Shirah Vollmer MD

The Musings of Dr. Vollmer


Posted by Dr. Vollmer on January 19, 2011

    ‘Childhood Anxiety Disorders,’ that is what I went to talk to parents of children at the early childhood center at UCLA today at noon. Ten questions from parents; six about nail-biting. I go through my mantras. Children should be exuberant about their lives. Anxiety is normal in children, but it is a problem if it interferes with social or school functioning. Anxiety disorders in children is divided into six categories, according to our current diagnostic manual. Five of those disorders are the same as adult anxiety disorders. Medications are helpful, but they are a last resort. Mindfulness, for children and adults, along with deep breathing should be tried first.

    After that came the questions. “What should I do with my three year old who bites his nails?” “First” I say, “be an observer of your child. Determine what settings the nail-biting gets better or worse. Determine if your child seems to self-soothe by nail-biting. See how bad it is over time.” The parents nod in recognition that they have heard all that before. “The question,” I say, “is whether the nail-biting is a window into internal distress, and if so, how severe that distress might be.” “This is a field of subjectivity,” one mother says, expressing distress about the subject. “Absolutely,” I say. “Parenting is subjective. You have to use your intuition, your reflective functioning, to speculate about the internal state of your child.” I guess she was a scientist, since she looked at me with dismay. “It is hard to be a parent,” I say, trying to redeem myself in her eyes. She smiled and she seemed to relax. I think to myself that maybe next time I will stick with symptoms and checklists and avoid talking about internal states. Then, I think again, and say, no, maybe I will start with nail-biting as a symptom which might indicate distress, but it might also indicate the ability to self-soothe. Nail-biting, like all childhood anxieties, are curiosities demanding further exploration before intervention. I will stick with that.

6 Responses to “Nail-Biting”

  1. Shelly said

    What is “mindfulness?” What are the six categories of anxiety disorders in children? Even though I should know the answer to this question…what do small children have to be anxious about?

    • Mindfulness is a kind of meditation where one learns to focus on one’s thoughts in an effort to see that thinking, and feeling change over time. Doing meditation often quiets the brain for the rest of the day. Doing mindfulness (here they have mindfulness classes and drop-in sessions) is the best way to understand how it helps.
      The six categories: separation anxiety disorder, social anxiety disorder, panic disorder, post-traumatic stress disorder, obsessive compulsive disorder and generalized anxiety disorder.
      Small children can be anxious about the uncertainties of the world-just like adults.

  2. Suzi said

    I don’t remember ever NOT biting my nails. I have no idea why I do it – and there are lots of times I don’t bite them and allow them to grow.

    When they become long it is difficult to play an instrument or do lots of things and often the end of long nails for me is biting them off in frustration. Thats how it is now anyway.

    I remember biting them the most (as a small child) while sitting listening to a story or watching the cartoons. Kind of when I’m relaxing the most. I remember doing it but I don’t remember deliberately doing it. The times I remember are the times that I realised I was doing it.

    Probably when someone was rousing on me for doing it.

    I remember I used to swirl my hair with a finger until my finger hurt and I needed help to unwind the hair to get my finger out. And… Ewww! I used to chew on my hair! Oh my goodness! I remember that too!

    I used to and still do.. pick at my sores. It hurts like crazy but the pain makes me feel good some how. It’s so weird… the things we do for no reason.

    • Interesting….I think the reason is neurochemical….in a few years, or decades, I suspect we will isolate the protein which dictates such “odd” behaviors. Thanks.

  3. Madelyn Griffith-Haynie said

    Fine motor hyperactives (i.e., the “fidget to focus” folk) often bite their nails – and they are infamous “hair twoozlers” and skin pickers. Anecdotally, nail-biting in young children is one of the “red flags” for ADD as well as anxiety. I appreciated your conclusion above – “observation before intervention” as well as your willingness to expose your inner musings.

    (BTW-Not saying, Shelly, that is what is going on with YOU – simply that there could be more than a few reasons for nail biting, etc. Somewhere here is a post on how important it is to get a good diagnosis – which my casual comment is certainly NOT.)

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