My daughter, who is eight years old, began picking a little at her face several years ago. It began with an itchy midge bite. I told her not to scratch or pick at it in case it got infected.
She did scratch at it and has continued to do it more or less ever since. She almost always has one or maybe two small red spots on her face due to picking. She also picks a little at other areas of her body, her back, shoulders or tummy.
I have tried everything I can think of to get her to stop. I ignored it completely for a year hoping that she would get out of the habit, but she didn't.
I tried rewards, threats, being firm, talking to her but she seems to be unaware that she is doing it. Recently, she is beginning to get a bit distressed when she sees that she has picked during her sleep.
She is, generally, a bright, happy child and is getting on very well at school.
I am sure she will stop eventually (do you think so?) but I worry in case she will have permanent scars on her face. Any advice about what would be the best way to help her?
David says: There are several things that you can do to try to change her behaviour. I usually like to try to firstly understand why a child might be behaving in a given way, as this usually points to the best solutions for long-term change.
Skin-picking is more properly known as Dermatillomania. Just like with your daughter, it often starts with a mole, a scab or some imperfection in the skin. In your daughter's case, it was the itchy fly bite that began the process.
Most commonly, children (and adults) will continue to pick at their skin as a form of stress-relief or release. It is almost like a coping mechanism for dealing with tension or stress.
Ultimately, the behaviour becomes habitual and, as you describe for your daughter, subconscious. Your daughter, for example, picks at her skin in her sleep.
Your aim is to work with her to solve this problem. The fact that she gets distressed herself about her habit and her apparent lack of control over it means she will probably be motivated to work with you.
The first step in dealing with it is to bring her awareness to it. You don't have to do this in a critical or punitive way. Staying matter-of-fact, you simply let her know that you notice her picking at her skin.
This might help both you and her to notice at what times of the day, or what kinds of situations, she picks more. For example, does she pick more when trying to do her homework? Does she pick when she is relaxed on the sofa? Does she pick more when she is tired, or cross, or upset, or bored?
I would imagine that you will find that there is a pattern to her picking. You have already noticed that she has picked more often or less often during particular periods. What was happening during the periods when she picked more?
You might also want to return to the idea of reinforcing her avoidance of picking. So perhaps you may be able to identify a reward that will be attractive to her if she can allow scabs to heal or avoid picking for a day, or a week.
Again this will have most success when she is alert to her own behaviour and more conscious of when she is picking. That will allow her to have more chance of being able to stop. So increasing her awareness will also help with this approach.
A further option is to give her gloves to wear, since the picking action will have less effect. Once the behaviour no longer fulfils its initial function (because it feels different or doesn't work as well) the behaviour should reduce.
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