Are you constantly catching your kid chewing on their fingers when nervous or bored? