# Hitting, biting and head-banging: keeping everyone safe > Hitting, biting and head-banging in autistic children are usually a sign of distress, pain or a need your child cannot express another way, not naughtiness. First keep everyone safe: move other people and hard objects away, protect your child's head and cut talking and noise. Then check for pain or illness, keep a simple diary of what happens before and after, and ask your GP for help. - Canonical page: https://rocksmakepebbles.co.uk/guides/hitting-biting-and-self-injury - Publisher: Rocks Make Pebbles (https://rocksmakepebbles.co.uk) - Topic: Feelings, sensory needs and behaviour - Applies to: UK - Last updated: 28 September 2026. Checked against sources: 28 September 2026 - Professional review: Not yet reviewed (waiting for review by a clinical psychologist or positive behaviour support practitioner) - Drafted with the help of AI tools and checked against the sources listed below. Editorial policy: https://rocksmakepebbles.co.uk/editorial-policy ## Key points - Hitting, biting and head-banging are communication, often of distress, pain or overload. They are not naughtiness. - In the moment, make space: move other people and hard objects away rather than holding your child. - Check for pain or illness first, such as constipation, earache or toothache, especially if the behaviour is new or sudden. - Keep an ABC chart for a few weeks to find out what sets the behaviour off and what it does for your child. - Call 999 for a serious injury, including a head injury with warning signs. See your GP about any self-injury. - Ask for a functional assessment and a written plan that is the same at home and at school. ## Why is my child hitting, biting or banging their head? These behaviours are usually a sign that something is wrong for your child. They may be overwhelmed, in pain, anxious, or unable to get a need met another way. They are not naughtiness. The [National Autistic Society](https://www.autism.org.uk/advice-and-guidance/topics/behaviour/distressed-behaviour/all-audiences) calls this distressed behaviour; health professionals often call it [behaviour that challenges](https://rocksmakepebbles.co.uk/glossary#behaviour-that-challenges). The [Challenging Behaviour Foundation](https://www.challengingbehaviour.org.uk/understanding-challenging-behaviour/what-is-challenging-behaviour/resource-finding-the-reasons-for-challenging-behaviour-part-2/) says: "All behaviour happens for a reason, and being aware of the causes is key." Head-banging, biting their own hands and other ways a child hurts themselves are called self-injury. The [National Autistic Society](https://www.autism.org.uk/advice-and-guidance/mental-health/self-harm) says "Harm is not the intent": it describes self-injury as "an attempt to regulate or express immediate physical pain or discomfort, or communicate a particular need". A [review of 37 studies with 14,379 people](https://doi.org/10.1007/s10803-020-04443-1) estimated that 42% of autistic people self-injure, most often by hand-hitting, with no overall link to age or intellectual disability. Common reasons, from the causes the National Autistic Society and [NICE](https://www.nice.org.uk/guidance/cg170/chapter/Recommendations) list: | What might be going on | What you might notice | What can help | |---|---|---| | Pain or illness | A sudden change | A GP check (see below) | | No quick way to say what they need | It happens when they want something, or want something to stop | A word, sign or picture for "stop", "help" or "break" | | Sensory overload | Busy, loud or bright places | Less noise and light, a quiet space | | Anxiety or change | New places, new routines, moving between activities | Showing what happens next with pictures | | Demands that feel too hard | It happens when asked to stop, start or do something | Smaller steps, choices and breaks | | Tiredness or hunger | Worse late in the day or before meals | Rest and snacks | ## What should I do right now to keep everyone safe? Keep everyone safe first. You can work out why later. 1. **Make space.** Move other children out of reach and move hard or sharp things away. This is usually safer than holding your child. 2. **Protect your child's head.** If they are banging their head, put a cushion or folded coat between their head and the floor or wall, if you can do it safely. 3. **Keep yourself safe.** Step back out of reach. You do not have to stand and be hurt. 4. **Say less.