Self-harm in children

Written by Dr. Joshua Harwood

Josh is a chartered clinical psychologist specialising in working with children and families.

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What is self-harm?

Self-harm is when a person hurts themselves on purpose as a way to manage distressing feelings, memories or experiences without wanting to die. Cutting is the most common form of self-harm among all age groups, but other methods common among children and adolescents include:

• Burning
• Biting
• Scratching
• Head banging
• Hair pulling 
• Plucking or picking skin
• Swallowing objects. 

Many young people who self-harm also have suicidal thoughts but most feel that there is a difference between suicidal acts, and acts of self-harm.

You should always take talk of suicide seriously. Only a small number of people who self-harm are suicidal (for most it is a release from emotional pain), but people who have self-harmed are at higher risk of suicide than other young people¹. If your child is talking about taking their life seek further help.).

Self-harm is not often talked about, even though it’s relatively common (about 1 in 10 adolescents self-harm2). It’s an unhelpful myth that people only self-harm for attention or to manipulate. Most people self-harm in private and try their utmost to conceal it. Some young people self-harm as a way to let adults know how bad things are, or to make their body show their emotional pain. Self-harm can be addictive and involve rituals that can be a difficult pattern of behaviour to change.

Seeing someone you care about harming themselves can feel incredibly distressing and worrying. It’s important to remember you, as a parent, are not alone and that many young people have been through this and come out the other side with new ways of coping with their emotions. There is lots of information and support available.  

Why do children self-harm?

There are many reasons that a child might describe wanting to harm themselves. Self-harm is a coping strategy to deal with difficult feelings, memories, or experiences. Some children describe feeling overwhelmed by intense distressing feelings and hurting themselves feels like the only way to cope, others feel numb and harming themselves is a way to feel something. The feeling of relief is often only temporary and does not last, because the reason for the distress remains. 

There are many reasons why someone might self-harm, such as: 

• To change emotional pain into physical pain
• A way to reduce overwhelming feelings and thoughts
• Having a sense of feeling in control
• Punishing themselves for their feelings or experiences
• To stop feeling numb
• To distract themselves from their emotional pain
• To express suicidal feelings without taking their own life

 Signs of self-harm in your child

Signs that your child might be self-harming can include:

• Covering up their body by wearing longs sleeves a lot of the time, including in hot weather, avoiding swimming
• Possessing unusual or inexplicable paraphernalia (e.g. multiple razor blades or inappropriate medication)
• Blood stains on clothing, or finding tissues with blood in their room
• Unexpected cuts, bruises, burns or bite marks on their body
• Feeling down, low self-esteem or blaming themselves for problems
• Outbursts of anger, or risky behaviour like drinking or taking drugs

Accidental harm:

The nature of self-harm means there is a risk that someone may accidentally cause more harm than intended. Whilst most scratches and bruises can be managed with first-aid type attention, any serious injuries or anything to do with heat or medicines should get prompt medical attention. If a wound has become infected (signs of infection are swelling, pus forming or spreading redness) seek medical help immediately, including going to your nearest A+E or calling 999.

If your child goes to hospital for self-harm, they should be seen by someone who will talk to them and assess their mental wellbeing. If it is not clear that this has happened, ask the hospital staff about it.

When to seek more urgent help

A proportion of young people feel so distressed or overwhelmed that they wish to end their life by suicide. They may feel that they want their problems to disappear and have no idea how to get help.

Has your child:

• Talked about wanting to die or wanting to kill themselves?
• Talked about how they might kill themselves?
• Expressed feelings of hopelessness about the future and can think of no reason to live?
• Access to a supply of medicine (“a stash”)? This can be very dangerous. Even small ‘overdoses can kill.

You may need to seek immediate care if you believe your child is in imminent danger, this includes getting an emergency appointment with your GP, phoning 111, 999 or taking them to the nearest emergency department. If your child has taken an overdose, take your child to  A&E as soon as possible. Try to find out what they have taken, or look around for empty bottles or blister packs and tell the emergency medical staff. For more information and advice from the NHS go to their website - Where to get urgent help for mental health³

How can I help my child?

