In one of the Facebook groups I’m in, a mom posted that both of her kids were exhibiting some worrisome behaviors during Zoom school — one picked at their cuticles until they bled, the other picked at scabs and bug bites over and over, obsessively. The mom was aware of these compulsive behaviors and even knew the clinical name — dermatillomania — but was stumped for ideas.
A chorus of moms weighed in. This woman’s daughter was biting her nails all of a sudden, too. Another was pulling out clumps of hair. There was clearly lots of picking, chewing, and biting happening, and with everyone at home all day — no escape.
What hath this pandemic wrought?
“COVID-19 has thrown us a curveball for almost a year, and there’s no end in sight right now,” says Dr. Nerissa Bauer, a behavioral pediatrician in Indianapolis and the doctor behind letstalkkidshealth.org. “Knowing that we live in the times that we do, children are susceptible to changes in behavior because of everyday stress that may be happening. And COVID has added an additional layer on top of that.”
Some common behaviors
There are a whole host of what are called body-focused repetitive behaviors, most of which emerge in the tween and teen years. Some are more common than others.
Dermatillomania — also called excoriation disorder and skin-picking disorder — involves the repetitive picking of your own skin, anything from acne to cuticles to scabs.
Onychophagia is compulsive nail-biting.
Trichotillomania — or trich — is repetitive hair-pulling, often to the point of hair loss. It can involve eyelashes and eyebrows, as well the scalp.
Trichophagia, or hair-eating, is often related to trichotillomania.
Chronic cheek-biting (morsicatio buccarum) is exactly what it sounds like.
Don’t label
Now that you know the names, forget them. Says Bauer, it’s important not to label a behavior right away.
Observe first
“If they are picking at their face, the parent’s knee-jerk reaction is, Stop doing that. I often advise parents, it’s important not to do that, because if it is a signal of some underlying anxiety or stress, parents can inadvertently cause more stress or anxiety.” If you notice some concerning behavior, take a beat. “The most important thing is to try to observe first before responding,” she says.
Take N.O.T.E.
As part of the American Academy of Pediatrics, Bauer helped develop a tool, called Take N.O.T.E., for parents who, thanks to stay-at-home orders and remote learning, are confronting certain behavioral issues in their children — perhaps for the first time. The tool can help parents notice, observe, and literally take note of repetitive behaviors that are of concern.
What’s the frequency, intensity, or severity of the behavior? What are the triggers? What is the setting? Is the child bored? Tired? Is it only in the context of school? All of these details matter when bringing the issue to a pediatrician. “And that’s why Take N.O.T.E. is really helpful for figuring this out,” says Bauer.
Be positive
“I know that parents want to talk with their child,” says Bauer, a mom herself. “I get that. We become concerned. We want to make things better for our kids. In this situation, I would really try to think, what do you want to see your child doing? Not focusing on what they shouldn’t be doing.”
She suggests parents look for what the child can do instead of picking. “You need to keep their hands busy,” she says.
When to worry
How do you know if a tic is just a tic — or something more? “It can be hard for even pediatricians to disentangle that,” says Bauer. And that’s why careful observation and context is so important.
“With COVID-19, it’s just a universal stressor for everybody regardless of circumstances and resources,” she says. “Pediatricians may be more apt to say, ‘Let’s continue to do preventive measures, supportive measures. Let’s follow this longer term, in case it’s a sign of something else going on.’ Because, hopefully, the pandemic is still somewhat of a temporary state, even though it feels like it’s forever.”
