BFRBs (Body-Focused Repetitive Behaviors) in children can be confusing and concerning for many parents. Behaviors like hair pulling, skin picking, or nail biting are often dismissed as simple habits or phases, but sometimes they may be signs of BFRBs. Understanding the early signs and intervening with compassion can make a significant difference in a child’s emotional and behavioral development.

What Are BFRBs in Children?

BFRBs (Body-Focused Repetitive Behaviors) are repetitive behaviors directed toward the body that can cause physical damage or emotional distress. These behaviors are often linked to stress, anxiety, boredom, or sensory needs.

Common BFRBs parents may notice in children include:

• Hair pulling (Trichotillomania) – pulling hair from the scalp, eyebrows, or eyelashes.
• Skin picking (Excoriation) – repeatedly picking at scabs, bumps, or healthy skin.
• Nail biting or cuticle picking, even to the point of causing pain.
• Cheek or lip biting, which can cause damage even when gentle if repeated over time.
• Pulling hair during homework, screen time, or while feeling anxious.

Some children may not even realize they’re doing it, while others may feel embarrassed or try to hide the behavior.

Tools for Early Intervention and Support

1 – Notice Patterns Without Shame

One of the unseen tolls of BFRBs is the impact that management can have on relationships. As a parent, it can feel compulsory to correct anything that could be detrimental, but in the case of BFRBs, how the behavior is addressed can also do harm. Instead of immediately correcting the behavior, try observing when it occurs.

• Does it happen during stress, boredom, or concentration? You may observe a combination of three with a tendency toward one. Knowing why behaviors occur can help you to come up with methods of alleviating them. For example, mitigating stress before a BFRB happens, or putting in a physical obstruction from behaviors that occur during concentration – these are often not registered by the person doing them, making it harder to stop.
• Is it more common before bedtime or during schoolwork? Bedtime can be a stressor; a list of things to do at the end of a long day full of things to do. If the day runs long and bedtime is a rush, or if your child experiences any revenge bedtime procrastination on days when they still feel the need to fill a certain cup (play time, socializing, decompression), it can be an emotional and challenging part of the day. Schoolwork, as well, can come with its own set of subconscious baggage about the school environment, pressure to achieve, confusion, and more. In both cases, underlying needs can be identified when we pay attention to the circumstances surrounding these tasks being a challenge or trigger for BFRBs.

Approaching the behavior with curiosity rather than criticism helps children feel safe discussing it. It is through discussion that you will both be able to gain more insight, and work through your understanding to try possible solutions.

2 – Introduce Replacement Behaviors

Children often benefit from sensory alternatives that keep their hands busy. In our Woodland Hills BFRB therapy sessions, we practice taking note of negative behaviors and replacing them with something more positive.

Examples include:

• Stress balls or fidget toys. Occupying the hands with something your child can take their anxiety out on is a great way to prevent BFRBs. Your child may use this tool often, or reach for it when they feel their anxiety begin. Whatever works best for them is the way to go.
• Putty or textured objects. Feeling textured objects, or manipulating putty, can take the place of picking and pulling body-focused behaviors. It is far healthier to wear out an object than to pick at, pull, or bite one’s own body.
• Drawing, doodling, or squeezing clay. The great thing about drawing or doodling is that it can be employed when you see a BFRB, or even before a behavior can show up. Typically, one hand draws or colors while the other holds the paper steady; this is a good tactic for a child who uses both hands in their process.

These tools can redirect the urge without punishment or shame. They aren’t a “perfect” solution (there is no such thing), but they can help to alleviate symptoms. They are helpful when conscious of anxiety, and also to occupy hands when engaging in activities like watching a movie, pre-empting any distracted BFRB behaviors or habits.

3 – Create Calm Emotional Check-Ins

BFRBs are often connected to underlying emotions like anxiety or frustration. Those who see us for BFRB Therapy in Woodland Hills often speak about the benefits of bringing their stress levels down. There is also a great benefit to normalizing conversations about BFRBs; reducing stigma and shame can relieve a lot of pressure and stress.