When you discover your child is self-harming, as a parent, you might experience a range of feelings, including anger, sadness, disbelief, fear, shame, helplessness, or disgust. Try not to take it personally, or to respond with frustration or anger. Try to think of their behaviour as a sign of serious emotional distress that they don’t feel able to handle in any other way. It’s important to remember to stay calm and that there are things that you can do to help.

There are things that you can do with your child at home that can have a big impact: 

 1. Learn about self-harm

Self-harm is often misunderstood and surrounded by stigma, negative attitudes, myths and unhelpful assumptions. Before talking to your child it may help to learn about self-harm by reading well-informed resources, contacting helplines or joining a support group. (see resources section below).

2. Learn about validation

Validating your child’s emotions and experience is fundamental to helping them with their self-harm behaviour. It’s a skill that anyone can learn. It involves communicating with words and actions (including facial expressions and body language) that their experience is valid and you understand their perspective.

Why validate?

• Validating builds and strengthens your relationship with your child, increasing trust and connection. You are showing you care about them and accept them for who they are.

• In the moment, it can help to lessen the intensity of strong emotions. Research suggests that it also helps your child to learn to regulate their own emotions4.

• By modelling it for them, it teaches your child self-validation. Validating your own thoughts and feelings can help you to manage strong feelings more effectively. 

How to validate:

• Actively listen - make eye contact, stay focused and adopt a curious approach.

• Be mindful of your actions (facial expressions and body language) as well as your words.

• Name their emotion - Observe what they are feeling in the moment. Look for a word that describes the feeling. It’s ok to check with them that you’ve got it right (e.g. ‘You seem to feel really sad about that, is that right?’ They might say, ‘No, I’m really angry about it’ and that’s ok).

• Concise and non-judgemental - When you reflect the feeling back, try to do so without judgment and to keep it concise. The goal is to communicate that you understand how they feel.

• Try to put yourself in their shoes - Look for how the feelings, thoughts, or actions make sense given their (or your own) history and current situation, even if you don’t agree with the behaviour, emotion, or action itself.

• Respond in a way that shows that you are taking them seriously (with or without words). 

Examples of validation:

The emotional pain but not the maladaptive behaviour - [“I can see you’re in incredible pain at the moment – your boyfriend just ended the relationship and that is a huge loss, but self-harming is not the answer”].

The problem’s importance - [“I can hear how important that relationship is to you – it must feel very frightening to think you might have lost it”].

The task’s difficulty - [“Wow, of course you’re really struggling with this – so many painful thoughts and emotions - it’s really hard”].

Thoughts, feelings - [“No wonder you’re feeling so overwhelmed - you’re having the thought that everyone at school hates you”].

Challenges

The first step of validation is to show interest in what your child is saying. This might sound easy, but sometimes when your child is sharing something that makes you angry or frustrated, you might struggle not to tell them that they’re wrong, shake your head or roll your eyes etc. Try to pay attention to both your body language and what you say to them. 

It can be harder to validate when you are feeling strong emotions yourself. It can be helpful to practice these skills with other people, in less emotional situations first.

You might fear that the validation is reinforcing the self-harming behaviour. Validation is not agreeing, approving, or condoning the behaviour, rather it is a way of communicating that you respect your child and their point of view. 

Validation is NOT:

• Praising or complimenting

• Trying to show them the positive

• Lecturing or advising.

It’s ok to disagree and validate at the same time.

3. Give them space to talk when they’re ready

When you are ready, try talking to your child. Your child might not feel comfortable talking about their self-harm. It is likely that your child is aware that self-harming behaviour is not socially acceptable, and might make people feel uncomfortable, scared, or disgusted. They may take time to be ready to talk. It may be difficult to wait, but don’t force your child to talk if they’re not ready.

It can be easier to start a conversation when you’re out on a walk, on a drive, or doing an activity. The neutral space, outside of the home, can be helpful and it might feel less pressurised for your child.

