AAP: Helping children believed to be self-harming

AAP: Helping children believed to be self-harming | Image Credit: © Khunatorn - © Khunatorn - stock.adobe.com.

Self-harm, self-injury, self-mutilation, or self-abuse happens when individuals purposely hurt themselves without the intention to kill themselves. Since May is Mental Health Awareness Month, the American Academy of Pediatrics suggests now is a good opportunity to learn how to further help youth who self-harm.

Cutting and other forms of self-harm are often referred to as nonsuicidal self-injury (NSSI) by medical experts. According to the AAP, medical experts acknowledge that self-harm can be a way for youth to take control of their bodies, if they feel a lack of control in other areas, or when their lives seem unmanageable.

“There is no single clear cause,” said Maria H. Rahmandar, MD, FAAP. “However, young people who self-harm often feel overwhelming emotional pain. Some may say they feel lonely, worthless or empty inside and will do anything to feel better or even different, if only for a moment. Still others report feeling overstimulated, misunderstood, fearful or a variety of other emotions. Some may use self-harm as a way to punish themselves for something they believe they've done.”

To help self-harming youth, the AAP offers the following tips that can be discussed with parents and caregivers.

1. Parents and caregivers should have the tough conversation:

The AAP recommends talking with a child that is self-harming or a child that is suspected of self-harming. Taking a nonjudgmental stance and listening more than speaking can help. When speaking with the child during this conversation, the AAP suggests expressing love and concern with the child. For example, “This is hard for me to even think about because I care about you and want you to be healthy and safe, always."

2. Be prepared for reactions:

Often, people that self-harm deny doing so or try to hide the evidence. As a result, children could be upset and might refuse to speak. The AAP advises expressing concerns to the child during a calmer moment, and to mention plans to speak with child’s doctor about the self-harm.

3. Express trust in the pediatrician:

The AAP recommends reassuring parents that doctors who focus on child health understand self-harm from other patients' experiences. Parents should not feel ashamed or blamed for their child’s struggles. Ensure that private, 1 on 1 time between the child and pediatrician is a positive, so they can discuss concerns together. Talk therapy, stress reduction techniques, medication, and other steps should be discussed through a patient-geared care plan.

4. Homes should be a safe space:

If a child is self-harming, parents should remove hazards like razors, sharp knives, poisons, and weapons from the home and from the child’s space. If a child is having suicidal thoughts, the AAP states it is especially important to remove such items from the home. Further, if suicidal thoughts are present or if there is evidence of self-harm, medications should be locked away.

5. Develop a safety plan:

Pediatricians and parents should discuss a “safety plan,” according to the AAP. This plan will consist of practical ways to keep the home environment safe, along with important information so that a child can obtain emergency care if a crisis arises.

6. Change the social media mindset:

The AAP states while digital channels may not be a direct cause of self-harm in a child, excessive screen time can lead to poor sleep habits and exaggerated feelings of envy, isolation, fear, and self-rejection. Issues like these could intensify emotions that prompt some children to self-harm. Click here for more on pediatric mental health in relation to social media use. 

7. Parents’ digital habits matter:

The AAP cites one study that revealed adolescents living with depression reported their respective parents spent up to 8 hours per day on social media. This type of pattern can block opportunities for conversations and emotional closeness. These opportunities, generally, reduce a child’s risk for depression and anxiety.

8. Prioritize family mental health:

If stress is high on a family-wide level, suggest the family takes time to consider a solution. The AAP suggests that young people need to know they can ask for downtime without feeling guilty, and that self-care is a priority, even above “mountains of schoolwork and extracurricular activities,” according to the AAP’s tips.

Parents should know self-harm doesn’t necessarily mean their child wants to die, and that it does not make them a bad parent. Expressing hope, embracing treatment, and showing unconditional support can help a child recover from self-harm or suspected self-harm.

“Some children and their family members are at higher risk of mental health challenges due to trauma, violence, unstable family dynamics and poverty that are part of their everyday lives,” said Alia McKean, DO, MPH. McKean states a supportive parent-child relationship can be a powerful buffer, and that pediatricians are a resource for strategy discussion that can help reduce stress and build child resiliency for those exposed to adversity.

Reference:

American Academy of Pediatrics: How to help when you believe a child is engaging in self-harm. American Academy of Pediatrics. May 9, 2023. Accessed May 10, 2023.https://www.aap.org/en/news-room/news-releases/health--safety-tips/american-academy-of-pediatrics-how-to-help-when-you-believe-a-child-is-engaging-in-self-harm/