“Why is my 4-year-old suddenly biting his nails and how can I make him stop?” For answers in this Sound Advice column, we reached out to Dr. Kaylee Davis-Bordovsky, pediatric psychiatrist at Children’s Health and assistant professor at UT Southwestern Medical Center in Dallas.
Kaylee Davis-Bordovsky, MD: We have all been there—that familiar sound and sight of someone (or ourselves) biting their nails. Though it may cause distress or irritation when we see children nail biting, a child may not notice they are doing it or even find it soothing. Research shows that between 35-50% of 3 to 17-year-olds bite their nails.
Nail biting is the most common type of body-focused repetitive behavior (BFRB), far exceeding other behaviors such as hair pulling, skin picking or lip chewing. As much as we want to stop nail biting by nagging or punishing a child, it is best to instead identify the “why” and address the underlying cause. A child may bite their nails for several reasons. Here’s what to know about why and how to encourage them to stop.
1. Keep Their Nails Trimmed
They have untrimmed nails that are bothering them. Just like having an itch you need to scratch, having untrimmed or uneven nails may be irksome to a child.
Potential Solution: This cause of nail biting is the easiest to treat because all you need to do is keep their nails trimmed. It may even be a source of pleasure as the child gets older and they learn to manicure their nails themselves.
2. Be the Example
The child has watched adults bite their nails. This case is an example of learned behavior, so it is important for parents to check their own habits. Research shows that about a third of children that bite their nails have a family member who bites theirs as well, indicating there may be a genetic link. Additionally, 20–25% of adults bite their nails making it prevalent across the age spectrum.
Potential Solution: It may be fun to make a friendly competition among family members to see who can go the longest without biting their nails or get prizes if they can go a certain amount of time without nail biting.
3. Keep Their Hands Busy
Nail biting has become a “habit” out of boredom or a way to self-stimulate. Many children (and adults) do not even realize they are biting their nails until someone points it out. They may do it when in school, riding in the car or watching TV at home.
Potential Solution: This can be tricky to treat because it requires that the child be aware of when they are biting so that they can stop. The first step in treatment is helping the child become aware of the habit, such as identifying the times or locations they are most likely to bite. Once they recognize that they are biting or wanting to, then they can replace it with another behavior. This is a great opportunity to introduce textured stress balls, fidget spinners or other activities to keep their hands busy.
4. Keep Stress in Check
Nail biting happens during anxiety-provoking or stressful situations. It isn’t always synonymous with anxiety, but it certainly can happen when tensions rise. As examples, child may bite their nails when entering a crowded room or before giving a class presentation.
Potential Solution: This form of nail biting is often self-soothing. Bringing awareness to the behavior and replacing it with a different acceptable self-soothing behavior is the best treatment. This is a core principle of Habit Reversal Therapy, the gold standard for treating BFRBs.
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No matter what “type” of nail biter your child is, you can utilize any (or all) of the techniques outlined above to curb the habit.
Though generally considered harmless behavior, severe cases of nail biting can be associated with:
- Destruction of the nail bed
- Recurrent bleeding/pain from repetitive biting
- Emergence of infections in the fingers
- Severe anxiety that accompanies nail biting
- Associated hair pulling or skin picking
If your child is experiencing any of the above symptoms, contact your pediatrician to discuss treatment options, which may include the involvement of a mental health specialist.
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