** Use a few calm words, or none. The [National Autistic Society](https://www.autism.org.uk/advice-and-guidance/topics/behaviour/distressed-behaviour/all-audiences) advises a "neutral and steady tone of voice" and to "Limit verbal comments, facial expressions and other displays of emotion". 5. **Turn things down.** Switch off loud music or the TV and dim bright lights, as the [National Autistic Society](https://www.autism.org.uk/advice-and-guidance/behaviour/meltdowns/all-audiences) suggests for meltdowns. 6. **Wait nearby.** Recovery from overload "can take a while", so give your child time. 7. **Afterwards, check and comfort.** Look for injuries on everyone, and comfort brothers and sisters. Do not punish your child: the [National Autistic Society](https://www.autism.org.uk/advice-and-guidance/positive-behaviour-support-pbs) does not support any approach that uses punishment. Later, write down what happened. > **Get help now:** Call 999 or go to A&E if anyone is seriously hurt, for example bleeding that will not stop, a suspected broken bone or an eye injury, or if your child may have swallowed something harmful ([NHS](https://www.nhs.uk/conditions/poisoning/)). For urgent medical advice, call [NHS 111](https://rocksmakepebbles.co.uk/where-to-get-help#nhs-111). See your GP promptly if your child hurts themselves, even if injuries seem small ([National Autistic Society](https://www.autism.org.uk/advice-and-guidance/mental-health/self-harm)). In Northern Ireland, where there is no NHS 111, call your GP or the [GP out of hours service](https://www.nidirect.gov.uk/articles/gp-out-hours-service). > **Get help now:** After a knock to the head, call 999 if your child has been knocked out and not woken up, has a fit, cannot stay awake, has problems seeing, hearing, walking or speaking, has clear fluid from their ears or nose, or is behaving differently, such as being more irritable ([NHS](https://www.nhs.uk/conditions/head-injury-and-concussion/)). Call 111 if they are being sick or dizzy, or for advice about a child under 5. In Northern Ireland, where there is no NHS 111, call your GP or the [GP out of hours service](https://www.nidirect.gov.uk/articles/gp-out-hours-service). ## Could my child be in pain or unwell? Check for pain and illness first, especially if the behaviour is new, sudden or getting worse. [NICE](https://www.nice.org.uk/guidance/cg170/chapter/Recommendations) asks professionals to look for "coexisting physical disorders, such as pain or gastrointestinal disorders" when behaviour becomes challenging, and to treat any they find before trying other approaches. Pain can be hard to spot: the [NHS](https://www.nhs.uk/conditions/autism/signs/children/) lists difficulty describing feelings, hunger or pain among the signs of autism in children. In a [study of 51 young children](https://doi.org/10.1352/1944-7558-121.3.194) being assessed for autism or developmental disabilities, those who self-injured showed more signs of pain. Tummy problems are common too: a [review of 15 studies](https://europepmc.org/article/MED/24777214) found autistic children had nearly four times the odds of constipation, and higher odds of diarrhoea and tummy pain, than other children. Ask your GP to check: - **Teeth and mouth.** The National Autistic Society suggests ruling out pain and dental problems. - **Ears, tummy and skin.** In its sleep advice, NICE gives "reflux, ear or toothache, constipation or eczema" as examples of physical discomfort to look for. - **Hearing and eyesight.** A GP can refer your child for a [hearing test](https://www.nhs.uk/conditions/hearing-tests-children/), and children who cannot read or speak can still have their [eyes tested](https://www.nhs.uk/conditions/eye-tests-in-children/). - **Medicines, injuries and sleep.** Note anything you have seen, such as your child holding their tummy or pulling at an ear. Our guide to [dentists, haircuts and doctors](https://rocksmakepebbles.co.uk/guides/dentist-haircuts-and-appointments) has ideas for making visits easier. ## How do I find out what sets it off? Keep an [ABC chart](https://rocksmakepebbles.co.uk/glossary#abc-chart): a simple diary of what happens before, during and after each incident. The [National Autistic Society](https://www.autism.org.uk/advice-and-guidance/topics/behaviour/distressed-behaviour/all-audiences) recommends a behaviour diary "which records what is occurring before, during and after the behaviour", and the [Challenging