Supporting Children with Body-Focused Repetitive Behaviors (BFRBs)
Body-Focused Repetitive Behaviors (BFRBs) are repetitive behaviors such as hair pulling, skin picking, nail biting, or cheek biting that children may use to cope with stress, anxiety, boredom, or sensory discomfort. For many families, these behaviors can feel confusing or concerning, especially when a child says that they cannot stop, or does it without fully realizing it.
It is important for parents to know that BFRBs are not simply attention-seeking behaviors or signs of laziness. Often, they are connected to emotional regulation, habit patterns, or sensory needs.
At OCD & Anxiety Treatment of Houston (OATH), we help families better understand the function behind these behaviors while creating supportive, realistic strategies that reduce shame and encourage progress over time.
What's helpful vs unhelpful, as a parent?
One of the most helpful things a parent can do is respond with calm curiosity instead of punishment or criticism. Children dealing with BFRBs are often already aware of the behavior and may feel embarrassed or frustrated by it. Constant reminders such as “stop picking” or “leave your hair alone” can unintentionally increase anxiety and make the behavior occur more frequently.
For example, a child who picks at their skin during homework may benefit more from a sensory replacement tool, movement breaks, or stress management support than repeated correction. Another example may involve a child who pulls at their hair while watching television. Instead of reprimanding, a parent might gently offer a fidget item or help the child notice patterns around when the urge appears.
Parents can also help by:
- Tracking triggers
- Celebrating small wins
- Focusing on progress instead of perfection
Consider spending one week observing when the behavior happens most often without without intervening in the moment. Patterns often provide helpful information.
At OATH, we understand that supporting a child with BFRBs can feel overwhelming at times. With patience, consistency and support, children can learn healthier coping tools and families can feel more confident navigating the process together.
The goal is to build awareness and create healthier replacements that meet the same emotional or sensory need. To learn more about whether or not therapy may be a good fit for you or your loved one, please feel free to reach out to our team today.
Meet the Author
Abeeb Oki, MEd, LPC-Associate, Supervised by Saharah Shrout, LPC-S
Some interesting facts about Abeeb:
My favorite ACT concept is staying present. It’s so easy to get caught in rumination cycles, but intentionally focusing on the present moment, the here and now, goes such a long way.
What I love the most about working with clients is when my clients notice their progression. Progress isn’t linear, and sometimes it can feel harder before it gets better, but when a client notices they aren’t where they were in the beginning anymore…chef’s kiss!
Self care strategy I recommend for BFRB client’s is to truly stop, take time to acknowledge what you’re feeling, and ask yourself… “What do I want to do in this moment?” Self care doesn’t have to be textbook or black and white. Listen to your body, and try to align self care with the things you value.
A book I’m enjoying right now is “A Parent Guide to Hair Pulling Disorder” by Suzanne Mouton-Odum & Ruth Goldfinger Golomb