It’s likely your child is having a tough time and feels overwhelmed. To begin with, don’t bring up self-harm. Instead of asking ‘have you been hurting yourself?’, try asking ‘how are you feeling?’ Validate their feelings. You might feel like you want to ‘fix it’ right away but this is not helpful for your child. The aim is to encourage your child to feel able to open up, feel listened to and to have their feelings understood. Let them know you’re not judging them, and that you love them using validation.

If your child doesn’t feel able to talk, try suggesting that they write you a letter or text you. This gives them time to reflect, and you time to process how to respond. They may prefer to talk to someone else, like a counsellor, helpline, or GP.

When your child is ready to talk, explore whether there are things going on at school or at home that are making them feel worried, frightened, angry or upset. Validate their experience.

Tips for talking with your child:

• Try to be direct and matter-of-fact when dealing with your child’s self-harm.
• Acknowledge to your child that talking about difficult feelings shows strength and courage.
• Let them know that you want to help but might not know the best thing to do, which might mean talking to someone else (for example the GP). Ensure your child feels that they will be consulted about any services that might be contacted.
• Your child may not seem to listen to what you say at the time, but they may remember what you say and might talk to you later.
• Don’t give up. When your child pushes you away, it’s often when they need you most.

4. Help them understand their thinking and feelings around their self-harm

Helping your child become more aware of how they feel when they self-harm, what’s making them feel this way, and what kind of things help, will empower your child to feel more in control.

One way to develop a deeper understanding is for your child to keep a self-harm diary. Over a week, suggest keeping track of what is happening before the episode, what your child is thinking, how they felt and what they did – parents can also help support with the completion of the diary. It could look like this:

Keeping a diary can be difficult and painful for your child, and it can be challenging for them to understand their thoughts and feelings. They could start with just the emotions (either words or emojis) and how their body feels and build up.  

Explain to your child that understanding the pattern of their self-harm means they can begin to try out methods that alter that pattern. Diaries are often used as a tool within a therapy setting by a clinician, who will then support the child in identifying these alternatives. 

5. Come up with ideas together for ways to help them stop harming

Next, if your child feels ready, create a list of strategies your child is willing to try when they feel the urge to self-harm. Remember that self-harm is the method your child is using to manage strong feelings, so the aim is to explore alternative ways they might manage or discharge their big feelings. These ideas and skills aim to help them to tolerate the distress and ‘ride the wave’ of the intense feelings without self-harming.

It’s useful to think about the need that the self-harm fulfils, for example if they use self-harm when they feel empty and fearful, try calling a friend when they feel the urge, or if they do it to feel connected to their body (dissociation), then focusing on their breathing and how they are feeling in their body may help.

There are popular and fast working strategies that can help manage the feeling of needing to self-harm. It can be remembered with the acronym TIPP (Temperature, Intense exercise, Paced breathing, Paired relaxation).

• Temperature. Intensely cool the temperature of their face. Ideas include holding a cold-pack or zip-lock bag with cold water on their eyes and cheeks; splash cold water on their face.

• Intense exercise. This helps your child calm down their body when it is revved up by emotion. 

• Ideas include engaging in intense aerobic exercise for a short while (10-15 minutes); expend stored up energy by running, walking fast, jumping rope, playing basketball, weightlifting or putting on music and dancing. But don’t over-do it!

• Paced breathing. Slow their breathing way down (aim for 5 to 7 in and out breaths per minute)

• Ideas include breathing deeply from the abdomen (it might help to practice together when in a relaxed state), breathe out more slowly than you breathe in (try 4 seconds in and 6 seconds out). Try this for 1 to 2 minutes to bring increased calm. 

• Paired relaxation. Consciously relaxing the muscles to bring the body back to a more relaxed physical state. Try the following (you could try talking them through it, or teach them to do it themselves).  First, starting with their feet, tense the muscles slowly while taking a deep slow breath through their nose. Hold both their muscles and breath for 5 seconds, and then breathe slowly out though the mouth while releasing the muscle tension in their feet. Now repeat, but with a different part of the body working their way up to their head.