Behaviour Foundation](https://www.challengingbehaviour.org.uk/understanding-challenging-behaviour/what-is-challenging-behaviour/resource-finding-the-reasons-for-challenging-behaviour-part-2/) suggests noting early warning signs too, such as "becoming red in the face". | Letter | What to write down | Example | |---|---|---| | A: before | Where, who was there, noise, any request, change or "no" | Tablet turned off for tea; TV loud | | B: behaviour | Exactly what your child did, and for how long | Hit me twice, then bit his own hand | | C: after | What happened next: what your child got, avoided or what changed | I moved away and turned the TV off; calm after 10 minutes | | Also note | Time, early warning signs, sleep, food, illness | 4.30pm; pacing first; slept badly | After a few weeks, look for patterns in times, places, requests, noise or tiredness. The Challenging Behaviour Foundation lists common reasons a behaviour keeps happening: to get attention, to get something, to escape something, or for sensory reasons. Knowing the reason tells you what to try. > **Try this:** Teach your child a quicker, easier way to get the same need met, such as a sign, picture or button for "stop", "help" or "break". For a child who bites, the National Autistic Society suggests safe things to chew, such as chewy tubes. NICE's [learning disability guideline](https://www.nice.org.uk/guidance/ng11/chapter/Recommendations) describes the same idea: a new skill that does the job the behaviour was doing. ## What are functional assessment and positive behaviour support? A [functional assessment](https://rocksmakepebbles.co.uk/glossary#functional-assessment) is a careful look at what triggers a behaviour and what need it meets. The Challenging Behaviour Foundation says it "is usually carried out by a Psychologist or behaviour nurse". **What NICE says for autistic children.** NICE guideline [CG170](https://www.nice.org.uk/guidance/cg170/chapter/Recommendations) asks professionals to look first at things that can lead to behaviour that challenges, such as communication difficulties, pain, anxiety, noise, changes to routine and "the absence of predictability and structure". If none of these explains the behaviour, NICE says to offer "a psychosocial intervention (informed by a functional assessment of behaviour) as a first-line treatment". A good plan, NICE says, has a clear target, "a focus on outcomes that are linked to quality of life", changes to the environment, "a specified timescale", a measure taken before and after, and the same approach at home and school, agreed between parents and professionals. **What NICE says for children with a learning disability.** NICE guideline [NG11](https://www.nice.org.uk/guidance/ng11/chapter/Recommendations) covers children, young people and adults with a [learning disability](https://rocksmakepebbles.co.uk/glossary#learning-disability) and behaviour that challenges, so it applies to some autistic children but not all. It describes a written behaviour support plan based on "a shared understanding about the function of the behaviour", with changes such as "reducing noise, increasing predictability", new skills, early calming strategies and a safety plan, reviewed "fortnightly for the first 2 months and monthly thereafter". It also suggests group parent-training programmes for these families when children are under 12. **Where positive behaviour support fits.** The [National Autistic Society](https://www.autism.org.uk/advice-and-guidance/positive-behaviour-support-pbs) describes [positive behaviour support](https://rocksmakepebbles.co.uk/glossary#positive-behaviour-support) (PBS) as "a widely used and person-centred approach to identifying and meeting a person's support needs, in particular if someone is distressed and at risk of harming themselves or others". Most often used with people with a learning disability, it "first emerged in the 1980s in response to rising concern over the use of punishment and restrictive strategies in intensive ABA practices". Our [autism therapies guide](https://rocksmakepebbles.co.uk/guides/autism-therapies-and-support) explains [ABA](https://rocksmakepebbles.co.uk/glossary#aba) (applied behaviour analysis). The Challenging Behaviour Foundation has a free [PBS information pack for families](https://www.challengingbehaviour.org.uk/information-and-guidance/positive-behaviour-support/pbs-an-information-pack-for-family-carers/). > **Evidence check:** In a