Dr. Greene`s Answer:

The most common cause of an undiagnosed recurrent headache in a child is a childhood migraine. Migraines in childhood are defined as recurrent headaches with at least three of the following features: specific location of pain, throbbing headache, relief with sleep, abdominal pain, nausea or vomiting, an “aura”–this could be changes in vision or tingling of the hands and feet–or a family history of migraines. Some kids do have abdominal migraines–they have stomachache without the headache.

Usually migraine treatment starts with ibuprofen, but if that doesn’t control them, there are a number of stronger drugs available to treat and/or prevent them. Also, biofeedback machines and self-hypnosis can really work for migraines.

Allergies, sinus infections, mono, dehydration and stress are other common causes of recurrent headaches. Many parents are also concerned about a less common cause for recurrent headaches: brain tumors. Headaches that awaken children or early morning headaches are the greatest concern, especially if they are accompanied by vomiting or other neurological symptoms.

The best thing is to know what type of headaches your daughter has. Sometimes bringing your doctor a “headache diary” — where you keep track of the date, time, type of headache, and what made it go away — can help your doctor correctly diagnose the type of headache. Also, a visit to a neurologist may help make the diagnosis and help find the best type of treatment.

The events that result in adult diseases often occur during childhood. The risk of osteoporosis later in life, for instance, is related to the amount of calcium someone receives in childhood.

New evidence suggests that the risk of Alzheimer’s disease correlates with head trauma during childhood (Journal of Neuropathology and Experimental Neurology 1999;58:982-992).

So make sure your children’s bike helmets fit well and are worn correctly. Even if head bonks don’t cause noticeable brain damage now, they can set in motion a chain of events that could erase their memories in the future, when they should be enjoying their golden years.

“Huffing,” or inhaling volatile substances, is becoming increasingly popular among children, especially among 12- to 14-year-olds (Archives of Pediatric and Adolescent Medicine, 1998;152(8):781–786).

Alarmingly, about 20% of eighth-graders report having done it (International Journal of Addiction, 1993;28:1613–1621).

Besides sudden cardiac arrest (the most common cause of death from inhalants), huffing can kill quickly in a number of other ways. Motor vehicle accidents, falls, and other traumatic injuries are common and horrible. Others die from suffocation, burns, suicide (from the depression that can follow the high), and from choking–on their own vomit.

Huffing can kill the very first time children experiment with it. About 22% of those who die from huffing do so the first time they try it (Human Toxicology, 1989;8:261–269).

When huffing doesn’t kill quickly, it damages the body each time–especially the brain. Huffing can cause memory loss, impaired concentration, hearing loss, loss of coordination, and permanent brain damage. Chronic use can cause permanent heart, lung, liver, and kidney damage as well.

Solvents (found in glues, paints, and polishes), fuels (such as butane), nitrites (found in deodorizers), and almost any kind of aerosol spray can be responsible.

Most huffing takes place with friends (although kids who sniff correction fluid in class when their teachers turn away are not uncommon). Be observant of your child and his or her friends.

Inhalants gradually leave the body for 2 weeks following huffing–mostly through exhaling. The characteristic odor is the biggest clue. Be on the lookout for breath or clothing that smells like chemicals. Look for clothing stains. Watch for spots or sores around the mouth.

Nausea, lack of appetite, weight loss, nervousness, restlessness, and outbursts of anger can all be signs of inhalant abuse. A drunk, dazed, or glassy-eyed appearance might mean your child is abusing inhalants right now.

If you suspect or discover that you child is huffing, get professional help. Treating inhalant abuse is very difficult and requires expert intervention. Withdrawal symptoms may last for weeks. The relapse rate without a long-term (2-year) program is very high.

Preventing huffing is far better than trying to treat an inhalant addiction. Talking with your child about it is more powerful than anything else (NIDA Research Monograph, 1988;85:8–29).

Start talking with your child about it now. Although huffing peaks between the ages of 12 and 15 years, it often starts “innocently” in children only 6 to 8 years old (Pediatrics, 1996;97:3).

Literally thousands of easily available substances can be inhaled, so you can’t keep your child away from them. You can, however, educate and inspire.

For more information on huffing, I recommend visiting www.inhalant.org.

Dr. Greene’s Answer:

There are moments in a child’s development that engender fear in her parents: those weeks before she was born when we wonder if she will really be okay, those moments after you have handed her car keys and she drives off with her boyfriend. For parents whose children develop head banging, this is one of those moments.

