By: Alia McKean, DO, MPH & Maria H. Rahmandar, MD, FAAP
If the child you love is hurting so badly they're harming themselves, you probably feel the pain, too.
Parents and caregivers may feel confused, angry and helpless when they see signs that their child or teen is engaging in self-harm. They realize their child needs immediate help, but many have no idea where to begin.
When families bring up concerns about self-injury to their pediatrician, it provides the opportunity to talk openly about their child's situation and work out solutions together.
Here are insights that address commonly held fears and misconceptions, along with ways you can support your child.
What is self-harm?
Self-harm—also known as self-injury, self-mutilation or self-abuse—happens when people hurt themselves on purpose without intending to kill themselves. Medical experts often refer to cutting and other forms of self-harm as non-suicidal self-injury, or NSSI.
If my child is self-harming, does it mean they are thinking about suicide?
Just because a child or adolescent starts engaging in self-harm, it does not automatically mean that they are having thoughts of suicide or hoping to die. However, newer studies show that when NSSI goes on for long periods, kids and teens face higher risks for suicidal thinking and actions. So parents and caregivers should take immediate steps when they believe their children are self-harming.
Are there myths about self-harm I should know about?
Here's a partial list of misconceptions that pediatricians hear:
Cutting is the only form of self-injury to worry about.
Self-harm is usually due to suicidal thoughts.
Kids or teens who self-injure are just seeking attention or being dramatic.
Girls are the only ones who self-harm.
If I ask my child about self-harm, they might be tempted to try it.
Kids and teens grow out of self-injuring behaviors so what is the point in treatment?
Cutting: signs to look out for
The most common form of NSSI is skin cutting, so you might see cuts or scars on your child's hands, wrists, stomach, legs or other areas of their body. Kids may inflict deep gashes or make dozens of smaller cuts in one spot. It is important to remember, though, that kids often hide their injuries by wearing lots of jewelry or long sleeves (even in hot weather), so the scars and cuts may not be visible or readily apparent.
Other subtle signs to look out for might include symptoms of
depression (such as having overwhelming feelings of hopelessness or worthlessness, sleep disturbances, and low energy levels). This is because kids who have depression are at higher risk of engaging in NSSI.
Parents, share this video on the AAP YouTube
channel with your teen: "What can I do if my friend is cutting themself?"
Other forms of self-harm
Other forms of self-injury include head-banging, burns, hair-pulling, or excessive scratching of the skin to the point of drawing blood. Some kids punch themselves, insert objects into body openings, drink harmful substances such as bleach or detergent, or attempt to break their bones on purpose. In some cases, kids or teens may only engage in self-harm one time, but those who continue engaging in NSSI often hurt themselves in more than one way.
What causes kids to hurt themselves like this?
There is no single clear cause. However, young people who self-harm often feel overwhelming emotional pain. Others say they feel lonely, worthless or empty inside and will do anything to feel better, if only for a moment. Still others report feeling overstimulated, misunderstood or fearful of close relationships. Some feel overwhelmed by school and family responsibilities, or want to punish themselves for something bad they believe they've done.
Self-harm can also be a way for kids to take control of their bodies when they feel a lack of control over other things—or when other aspects of their lives seem unmanageable.
How can something so painful actually relieve pain?
We know that when human bodies are injured, certain chemicals are released by the brain to help us cope with the trauma. This rapid burst of endorphins and other natural painkillers may offer a momentary escape from the struggles a child can't seem to handle any other way.
Are there any patterns of self-harm related to gender?
Female youth who self-harm are more likely to cut, while male youth are likelier to hit themselves. However, kids of all genders engage in NSSI, including males and children who identify as
non-binary or transgender.
Do kids who self-injure face higher risks for suicide?
Most self-harm comes from a momentary need to escape, not a wish to die. However, newer research suggests that adolescents who have trouble quitting NSSI face much higher rates of experiencing suicidal thoughts and dying by suicide than their peers who do not engage in self-harm. Native American and Native Alaskan youth are at particularly high risk.
How can I tell the difference between NSSI and suicidal behavior?
When in doubt, get help. Reach out to your child's pediatrician, therapist or the nearest emergency room. Medical and mental health professionals can get more information and provide guidance on next steps to keep your child safe and healthy.
What ages are at highest risk for engaging in self-harm?
Self-harm behaviors are most common among teenagers. Fortunately, most youth who do repeatedly self-harm stop after their teenage years.
Is NSSI a sign of other mental health problems?
Kids and teens who experience depression,
anxiety, attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), eating disorders, substance use disorders, personality disorders and other mental health conditions are at higher risk of engaging in self-harm. Looking for and treating both the mental health condition and the self-injury is important.