US trial of 180 autistic children aged 3 to 7, parents' ratings of irritability fell by 47.7% after 24 weeks of parent training and by 31.8% after parent education, though the authors called the clinical significance unclear ([Bearss et al. 2015](https://doi.org/10.1001/jama.2015.3150)). The National Autistic Society says PBS needs more research. ## Is it ever OK to hold or restrain my child? Only as a last resort, when there is a risk of serious harm and nothing less restrictive will work. NICE's [NG11](https://www.nice.org.uk/guidance/ng11/chapter/Recommendations) says responses should use "a graded approach that considers the least restrictive alternatives first". [Guidance for schools in England](https://assets.publishing.service.gov.uk/media/6943dad6501cdd438f4cf5aa/Restrictive_interventions_including_use_of_reasonable_force_in_schools.pdf) warns that "For any form of restraint, including seated and standing, there is a risk of physical and psychological harm", and that a child should never be held in a way that affects their "airway, breathing or circulation". At home, moving people and objects is usually safer than holding your child. A tight hug your child chooses is different: an [NHS CAMHS team](https://www.camhsnorthderbyshire.nhs.uk/learning-disabilities-sensory-processing) notes that some children seek heavy touch, such as hugs, and find it calming. If you often have to hold your child to keep people safe, ask your GP for specialist help and a written plan. At school in England, [new guidance took effect on 1 April 2026](https://www.gov.uk/government/publications/use-of-reasonable-force-in-schools). Under it: - schools must report each significant use of force to you "as soon as practicable after the incident", and "should endeavour to do this no later than the same day", in writing - the report should say when, where and for how long, why force was needed, what force was used and any injuries - this applies even if restraint is part of your child's agreed plan - seclusion must now be recorded and reported too; it should only be used to keep others safe, never as a threat of punishment, with the child supervised at all times - schools should not agree to requests never to use force, but should make behaviour support plans with you and review them after any significant incident. > **Scotland, Wales and Northern Ireland:** The Department for Education guidance on force and seclusion covers schools in England. If you live elsewhere in the UK, ask your child's school or local authority for its policy on physical intervention and how it tells parents. ## How do I keep brothers and sisters safe? Plan ahead so everyone knows what to do. The charity [Sibs](https://www.sibs.org.uk/supporting-young-siblings/parents/when-to-be-concerned-about-your-sibling-child) advises having an emergency plan for times when aggressive behaviour gets out of control, such as a safe spot for brothers and sisters to go and a signal that means "go there now". If a sibling is hurt, Sibs suggests you comfort them, give first aid if needed, say you are sorry they are hurt, and tell your autistic child the behaviour was not OK, even if that will not change it straight away. Young siblings need "clear, simple explanations, alongside extra emotional support", according to [Sibs](https://www.sibs.org.uk/supporting-young-siblings/parents/siblings-under-6). Its example: "Your brother bangs his head because words are hard for him; when you are upset you can use your words to tell me." A brother or sister who regularly does care that an adult should be doing may be a young carer. In England, [your council must arrange a young carer's assessment](https://www.nhs.uk/social-care-and-support/support-and-benefits-for-carers/being-a-young-carer-your-rights/) if you ask. See our guide to [brothers and sisters](https://rocksmakepebbles.co.uk/guides/siblings). ## Where can I get help? Your GP or health visitor is the usual first step. - **GP or health visitor:** to check for pain and illness, and to refer your child to a [community paediatrician](https://rocksmakepebbles.co.uk/glossary#community-paediatrician), [CAMHS](https://rocksmakepebbles.co.uk/glossary#camhs) or, if your child has a learning disability, a learning disability team, for a functional assessment. - **Nursery or school:** ask the [SENCO](https://rocksmakepebbles.co.uk/glossary#senco) for a written plan made with you, so the approach is the same at home and at