Biting Others
Barbara Howard
I. Description of the problem.
A. Epidemiology.
1. Almost all children bite at some time during the first 3 years. For example, 50% of toddlers in childcare are bitten three times every year. Bites constitute 6% of injuries to males and 3% to females in childcare.
2. As with most other aggressive behaviors, boys are more likely than girls to bite.
3. Biting is more severe or persistent in children with family dysfunction, where physical punishment is used, or when there is chronic stress.
4. Acceptability or modeling of violence predisposes to aggressive behaviors, such as biting.
B. Contributing factors.
1. Environmental. Children are more likely to bite others when they are in social situations beyond their coping abilities. Biting in these situations is usually intended to obtain objects, to gain attention, or to express frustration. It is also a powerful way of acquiring attention from adults. For example, some parents remove the child from the childcare setting for the day after a biting incident. Such secondary gain from the environment may prolong the biting phase.
2. Developmental. Biting emerges at predictable developmental stages.
a. The first peak, at the time of tooth eruption, is rarely reported as a problem since caregivers interpret it as normal experimentation. Interestingly, breastfed infants generally learn very quickly not to bite the breast, probably because of their mother’s shriek, her affective distress, and the prompt removal of the infant from the breast.
b. The next peak in biting occurs around 8-12 months when infants bite as an expression of excitement. A strong negative emotional response by caregivers accompanied by putting down the infant generally leads to rapid extinction.
c. The second year of life is normally a time when skills develop unevenly, and there is a strong desire to act autonomously. Fledgling or delayed abilities in expressive language and fine motor skills serve to cause frustration and set the child up for aggressive outbursts. Biting in toddlers may be used to dominate, to acquire an object, or to express anger or frustration. In addition, children undergoing stressful separation experiences (such as to go to childcare) may get emotional relief from causing distress in others by biting. This phase of biting typically disappears quickly.
d. Biting in children older than 3 years should occur only in extreme circumstances (e.g., if they are losing a fight, perceive their survival to be threatened, or are very stressed).
II. Recognizing the issue.
A. History: key clinical questions.
1. “When did the biting start? What else was different around that time”? Look for recent stress (such as new childcare or a new sibling).
2. “In what situations does it occur?” Look for situations in which frustration is common and the child has poor coping skills. This may be a clue to developmental weaknesses such as fine motor delay (e.g., if biting occurs when coloring with crayons is expected). Biting that occurs when there has been a long period between meals may suggest hunger as a cause.
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