Saturday 24 February 2018

Dear Dr Nina: Is there a remedy for extreme nail-biting?

Nail-biting is a habit which can be broken
Nail-biting is a habit which can be broken

Nina Byrnes

In the last month my little boy has begun biting his nails. He's three-and-a-half and it came out of nowhere. Now, wherever he goes he has a hand in his mouth and he's biting them. His Montessori teacher called me to flag it as a problem because he's dropping his work in order to bite his nails. His nails are down to stubs and he keeps going. I bought the liquid for painting on his nails but it made him throw up. I've tried to give him something to hold in his hands but he just throws it away. And he's getting stressed and annoyed with me constantly saying, 'take your fingers out your of mouth'. Should I just ignore it and hope it passes? His babysitter is a compulsive nail-biter and so am I. Help!

Dr Nina replies: Most people have bitten their nails occasionally. The most common reason is to get rid of an annoying hangnail when you are far from a scissors or clippers. The habit of nail-biting usually starts in childhood. Studies suggest that 60pc of children and 45pc of teenagers may regularly bite their nails. Nail-biting doesn't usually start until about the age of three or four. The percentage decreases in those over the age of 18 but it does continue into adulthood for some. Nail-biting isn't genetic but it can be a learned behaviour and those who bite nails may often have witnessed a sibling or carer doing similar.

There are lots of theories as to why people bite their nails. Sigmund Freud felt it was due to arrested psychosexual development at the oral stage. Others have hypothesised it is some form of frustrated hostility or self-harming behaviour. More recently, psychiatrists have theorised that it belongs to a group of behaviours called grooming disorders, which are a form of obsessive-compulsive disorder or may be linked with perfectionistic traits. None of these theories is proven and there are many perfectly well-adjusted people who still bite their nails.

Nail-biting isn't dangerous in its own right but it does have some health issues associated with it. The skin around the nail beds may become damaged and inflamed, making infection more likely.

The continuous introduction of the nails to the mouth makes it easy for germs and dirt located on the hands and under nails to enter the mouth, possibly leading to an increased incidence of other infections and viruses. Nail-biting can damage teeth over time and affect dental alignment. Others may feel ashamed or embarrassed about their habit.

If you want to quit start by being aware of your triggers for biting. Nail-biting is more common in times of boredom or anxiety or tension in many people. Keeping hands busy can be a start.

Try giving your child a stress ball and telling him to squeeze it, as this can take away the urge to bite. For adults, chewing gum may help stop you putting your hands in your mouth.

If anxiety or stress are triggers, consider taking up activities such as meditation or yoga to help ease this. Some have tried hypnotherapy but the efficacy of this treatment is not guaranteed.

Most people have tried applying the bitter nail coat that is supposed to help. I have met many nail-biters who just bite through this but the taste can at least act as a reminder that you are biting and need to stop. A more extreme measure is to apply plasters to the tips of all your fingers. Biting through these may stop you biting your nails.

It is important to remember that nail-biting is a habit and although difficult, most habits can be broken. The most important thing is to remain motivated and to keep trying with your son. Don't give up if you fail, just try again. For adult nail-biters, remember that each time you quit, your chance of stopping forever increases.

Q. I am in the final stages of chemotherapy and have been given iron tablets by my doctor as part of my treatment. This has caused constipation. What is safe to take to ease the problem?

Dr Nina replies: Constipation is a problem most people suffer at some stage but few people talk about. It is the passage of infrequent, hard stool. Normal stool should have the consistency of toothpaste and be passed in a similar manner to toothpaste coming out of a tube. Constipated stool is usually hard, small and pellet-like.

The most common cause of constipation is poor diet and inactive lifestyle but other factors do play a role. Certain illnesses, medication, pregnancy and conditions that affect the movement of the gut can increase the risk. Constipation may also occur due to disease or obstruction in the bowel. It is common during cancer treatment. Many of the medicines used during treatment such as painkillers can alter transit through the gut. Iron remedies commonly cause constipation.

It is worth trying a few remedies at home. The first thing to do is increase the amount of fibre and fluid in your diet. Most people don't get anywhere near the 20g or so of daily fibre that is recommended. Increase this gradually or you may experience abdominal bloating and cramping. It is essential to drink plenty of fluid, at least 2 litres daily, as this is needed to flush stool through the bowel. Exercising daily will encourage gut motility and help improve symptoms.

Certain foods can help encourage gut motility. Prunes are a common remedy. Fruits containing the sugar sorbitol may also help. This sugar isn't easily absorbed and draws fluid into the bowel, which may move things along. Dried fruits are particularly high in sorbitol. Apples, apricots, grapes, strawberries and raspberries, peaches, pears and plums also contain sorbitol.

Laxatives can have a role particularly in initiating bowel movement in cases of constipation. Talk to a doctor who knows your full history before deciding which one to use.

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