a time
of the day when he tends to feel more stressed

(08:09):
and do more biting, give him something like a stress
ball to squeeze. Talk with him about what is on
his mind and whether he is feeling nervous about anything
in particular, what his feelings are like, and think about
ways to decrease stresses for him. For example, is he overscheduled,

(08:32):
Is he getting exercise which helps to decrease stress. Does
he have methods of soothing himself when he feels uptight,
like slow deep breathing. In addition, positive reinforcement is definitely
more effective than negative reinforcement, So having him choose something
special like a toy or a game he's really wanted,

(08:56):
and tell him that that's the final eyes once he
has stopped for a month, that's what he can look
forward to getting as a reward. One good way to
start is to spend thirty minutes together each evening a
time period of not doing the habit. So, for example,

(09:18):
have him sit with you for thirty minutes where his
mission will be to not bite. This is a pretty
accomplishable mission, but as you are testing this out, he
will find he does have the urge and he can
consciously not do it with you there, so you could say, hey,

(09:41):
that was a great job and actually believe it or not.
Starting with just this thirty minutes will over the period
of a couple of weeks, help him to intervene with
the urge at other times. So do this daily to
help you on the road to stopping altogether. Also, if

(10:01):
he's biting a ragged nail, which honestly is often the case.
Many people who bite their nails do so to quote
even things up or smooth them out, make sure to
file or cut his nails to help keep them smooth
and neat, because it is often this raggedness or an

(10:21):
evenness that stimulates the desire to bite. I hope that
was helpful. When it comes to all of these types
of habits in general for kids, consider these general guidelines. Firstly,
taking down the child's stress levels can help curb the habit.

(10:44):
Talk to your child about what might be making them nervous,
If you note the habit gone wild before or after
certain events, this may point to what is especially stressing them.
Give your child other soothing things to do if they
are feeling stressed or bored, like coloring, exercise, listening to music.

(11:09):
Redirect where they can and cannot do their habits socially speaking, So,
for example, masturbation is a perfectly normal thing a child
may do, but let them know it needs to be
done in private, like in their room when they are alone,
and not in any public areas. Give them ways to

(11:30):
make it easier to avoid the habit. For example, skin
picking and nail biting are often triggered by something that
feels uneven, sticking up, or ragged, so help your child
with hang nails and nail file and moisturizing cream is
for cuticles or other areas of skin that can get
dry and cracked and be more tempting to pick. Offer

(11:54):
positive incentives or not doing the behavior. Just as it's
best to avoid negative attention, it's good to offer positive
attention for not doing the habit, So for example, getting
a gold star on a chart, you keep giving them
a treat, an enthusiastic great job for an evening spent

(12:18):
without neo biding or evidence, for example, of growing nails,
explain why it's not a good habit other than you
don't like it. It can help a child to understand
that nail biding or nose picking can increase the likelihood
of colds and other contagious illnesses. By giving them an

(12:38):
understanding of how germs are passed and that upsetting the
body's natural defenses lowers your ability to avoid illness, they
can understand the motivation to stop now. I should say here,
I am not lumping masturbation in this category because it's
not that kind of habit, but it is important to

(13:01):
let them know where it's okay to do that. How
big a problem a habit is has much to do
with how much time they spend doing it. The sometimes
neo nibbler is likely to basically grow out of it,
but the blighter who has bleeding fingers needs more help.

(13:23):
The thumb sucking hair twirler will eventually probably grow out
of this. The child who starts pulling out hairs and
getting bald patches may have a condition called tricotillomania, a
disorder of hair pulling that requires mental health treatment. If
a child is masturbating sometimes it's very normal. If they

(13:47):
are masturbating all the time, then this may be a
sign of an anxiety disorder, requiring evaluation from a mental
health professional and treatment. But most habits in children can
be solved with removing a little stress from their lives
and encouraging other ways of coping with stress. Do you

(14:12):
have a problem I can help with? If so, email
me at how Can I Help? At Seneca women dot com.
All centers remain anonymous and listen every Friday to how
Can I Help with Me? Doctor Gale's Salts