Who should read this chapter? Parents who want to understand this special type of tantrum behavior to learn how to stop this behavior. Why do children do this?
Summary: Breath-holding and head-banging are extreme forms of tantrum behavior that deserve special discussion. These behaviors are generally attention seeking measures. A natural parental response to breath-holding and head-banging is instant attention to stop the episode. Unfortunately, this rewards the child for this behavior which reinforces and perpetuates it. To eliminate this type of behavior, parents should respond to these episodes with the exact opposite of what the child seeks. Since they seek attention, parents should respond with abandonment. Leave the room as soon as a breath-holding or head-banging episode starts. This might seem unacceptable to you at first, but the alternative is to continue rewarding the breath-holding and head-banging behavior; hence, more breath-holding and head-banging episodes. Discuss this with your pediatrician or family physician first.
Tantrum behavior can become very unpleasant. This should not be surprising since the purpose of a tantrum is to get attention and such unpleasant acts are naturally attention getting. Breath-holding and head-banging in children 20 months of age and older are extreme forms of tantrum behavior that are particularly unpleasant. Just like vomiting, we would like to eliminate this type of behavior as soon as possible.
Breath-holding can be very dramatic and attention getting. Children can learn to hold their breath until they turn blue. I have seen many children who can hold their breath until they turn blue AND have a seizure. The seizure results from inadequate oxygen delivery to the brain (hypoxia). The seizure results in loss of voluntary muscle control by the child. The seizure is brief and it actually restores breathing, which brings an end to the breath-holding episode. However, by this time, parents are extremely distraught. Turning blue and having a seizure is very upsetting. Does this cause brain damage? Probably not, but it would be preferable to eliminate this behavior as soon as possible. If this behavior is not eliminated, multiple repeated insults of hypoxia (inadequate oxygen) to the brain are more likely to result in noticeable brain injury rather than just a few episodes..
When children begin to hold their breath, parents often immediately give them instant attention (by carrying and hugging them) to stop the breath-holding. This actually reinforces the breath-holding behavior by rewarding the child with attention. To stop the breath-holding behavior, parents must do the exact opposite of what the child wants. You should respond to the onset of a breath-holding episode by leaving the room (the opposite of attention). Parents have a hard time doing this because they want to remain visible to be sure that the breath-holding episode stops. This is why breath-holding episodes are particularly difficult to stop. But you must do this. If you notice breath-holding behavior, you must eliminate this behavior pattern as soon as possible. You must leave the room when it begins. You should peek through a small door opening to be sure your child is OK, but your child must not see you. Since it is attention that they want, you must give them the exact opposite (abandonment) when the breath-holding episode starts. You must do this consistently, and the breath-holding episodes will stop.
Discuss this with your child's physician first. With your physician, develop a plan for the family on eliminating the breath-holding behavior. Everyone in the family must agree to it or it won't work.
If you sometimes leave the room and sometimes give your child attention in response to breath-holding episodes, you are providing partial reinforcement which is the strongest form of reinforcement. Expect the breath-holding episodes to continue. To eliminate these permanently, you must leave the room with ALL breath-holding episodes.
It should be noted that younger children (under 18 months of age) occasionally have breath-holding episodes associated with turning blue. These are usually NOT associated with attention getting behavior. These usually stop of their own. Consult your physician if these occur.
Head-banging can be very dramatic and attention getting. The issues surrounding head-banging are very similar to breath-holding. Children may learn that head-banging results in parental attention. They may have observed that conventional tantrum behavior is unsuccessful at getting attention, but head-banging succeeds at getting attention. When a child beings to bang his/her head, it is instinctive to pick them up to prevent further head-banging. Naturally, parents do not want their children to bang their heads which could cause brain injury. But by doing this, parents reward and reinforce the head-banging behavior. This results in more head-banging episodes in the future.
Just like with breath-holding, when a head-banging episode starts, parents must respond with the exact opposite of what the child desires. Since this is often done to get attention, a parent should respond to a head-banging episode by leaving the room. Just like with breath-holding, this is difficult to do since parents want to witness that the head-banging has stopped. You should observe your child through a crack in the door, but again, do not let your child see you. They must learn that head-banging will result in abandonment; the exact opposite of what they want. Once this consistent response is demonstrated to them, they will be convinced that head-banging results in no benefit and these episodes will stop.
Discuss this with your pediatrician or family physician first. With your child's physician, develop a plan for the family on eliminating the head-banging behavior. Everyone in the family must agree to it or it won't work. Head banging is sometimes due to a psychiatric or neurologic illness. A medical evaluation is necessary to check for this possibility.
Just like with breath-holding, avoid partial reinforcement.