Watching your child bang their head on the floor, bite their own hand or hit their face is one of the hardest things a parent can see. You may feel scared, helpless or guilty. You are not alone, and you did not cause this. Self-injury is more common in autistic children than in other children, and there is real help for it. This guide explains when to get help right away, what medical causes to check, how to keep your child safer in the moment without restraint, and how a behavior assessment works.
When is self-injury an emergency?
Call 911 or go to the nearest emergency department if your child has hit their head and you see any of the danger signs the CDC lists for a head injury, including:
- convulsions or seizures (shaking or twitching);
- repeated nausea or vomiting;
- loss of consciousness, increasing drowsiness, or being unable to wake up or stay awake;
- one pupil larger than the other, or double vision;
- slurred speech, weakness, numbness or poor coordination;
- a headache that gets worse and does not go away;
- not recognizing people or places, or new confusion, restlessness or agitation;
- in infants and toddlers, crying that cannot be consoled, or refusing to nurse or eat.
The CDC also notes that spotting a concussion "may be harder in young children and some children with disabilities because they may not be able to communicate or express how they feel." You know your child better than anyone. If something seems different after a hard hit, get them checked.
Also call 911 if your child is causing serious injury (deep bites, bleeding that will not stop, eye injuries) or if you cannot keep your child or others safe.
Why do some autistic children hurt themselves?
A 2014 research review by Minshawi and colleagues describes self-injurious behavior as behavior "that may cause physical harm, such as head banging, or self-biting," and notes that it is more common in children with autism than in typically developing children or children with other neurodevelopmental disabilities. It also reports that limited communication, greater social difficulties, motor difficulties and sleep problems have all been linked with a higher risk.
Like other behavior, self-injury usually serves a purpose for the child. Classic functional analysis research by Brian Iwata and colleagues found that for six of the nine people studied, self-injury was consistently higher under one specific set of conditions. The conditions they tested varied demands, access to play materials and adult attention. Common functions are:
- Escape: ending a demand, a noise, a transition or an uncomfortable situation;
- Access or attention: getting a wanted item or a reaction;
- Sensory or automatic: the feeling itself, or relief from another feeling such as pain or anxiety;
- Communication of distress when a child has no other way to say "I hurt" or "this is too much."
Could there be a medical cause?
Yes, and this is why the child's doctor comes first, especially when self-injury is new, sudden or suddenly worse. The Minshawi review says that before any intervention, an evaluation of self-injury should include interviews, observation, data, "a medical evaluation, and a FBA" (functional behavior assessment). One well-known case study found that a child's head-hitting happened only during periods of ear infections (otitis media). Things to raise with the pediatrician include:
- ear infections, sinus pain or headaches (watch for hitting one side of the head or ear);
- dental pain (hitting the jaw or mouth, biting hands);
- constipation, reflux or other stomach pain (pressing on the belly, self-injury after meals);
- poor sleep;
- seizures;
- side effects of a new medication or a change in dose;
- allergies, eczema or skin conditions (scratching or picking).
The CDC lists epilepsy or seizure disorder, unusual eating and sleeping habits, and gastrointestinal issues such as constipation among characteristics that often come with autism. Bring a short log of when the behavior happens to the appointment; it helps the doctor.
How can I keep my child safer in the moment?
These steps reflect the approach Hope Center uses: protect, remove hazards, redirect, and never restrain.
- Make the space softer. Move your child, if you can do it calmly, to carpet or a bed, or slide a pillow or cushion between their head and a hard surface.
- Remove hazards. Move furniture with sharp corners, glass and hard toys out of reach.
- Block briefly, then redirect. You can briefly put a cushion or your open hand in the way of a hit and then offer something else for their hands, such as squeezing a ball, pushing on your palms or holding a favorite object. Behavior analysts call this brief response interruption and redirection.
- Use few words and lower demands. Pause the task. Speak softly. Reduce noise and light.
- Do not hold your child down. Restraint can injure children and caregivers and often increases distress.
- Afterward, check for injuries, note what happened before, and offer comfort and rest.
Some families are advised to use protective gear, such as a helmet. Protective equipment is a decision for your child's doctor and behavior team, not something to try on your own, because it can affect how a child moves and learns, and it does not address the cause.
How fast should I get a behavior assessment?
Do not wait to see if it passes when self-injury causes injuries, happens daily or is getting worse. After the doctor has checked for medical causes, ask for a functional behavior assessment. A BCBA will interview you, observe your child and collect data on what happens before and after each episode, then write a plan that:
- changes triggers where possible (for example, shorter tasks, warnings before transitions, quieter spaces);
- teaches a safer way to communicate the same need, such as asking for a break or saying "hurts";
- gives safe sensory alternatives when the behavior is sensory;
- makes sure self-injury no longer "works" while the new skill is rewarded quickly;
- keeps working with the doctor when medical factors are involved.
Insurers and public programs treat self-injury as a safety concern. For example, the Florida Medicaid behavior analysis coverage policy lists self-injury among the safety impairments that behavior analysis can address. Commercial plans have their own medical necessity rules, so check your coverage. The Hope Center ABA assessments page explains what an assessment involves.
What else should I know?
- Autism alone is not a reason for a Baker Act exam in Florida. Florida's Baker Act defines mental illness to exclude a developmental disability as defined in chapter 393, which includes autism. If your child also has thoughts of suicide or a co-occurring mental health crisis, call or text 988, or 911 in an emergency.
- Self-injury and aggression often go together. Our guide on hitting, biting and aggression covers the overlap.
- Take care of yourself too. Caring for a child who self-injures is draining. See caregiver burnout and support in Florida.
How Hope Center can help
At Hope Center for Behavior Change, a BCBA assesses your child and writes a plan focused on safety and communication, reviewed by our clinical director before it goes to insurance. RBTs deliver sessions with weekly BCBA supervision, and our team can join doctor visits where allowed so medical and behavior plans fit together. Our approach is trauma-informed and assent-based, uses the least intrusive and safest strategies, and never uses restraint. If a child in our care cannot be kept safe, families call 911 and report to the behavior analyst, who returns the call within 24 hours.
We have no waitlist. Request a free consultation or call 561-337-8865, and we will also check your benefits for free.