school. - **Charities:** the [Challenging Behaviour Foundation](https://rocksmakepebbles.co.uk/where-to-get-help#challenging-behaviour-foundation) supports families of people with severe learning disabilities, and the [National Autistic Society](https://rocksmakepebbles.co.uk/where-to-get-help#nas) and [Contact](https://rocksmakepebbles.co.uk/where-to-get-help#contact) offer information and support. - **Medicine:** NICE says a paediatrician or psychiatrist may consider a type of medicine called an antipsychotic when other support has not been enough or could not be given because the behaviour is so severe. It should be checked after 3 to 4 weeks and stopped at 6 weeks if it is not clearly helping ([NICE CG170](https://www.nice.org.uk/guidance/cg170/chapter/Recommendations)). For self-injury, the [Challenging Behaviour Foundation](https://www.challengingbehaviour.org.uk/understanding-challenging-behaviour/specific-behaviours/self-injurious-behaviour/) notes there "is not much evidence that medicine can help". - **You:** being hurt by your child is exhausting and upsetting. See [looking after yourself](https://rocksmakepebbles.co.uk/guides/looking-after-yourself). In England, you can ask your council for a [parent carer needs assessment](https://rocksmakepebbles.co.uk/glossary#parent-carer-needs-assessment). ## Questions parents ask ### What should I do when my autistic child hits me? Keep yourself and others safe first: step back out of reach, move other children away and say as little as possible. Hitting is usually a sign of distress or a need your child cannot put into words, not naughtiness. Common reasons include pain, overload from noise or crowds, worry about change, a demand that feels too hard, tiredness and hunger. Afterwards, keep a diary of what happened before each incident to find the pattern. ### Is my child doing it for attention? Sometimes a behaviour carries on because it gets a child something, such as attention, a favourite thing or a break from something hard. The Challenging Behaviour Foundation lists these among the common reasons, along with sensory reasons. That still means your child has a real need. NICE asks professionals to look at pain, communication, anxiety and the environment too, and a functional assessment can show what the behaviour is doing for your child. ### My child bangs their head. When should I worry? After a knock to the head, NHS advice is to call 999 if your child was knocked out and has not woken up, has a fit, cannot stay awake, has problems seeing, hearing, walking or speaking, has clear fluid coming from their ears or nose, or their behaviour has changed. Call 111 (in Northern Ireland, your GP or GP out of hours service) if they are being sick or seem dizzy. See your GP if head-banging is new, getting worse or causing injuries, because pain or illness can be the cause. ### How do I keep my child's brother or sister safe? Plan ahead. Agree a safe spot for brothers and sisters to go to, and a signal that means go there now. The charity Sibs advises having an emergency plan for times when aggressive behaviour gets out of control. If a sibling is hurt, comfort them, give first aid if needed, tell them you are sorry they are hurt, and tell your autistic child that the behaviour was not OK. ### The school restrained my child. What are my rights? In England, since 1 April 2026, schools must tell you about each significant use of force as soon as practicable, aiming for the same day, and should do this in writing. The report should say when and where it happened, how long it lasted, why it was needed, what force was used and any injuries. This applies even if restraint is part of an agreed plan. Ask for a meeting to review your child's behaviour support plan. ### What is an ABC chart? An ABC chart is a simple diary of each incident. A is what happened just before, B is exactly what your child did, and C is what happened straight afterwards. Add the time, place and any early warning signs. Over a few weeks, patterns may show up, such as a time of day, a place or a type of request. Share it with your GP, the school or any specialist. ### Will medication stop the hitting? Medicine is not the first step. NICE says professionals should first look for causes such as pain, and then offer support based on a functional assessment. A paediatrician or psychiatrist may consider a type of medicine called an antipsychotic if that has not been enough, or could not be given because