Other general ideas for helping your child to resist the urge to self-harm include:

Distraction

• Try helping them to engage in ‘absorbing activities’ (things that you really get into and take over your mind and make you forget about everything else) like sudoku, computer games, drawing, drawing, reading or listening to music.
• Try using other strong sensations to help distract them. They could try loud music, a cold shower, a fast run, squeezing something very hard.

Soothing

• Do something for themselves. They could try pampering themselves, eating something nice or taking a relaxing bath.
• Make and use a self-soothe box. A self sooth box contains items that your child finds soothing. It can be useful to have one prepared in advance so they can use its contents when they are feeling distressed.
• Focus on breathing, how it feels in their body to breathe in and out.
• Do something for someone else they care about.
• Wrapping themselves up in a weighted blanket. This can feel comforting and safe for young people, especially those with additional sensory needs.
• Try an app like ‘Calm Harm’ which has different techniques to try.
• Focus on breathing, how it feels in their body to breathe in and out.

Physical

• Shout out loud ‘No’ or ‘Stop’.
• Write down difficult feelings on paper and rip them up.
• Rip up a newspaper or magazine.
• Hit a soft cushion, or bean bag..

Social

• Encourage them to find some company. Most people self-harm when alone so being in a public place can be helpful.
• Seek out a good friend or safe family member.
• Phone a friend.
• Do something for someone else they care about.

Look at The National Self Harm Network’s (NSHN’s) ideas for distractions: NSHN distractions that can help⁵

6. Make a safety plan together

Self-harm is a difficult pattern to break. You will work with your child’s therapist to develop a plan to support your child that helps keep them safe. Alongside your child’s therapist, discuss with your child the following questions and write up a plan that can used by your child, and people they are happy to share it with.

Discuss the following questions with your child and write up their answers.

• Warning signs that make your child feel upset and more likely to consider self-harm.
• Thoughts and feelings your child has before they self-harm
• Things they can do to help themselves when they feel upset.
• Who would they tell if they were thinking of or have hurt themselves?
• What can other people do to help them?
• Things they can do to help keep calm and to soothe themselves.
• Things they have to live for/feel good about.
• A safe place they can go.

What to do next?

If you need support or would like to know more about self-harm for teenagers and children, and how to manage it, here are some reliable resources:

Contact a national mental health helpline – for you or your child

Samaritans - 116 123  

MIND – national mental health charity offers an advice helpline - 0300 123 3393 

Give us a shout – Text “SHOUT” to 85258. Free, 24/7, text-based confidential support. 

We are with you – Free, confidential support with alcohol, drugs or mental health, online or from local services. 

Speak with your GP – your GP is the gateway to most additional support around both your mental and physical health. Talking with your GP can be very helpful. If you say it is an emergency you can get a same day or next day appointment. 

Websites

• Young minds
• NHS
• Mind - Self-harm
• National Self Harm Network (survivor-led support)
• Minded (hints and tips for parents worried about the mental health of their child)  

Support for you as a parent

 It can feel very overwhelming and isolating when your child is self-harming. Talking to people you trust can be a big help. If you don’t feel able to talk to family or friends, you might consider calling a helpline, joining a support group or talking to a counsellor about your feelings.

 There are organisations available for carers of children with mental health difficulties:

• Mind: https://www.mind.org.uk/information-support/tips-for-everyday-living/parenting-with-a-mental-health-problem/support/
• Young Mind Parent Helpline: https://www.youngminds.org.uk/parent/parents-helpline-and-webchat/

References

1. Mental Health Foundation - The truth about self-harm
2. Mental Health Foundation - The truth about self-harm
3. NHS - Where to get urgent help for mental health
4. NCBI - Parental Validation and Invalidation Predict Adolescent Self-Harm
5. The National Self Harm Network - NSHN distractions that can help

Where we provide links to other websites or third party resources within this article, these links are provided for your information only and are correct at the time of publication. AXA Health has no control over and is not responsible for the content and resources within external websites or apps, nor any link contained therein, or any changes or updates required.