Nail picking or biting in children could be linked to a stress-related syndrome resulting from peer bullying and authoritarian parenting, a doctor said.
Many cases of onychophagy (nail biting) and onychotillomania (nail picking) are related to stress, dermatologist Ko Shih-chung (柯適中) said.
If a child has been bullied at school, or subjected to extreme exam pressure or strict parenting, then they are likely to absently bite their nails or pick at them, Ko said.
Many parents take children with extremely short nails and inflamed skin to a doctor, fearing they may have a microbial or fungal infection, Ko said.
In one case, a boy stood timidly next to his mother, so Ko said he asked whether the mother and father had high expectations for their son, or whether he had to deal with peer pressure, Ko said.
“I tried to communicate to the mother that strict parenting can cause nail biting, but to no avail,” Ko said. “I found the mother yelling at the boy and punishing him right afterward, because he had made a simple mistake at the pharmacy counter — and then the boy started picking his nails again.”
In another case, a junior-high girl had chronic paronychia — when a tender infection forms where the nail and skin meet at the side or base of a fingernail — because she constantly picked at her nails and bit them as a way of coping with exam pressure, he said.
Some children compulsively pull their hair, Ko said, adding that he once treated a seven-year-old girl raised by her grandparents who frequently pulled her hair to cope with loneliness.
“It was only when an area on her head became bald that the girl was taken to a doctor,” he said. “She had to be referred to the department of child and adolescent psychiatry for further treatment.”
Medication can heal the infections caused by nail biting, but it is crucial to address the stress that leads to the behavior, Ko said.
A person who stops picking their nails or biting them can develop healthy nails within six months, he said.
However, when a child also has attention deficit hyperactivity disorder, obsessive compulsive disorder, anxiety disorder or Tourette syndrome, they might require consultations with a psychiatrist, Ko said.
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