the behaviour is so severe. NICE says it should be checked after 3 to 4 weeks and stopped at 6 weeks if it is not clearly helping. Ask the specialist about benefits and side effects. ## Sources 1. [GP out of hours service](https://www.nidirect.gov.uk/articles/gp-out-hours-service), nidirect, 26 November 2024 2. [Distressed behaviour](https://www.autism.org.uk/advice-and-guidance/topics/behaviour/distressed-behaviour/all-audiences), National Autistic Society, 14 August 2020 3. [Self-harm](https://www.autism.org.uk/advice-and-guidance/mental-health/self-harm), National Autistic Society, March 2022 4. [Meltdowns: a guide for all audiences](https://www.autism.org.uk/advice-and-guidance/behaviour/meltdowns/all-audiences), National Autistic Society, 14 August 2020 5. [Positive behaviour support (PBS)](https://www.autism.org.uk/advice-and-guidance/positive-behaviour-support-pbs), National Autistic Society 6. [Finding the reasons for challenging behaviour, part 2](https://www.challengingbehaviour.org.uk/understanding-challenging-behaviour/what-is-challenging-behaviour/resource-finding-the-reasons-for-challenging-behaviour-part-2/), Challenging Behaviour Foundation 7. [Self-injurious behaviour](https://www.challengingbehaviour.org.uk/understanding-challenging-behaviour/specific-behaviours/self-injurious-behaviour/), Challenging Behaviour Foundation 8. [Positive behaviour support: an information pack for family carers](https://www.challengingbehaviour.org.uk/information-and-guidance/positive-behaviour-support/pbs-an-information-pack-for-family-carers/), Challenging Behaviour Foundation 9. [Autism spectrum disorder in under 19s: support and management (CG170)](https://www.nice.org.uk/guidance/cg170/chapter/Recommendations), NICE, June 2021 10. [Challenging behaviour and learning disabilities: prevention and interventions (NG11)](https://www.nice.org.uk/guidance/ng11/chapter/Recommendations), NICE, May 2015 11. [Restrictive interventions, including the use of reasonable force, in schools](https://assets.publishing.service.gov.uk/media/6943dad6501cdd438f4cf5aa/Restrictive_interventions_including_use_of_reasonable_force_in_schools.pdf), Department for Education, December 2025 12. [Use of reasonable force in schools (publication page)](https://www.gov.uk/government/publications/use-of-reasonable-force-in-schools), GOV.UK, 18 December 2025 13. [The prevalence of self-injurious behaviour in autism: a meta-analytic study (Steenfeldt-Kristensen et al.)](https://doi.org/10.1007/s10803-020-04443-1), Journal of Autism and Developmental Disorders, 2020 14. [The relationship between pain, self-injury and other problem behaviors in young children with autism and other developmental disabilities (Courtemanche et al.)](https://doi.org/10.1352/1944-7558-121.3.194), American Journal on Intellectual and Developmental Disabilities, 2016 15. [Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis (McElhanon et al., Pediatrics)](https://europepmc.org/article/MED/24777214), Europe PMC, 2014 16. [Signs of autism in children](https://www.nhs.uk/conditions/autism/signs/children/), NHS, 6 May 2026 17. [Eye tests for children](https://www.nhs.uk/conditions/eye-tests-in-children/), NHS 18. [Hearing tests for children](https://www.nhs.uk/conditions/hearing-tests-children/), NHS 19. [Head injury and concussion](https://www.nhs.uk/conditions/head-injury-and-concussion/), NHS, 29 May 2025 20. [Poisoning](https://www.nhs.uk/conditions/poisoning/), NHS, 12 June 2025 21. [Effect of parent training vs parent education on behavioral problems in children with autism (Bearss et al., JAMA)](https://doi.org/10.1001/jama.2015.3150), JAMA, 2015 22. [Sensory processing (learning disabilities)](https://www.camhsnorthderbyshire.nhs.uk/learning-disabilities-sensory-processing), Derbyshire CAMHS, NHS 23. [When to be concerned about your sibling child](https://www.sibs.org.uk/supporting-young-siblings/parents/when-to-be-concerned-about-your-sibling-child), Sibs 24. [Siblings under 6](https://www.sibs.org.uk/supporting-young-siblings/parents/siblings-under-6), Sibs 25. [Being a young carer: your rights](https://www.nhs.uk/social-care-and-support/support-and-benefits-for-carers/being-a-young-carer-your-rights/), NHS --- General information for families in the UK, not medical, legal or financial advice. If you are worried about your child's health, contact your GP or call NHS 111 (in Northern Ireland, your GP out of hours service). In an emergency, call 999.