Pediatric Skin-Picking: Parent Do's and Don'ts

When supporting a child with pediatric skin picking disorder (excoriation disorder), it's important for parents to approach the situation with empathy, understanding, and appropriate strategies. 

Pediatric excoriation disorder, also known as skin picking disorder or dermatillomania, is a condition characterized by recurrent picking at one's own skin, leading to tissue damage. It typically begins in childhood or adolescence, but can also occur in adults. Here are some key points regarding the onset and distinct features of pediatric excoriation disorder:

1. Onset of pediatric excoriation disorder: This condition usually starts in late childhood or early adolescence, with an average age of onset around 11 to 12 years. However, it can also begin earlier or later in life. The specific triggers or causes of pediatric excoriation disorder are not yet fully understood, but factors such as genetic predisposition, environmental influences, and underlying psychological factors may contribute.

2. Distinctive Features of Pediatric Excoriation Disorder: Pediatric excoriation disorder is characterized by repetitive picking or scratching at the skin, resulting in noticeable tissue damage. The picking behavior is often preceded by tension or anxiety, and it provides temporary relief or gratification. However, it is not motivated by a desire for external rewards or a response to delusions, as seen in other skin-related conditions like delusional parasitosis.

3. Site of Picking: The most common areas targeted for picking in pediatric excoriation disorder include the face, scalp, arms, and legs. However, the picking can occur on any part of the body. The chosen sites may vary based on personal preference or accessibility. It's important to note that the behavior must cause significant distress or impairment in functioning to meet the diagnostic criteria for pediatric excoriation disorder.

4. Co-occurring Anxiety Disorders: Pediatric excoriation disorder frequently co-occurs with other mental health conditions, such as anxiety disorders, obsessive-compulsive disorder (OCD), and body dysmorphic disorder. These co-occurring conditions may share underlying features, such as difficulties with impulse control, emotion regulation, or body-focused repetitive behaviors.

Here are some general dos and don'ts for parents:

Dos:

1. Educate Yourself: Learn about pediatric skin picking disorder, its causes, symptoms, and available treatment options. This will help you better understand your child's condition and provide appropriate support. The top recommended book by Kairos Wellness Collective for skin is Dr. Charles Mansueto’s book, Overcoming Body-Focused Repetitive Behaviors: A Comprehensive Behavioral Treatment for Hair Pulling and Skin Picking.  

2. Seek Professional Help: Consult with a mental health professional who specializes in working with children and adolescents to receive an accurate diagnosis and develop a comprehensive treatment plan. Kairos Wellness Center has clinicians who are trained in child-centric ERP for Body Based Repetitive Behaviors like Skin Picking.  

3. Maintain Open Communication: Encourage your child to share their feelings and experiences related to their skin picking. Create a safe and non-judgmental space for open conversations about their struggles and concerns. Understand that children may already regard their skin picking with shame and not feel comfortable speaking about it.  

4. Be Empathetic and Supportive: Show understanding and empathy towards your child's challenges. Let them know that you are there to support them and that their condition does not define their worth.

5. Establish Routines and Distractions: Help your child establish structured routines and engage in activities that can distract them from skin picking behaviors. Encourage them to participate in hobbies, sports, or creative activities that they enjoy.

6. Teach Healthy Coping Strategies: Help your child develop healthy coping strategies for managing stress, anxiety, or boredom. This can include deep breathing exercises, mindfulness techniques, or engaging in relaxing activities.

7. Encourage Self-Care: Promote good self-care habits for your child, including maintaining a regular sleep schedule, practicing good hygiene, and engaging in activities that promote overall well-being.

Don'ts:

1. Don't Shame or Blame: Avoid shaming or blaming your child for their skin picking behaviors. It is essential to approach the issue with understanding and compassion rather than criticism. Many parents unwittingly add to shame by pathologizing the behaviors too much. 

2. Don't Force Stoppage: Avoid pressuring or forcing your child to stop picking their skin abruptly. This can create additional stress and may lead to increased resistance. Instead, focus on gradual behavior modification techniques and professional guidance.

3. Don't Punish or Condemn: Punishing or scolding your child for skin picking can exacerbate their distress and negatively impact their self-esteem. Instead, offer reassurance and support while working towards finding appropriate treatment options.

4. Don't Overemphasize Appearance: Try not to overly focus on your child's physical appearance or draw unnecessary attention to their skin picking. Instead, emphasize their qualities, strengths, and other aspects of their identity.

5. Don't Enable or Ignore: While it is essential to avoid harsh criticism, it's also important not to ignore the problem or enable the behavior. Strike a balance by acknowledging the challenge while providing support and guidance towards healthier alternatives.

Remember, each child's experience with skin picking is unique, so it's crucial to tailor your approach based on their specific needs. Consulting with professionals and involving them in the treatment process will provide the best chance for managing and overcoming pediatric skin picking disorder.

To learn more about how our therapists can support pediatric skin-picking, please contact Kairos Wellness Collective today.