By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 21-month-old son head-butts. He has been doing this since about 13 months. He bangs his head on the wall or ceramic floor and doesn’t cry. When told no, he does it again. Sometimes he bangs his head so hard he bruises his forehead.

My pediatrician says this is normal. My mother thinks this is abnormal and he should be checked out.

A. Many children bang their heads in the second year when they begin to have temper tantrums or meltdowns. Some also rock themselves forcefully in their cribs or on the floor.

These actions seem to be a child’s way to handle uncomfortable feelings – frustration, disappointment, tension, anger, boredom. But of course such behavior frightens parents.

Even though toddlers bang their heads hard, I have never heard of one who hurt himself. As a precaution, though, I recommend putting carpet or other “shock absorbers” on concrete floors, cinder block walls and other unyielding surfaces – without making a big deal of it.

I don’t think that telling him no will help. If he could stop himself, he probably would. Struggling with him over the issue might give him another reason to bang his head: It not only helps him soothe himself but also gets your attention.

Look for opportunities to engage him before he bangs his head. When he is playing quietly by himself, you can help him learn how to prolong his play so he wards off boredom.

Try to protect this quiet time by avoiding interruptions and cutting down on distractions. When he starts to lose interest or to become bored or frustrated, you can move in briefly to help him with what he’s doing or to introduce a different activity.

When he’s ready for a break, cuddle him before he gets to the point of head-banging. Look for sources of tension that you can control and try to minimize them. If you or other family members are under stress, take a break and let off steam.

Help your son focus on his other ways of calming himself, and teach him new ones. Does he like to cuddle with and talk to a stuffed animal? Look at a storybook? Scribble with crayons? Listen to calming music? Or suck his thumb?

At the first warning signs for head-banging, offer an alternative like cuddling or singing with you. If all else fails, you can’t do much more than sit nearby and say soothingly, “I am here and I would like to help but I can’t.”

If a child is otherwise healthy and developing on track, he’s likely to outgrow head-banging. If the behavior persists, there may be a more serious problem. If a parent is concerned that a child’s development is not on pace, it is important to alert the pediatrician as soon as possible. Early intervention can make a big difference for developmental delays and disabilities.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.