If the child you love is hurting so badly they're harming themselves, you probably feel the pain, too.
Self-harm—sometimes called 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.
The month of May is Mental Health Awareness Month, offering us an opportunity to learn more about helping youth who self-harm.
“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.”
Medical experts recognize that 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. The American Academy of Pediatrics offers information in this video and provides tips below on how parents and caregivers can help.
- Have the conversation. Don't be afraid to ask kids if they're engaging in self-injury or know others who are. Take a non-judgmental stance, 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 self-harm 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 the conversation and to be present during the appointment.
- Trust your pediatrician. Doctors who focus on child health often know about self-harm, 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 your 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 from the home, it is especially important to do so if your child lets you know they are having thoughts or urges to self-harm. 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 "safety plan." This will include practical ways to keep the home environment safe, as well as important information so that your child can obtain emergency care if they are experiencing a crisis.
- Change the way you think about social media. While digital channels may not be a direct cause of self-harm, 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 and 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,” said Alia McKean, DO, MPH. “A supportive parent-child relationship can serve as a powerful buffer. Talk with your pediatrician about strategies that may help reduce stress and build resiliency for kids exposed to adversity.”
Self-harm doesn't necessarily 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.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.