• Choose a time that is most likely to be productive. For example, a quiet moment when there won’t be any interruptions, and when no one else is listening, is likely to be the best time for connection and open communication. You may tie it to an activity, such as working on a puzzle together, or drawing, or during after-school snack. You might prefer to talk about it at night if you find that sharing and being reassured helps your child let go of ruminating; anxious thoughts can disrupt sleep. Depending on what works best for your child, you may plan chats in advance for some conversations, such as your child knowing that you’ll ask them about their day. Other times, you may seize opportunities as they arise, so that your child can answer organically.
• Lead the conversation with curiosity. Try asking gentle questions like:
  • “Was anything stressful about your day today?” Be prepared for initial responses like, “I don’t know” or, “I’m not sure”. This is where it can be helpful to be doing something else, such as drawing or coloring, so that you are both sitting quietly together, but you’re not sitting in awkward, expectant silence. You could also ask this question while out for a walk, or driving somewhere in the car.
  • “When you pull your hair, what are you usually thinking about?” This question might be answered with examples of stressors, or your child may describe less what they are thinking and more what they are feeling. If so, you might ask a question about what they remember doing or hearing or thinking about before that feeling started. The more calm and curious you are, the easier it will be for your child to consider their answers and open up to you.

Helping children identify their feelings can reduce the urge to cope through repetitive behaviors.

4 – Seek Professional Support Early

If the behavior becomes frequent, causes hair loss or skin damage, or affects your child’s confidence, early intervention can be incredibly helpful. Professional support is not an overreaction, but rather a standard of care on par with other healthcare visits.

• Find a therapist who is experienced in modalities that treat BFRBs. A therapist trained in Habit Reversal Training (HRT) or Cognitive Behavioral Therapy (CBT) can help children learn skills to manage urges in a supportive way. As a BFRB Counselor in Woodland Hills, I have seen that professional support can help a child feel understood and safe. Even the fact that they are being provided with this kind of care can help to reduce the stress and anxiety that can lead to an increase in BFRBs. Adding to that the protocols of managing BFRBs through HRT and CBT, and great strides can be made.
• Explain that care is care. Your child may have questions or concerns about seeing a therapist. Be prepared to answer questions and explain that the purpose of BFRB therapy is. For example, you may remind your child that they get professional care from their doctor, their dentist, and maybe an optometrist or other specialised healthcare provider. A therapist is someone who is trained to look after mental health, which is just as important as physical health!

Key Takeaways

• BFRBs in children are more than just habits—they can be connected to stress, anxiety, or sensory needs.
• Early awareness and compassionate intervention can prevent long-term emotional distress. A behavior can be corrected without a child being made to feel that they have done something wrong or that something is wrong with them.
• Children benefit most from support, understanding, and tools—not punishment or shame. Even something said casually, or as a bit of a joke, can cause a child to shy away from talking about their struggles.
• Those who attend in-person or Online BFRB Therapy benefit from a safe environment in which to consider how BFRBs show up in their lives, discuss their feelings around their struggles, and explore and practice tactics for improving their management of symptoms.

How Therapy Can Help

Therapy provides children and parents with practical tools to understand and manage BFRBs. Through approaches like CBT and Habit Reversal Training, children can learn healthier coping strategies while parents gain guidance on how to support their child with empathy and confidence.

BFRB Treatment in Woodland Hills 

Bodily Focused Repetitive Behaviors (BFRBs)—such as nail-biting, hair-pulling, and skin-picking—are often misunderstood and highly stigmatized, despite being part of the obsessive-compulsive spectrum. While physical health conditions tend to receive empathy and understanding, those struggling with BFRBs are often met with judgment or silence—even though the impact is very real.

At Embracing You Therapy, we’re committed to changing that. Our therapist specializes in treating BFRBs and OCD-related disorders using evidence-based approaches tailored to your unique experience. With the right support, you can regain a sense of control, rebuild your confidence, and move forward without BFRBs holding you back from the life you want to live.

Contact us today for your complimentary 20-minute phone consultation with our Client Care Coordinator.