Every week someone mentions this concern to me (usually in an off-hand way) and then watches to see if I am alarmed. The unspoken fear: autism.

Up to 20 percent of healthy children are head-bangers for a time (Journal of the American Academy of Child Psychiatry, Jul 1983). Head-banging appears in the latter half of the first year of life and generally ends spontaneously by four years of age. Boys are three or four times more likely to be head-bangers than girls.

The child seems compelled to rhythmically move his head against a solid object such as a wall or the side of a crib. Often he rocks his entire body. For most children it occurs at sleepy times or when upset (often as part of tantrums). This behavior can last for minutes at a time — or sometimes for hours. It can even continue once the child has fallen asleep.

Parents’ fear of autism makes sense. Head-banging, head-rolling, and body rocking are each far more common in autistic children. But these rhythmic motor activities are also normal behaviors in healthy infants and young children (and young monkeys for that matter!). This behavior is abnormal, though, if it persists beyond the early years. Any child who is still head-banging beyond three years of age deserves further evaluation.

How can one tell if the head-banging is a part of normal development or an early sign of autism?

Researchers at Cambridge University have found an easy and early way to detect autism. Three hallmark behaviors are the key signs:

1. Lack of pointing — by fourteen months of age most children will point at objects in order to get another person to look.
2. Lack of gaze-following — by fourteen months, infants will often turn to look in the same direction an adult is looking.
3. Lack of pretend play — by fourteen months children will begin to play using object substitution, e.g. pretending to comb the hair with a block.

All three behaviors are typically absent in children with autism.

If a child begins even one of these three behaviors by 18 months, the chances of ever developing true autism are vanishingly small. (British Journal of Psychiatry, Feb 1996)

Why do kids without autism bang their heads?

Many theories have been put forward to explain this common behavior. Perhaps the rocking and even the head-banging provide a form of pleasure related to the movement. This joy in movement is called our kinesthetic drive. All infants are rocked by their mothers when they are carried about in utero. Later on, they enjoy being held and rocked in parents’ arms. Movement activities continue as kids grow: the pleasure of jump rope, swings, slides, amusement park rides (bumper cars!) and dancing. These activities all engage the vestibular system of the brain. The amount and type of movement that provides pleasure varies from child to child.

Kids who are understimulated (those who are blind, deaf, bored, or lonely) head bang for stimulation. But children who are overstimulated (in an overwhelming environment) find these rhythmic movements soothing. These are some of the reasons why we see more head banging in kids with developmental delays or neglect.

For some children, head-banging is a way to release tension and prepare for sleep. Some kids head-bang for relief when they are teething or have an ear infection (Primary Pediatric Care, Mosby 1992). Some kids bang their heads out of frustration or anger, as in a temper tantrum. Head-banging is an effective attention-seeking maneuver. The more reaction children get from parents or other adults, the more likely they are to continue this habit.

Generally, healthy children do not head-bang in order to injure themselves.

Will they hurt themselves?

Toddlers don’t seriously injure themselves from this habit. Pain prevents them from banging too hard, but even if it didn’t, children under 3 don’t generate enough force to cause brain damage or neurologic problems. The front or front/side of the head is the most frequently struck. Toddler heads are built to take all of the minor head trauma that is a normal part of learning to walk and climb. Healthy infants and toddlers who are head-bangers grow up to be coordinated and completely normal children.

How can you get head-banging to stop?

Most children will outgrow the habit on their own. You can speed up this process by reacting to it in a matter-of-fact way. Pretend not to notice. And if it is part of a tantrum, do not give her whatever she threw the tantrum to get. When you notice her head-banging, you might be able to get her to stop for the moment by distracting her or engaging her in a different activity. By decreasing the amount of time she spends in this habitual activity, she will outgrow it more quickly.

Will it affect their development?

Curiously, one large study of this habit in 525 healthy children found head-bangers to be measurably advanced in their gross motor development compared to their peers (Journal of Pediatrics; 93(4), Oct 1978). Specifically, this study of children who body-rock, head-bang, and head-roll found that body-rocking and head-banging behavior was associated with a statistically significant difference in gross motor development. For children who head-bang, the study showed they were able to hold their head up without support and walk without support earlier than children who do not head-bang. So Jane, the very behavior that was frightening could be a sign of something positive.

Now, of course, this doesn’t mean that teaching our children to head-bang will make them smarter! But this study reminds us that stimulating our children’s bodies and minds from an early age can have a profound impact on their development.