Get Some Sleep: Are your kids night-time head-bangers?
June 21st, 2011
02:01 PM ET

Get Some Sleep: Are your kids night-time head-bangers?

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

We were supposed to be talking about Kathy’s insomnia, but, as is often the case, she was wanted to tell me about a loved one’s sleep problem, in this case, her grand-daughter’s.

“She is banging her head up and down every night, sometimes hitting the headboard. It is scaring her parents to death because, well, it is kind of creepy, and they are afraid that she has psychiatric problems, not to mention, they are worried she could hurt herself.”

She nailed every concern that parents have when a child displays rhythmic movements. Sleep-related rhythmic movements are very common; at nine months, research shows that 59% of all infants have rhythmic movement disorder (RMD); by 18 months, the prevalence is 33%; and by age 5, the prevalence has declined to 5%.

Technically speaking, we label these rhythmic movements as a disorder only if they: 1. Cause injury; 2. Interfere with sleep; 3. Result in significant impairment in daytime function. However, for simplicity’s sake, I will use the acronym, RMD to describe the whole phenomenon.

In most cases, RMD occurs, as stated above, in pre-school children who are neurologically normal. It is very unusual to have RMD present in adulthood, and when it does, there is serious concern for seizure disorder. Even in children who present at the classic age, we are careful to keep seizure in mind, and for that reason, an overnight polysomnogram (sleep test) is recommended.

The rhythmic movement usually occur at the transition from wake to sleep, but can continue into sleep. They can occur when children are drowsy. They involve stereotyped, repetitive movements that involve large muscle groups, for example, head banging, head rolling, rocking on hands and knees, body rolling, leg banging or rolling. One way to be sure that this is not seizure is to gently ask the child to stop doing it. In RMD, if the child is awake, she will be able to stop, whereas in seizure, she will not.

We do also see RMD in children who have autism or other developmental delay, but the difference is that they will do the movements while fully awake as well as while drowsy. For this subgroup of patients with RMD, the disorder often persists into later childhood and indeed adulthood.

Some research does show an increase in anxiety levels among children with RMD, but there is little evidence that serious psychiatric problems are a cause. Experts believe that these behaviors are likely a form of self-soothing or self-stimulation if there is a lack of it in the environment. Some studies suggest that for some children there might be an element of attention-getting behavior or passive aggression.

It can run in families, but the genetics have not been described. There seems to be no gender difference and so is just as likely to occur in boys as well as girls.

We diagnose it by clinical history and overnight sleep study. It is important that a sleep center know that there is a specific protocol that needs to be followed as well as specific scoring criteria.

The main reason we treat RMD is real or potential self-injury. It is usually the head banging that poses danger. Medications such as benzodiazepines or tricyclic antidepressants have been tried, but are not well studied, not approved for use in children, and should be considered a last-ditch therapeutic option.

A more creative approach to mitigate the danger of head banging is to have the child practice the movement in the daytime with the difference being that the “game” is to stop just short of the pillow or headboard. Often, the new learned behavior will persist into drowsiness and sleep. Another non-pharmacologic approach that shows promise is hypnosis.

The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.

soundoff (77 Responses)
  1. Stephanie

    My son bangs his head and feet to go to sleep I talked to my doctor and he told me to take him to a sycaratris please help me I can't sleep please

    February 27, 2015 at 06:38 | Report abuse | Reply
  2. Brandon Bever

    Well I have a concern about headbangers my girlfriend of 19 bangs her head still she says it releives her pain and I continue to say it is unhealthy I need a professionals advice as to how I can stop it before it hurts her it has even gotten so bad she starts bleeding from the forehead

    March 3, 2015 at 23:54 | Report abuse | Reply
    • SG

      Hey, Brandon. I never replied to anything/anyone on blog but feel I need to say something as I was a head banger. I'm no doctor but the pain part seem odd to me you should take her to get checked out by a doctor. I never experienced pain when I did this and I did it for hours listening to music and never any pain. It just was soothing. If she was like me its just an urge that we have to do I stopped when I moved in with my girlfriend and was embarrassed to admit to this at the time. But, you won't be able to force her to stop now that she knows you know. Again, have her see a doctor for the pain. Read my last post. I am very healthy. Maybe an M.R.I. of her head to really see what is going on.

      March 18, 2015 at 15:52 | Report abuse |
    • Shana

      I think what your girlfriend is displaying is self harm, similar to cutting or carving on oneself. What pain is she trying to relieve? I feel their are some mental health issues that need to be looked at here. She needs to find a more appropriate type of coping mechanism.

      September 28, 2015 at 17:33 | Report abuse |
  3. SG

    Its strange to read all these posts now in my 40's. I too did this and thought it was odd at the time. But like most post I'm healthly with a great career and a family. On a separate note, what me an my little brother would do is listen to music as we banged our heads on pillows. I would tell him to daydream to the music it was very soothing. I had a little bit of anxiety as a young man but quickly lost said anxiety as I became as I too was good sports and that really gave me the confidence I needed to take on the challenges of life. I did stop in my teens but recently told my wife who had this odd look on her face. Hope she doesn't think I'm crazy...lol. Will that's my story but I still wonder why?

    March 18, 2015 at 15:27 | Report abuse | Reply
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