How can I help my child?
Have the
conversation. Don't be afraid to ask kids if they're engaging in NSSI or know others who are. Take a non-judgmental position, listening more than you speak. It's OK to admit that the subject is tough for you, but express your love and concern: "This is hard for me to even think about because I care about you and want you to be healthy and safe, always."
Be prepared for strong reactions. Because people who practice NSSI often deny it (and try to hide the evidence), your child might be upset or refuse to talk. In a calmer moment, tell your child that you're worried they might be self-harming and plan to talk with their doctor about it. Encourage them to be there for this conversation, but even if they won't go with you, make the appointment.
Trust your pediatrician. Doctors who focus on child health often know about NSSI, from treating kids and families who've been in a similar position. You should not be shamed or blamed for your child's struggles. Allow private,
one-on-one time for you child with their pediatrician so they can discuss concerns together. Your pediatrician can work with you and your child to create a care plan geared to your child's needs, which might include talk therapy, stress reduction techniques, medication or other steps that have been shown to help others.
Make your home environment safer. If your child is self-harming, you can help by removing hazards such as sharp knives, razors, poisons, weapons and more from your space. Though it can be difficult to remove all items all the time, it is especially important if your child lets you know they are having thoughts or urges to self-harm, or during difficult, stressful periods that could trigger these thoughts or urges. It is also important to keep firearms inaccessible and all medications locked away, especially if your child is having suicidal thoughts.
Talk with your pediatrician or mental health provider about establishing a suicide prevention "safety plan." This will include practical ways to reorganize your home and get emergency care in any crisis.
Change the way you think about social media. While digital channels may not be a direct cause of NSSI, excessive screen time can lead to poor sleep and exaggerated feelings of envy, isolation, fear and self-rejection. These issues may feed the powerful emotions that prompt some kids to self-injure, so it's worth the time to establish a healthy
family media plan.
Your own digital habits matter, too. One study showed that adolescents living with depression reported that their parents spent up to
8 hours a day on social media. This doesn't mean that parents are to blame for making their children sick, but this pattern can block opportunities for conversation and emotional closeness, which generally reduce a child's risks for depression and anxiety.
Prioritize family mental health & relationships. If your family faces consistently high levels of stress, take time to consider how you can turn this around. Young people need to know they can ask for downtime without guilt, and that self-care is a priority above mountains of schoolwork and extracurricular activities.
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. A supportive parent-child relationship can serve as a powerful buffer. Talk with your pediatrician about other ways that may help reduce stress and build
resiliency for kids exposed to
adversity.
Share what you know. Your child's well-being depends on the support of family, teachers, coaches and many others, so don't keep their struggles a secret and share what your child allows or what you think is important. If you're wondering how to disclose your child's NSSI in a way that respects their privacy as much as possible, ask your pediatrician for guidance. You can help educate others by sharing
this infographic or the article you're reading right now. The Mighty, an online network of peers living with chronic health issues, offers
a helpful primer, too.
Remember
Self-harm doesn't mean your child or teen wants to die—and it does NOT make you a bad parent. As with any health issue, you can help your child recover by expressing hope, embracing
treatment, and making sure they feel your loving, unconditional support.
More information
About Dr. McKean
 Alia McKean, DO, MPH, is a resident physician at UCSF Fresno Pediatrics, where she serves as AAP Section on Pediatric Trainees Co-Delegate and is a member of the UCSF Fresno LIVE Committee. She received her Master of Public Health at the University of California, Davis. She is currently partnering with the Fresno County Public Library to improve access to literacy resources in her community, and is also working to develop a mental health literacy curriculum. Her professional interests include community pediatrics and adolescent mental health.
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About Dr. Rahmandar
 Maria Rahmandar, MD, FAAP is a board-certified pediatrician and adolescent medicine physician. She serves as the Medical Director for the
Substance Use & Prevention Program at Lurie Children's Hospital of Chicago and is an Assistant Professor at Northwestern University Feinberg School of Medicine. Within the American Academy of Pediatrics, Dr. Rahmandar sits on the Section on Adolescent Health Executive Committee, is a liaison to the Committee on Adolescence where she is a co-author on a revised Clinical Report on suicide, co-facilitates a learning collaborative on depression and anxiety, serves as an E-Cigarette Faculty Expert and is a subject matter expert for the
AAP National Center of Excellence: Creating a Healthy Digital Ecosystem for Children and Youth. Her clinical, research and advocacy interests include adolescent substance use, mental health and birth control.
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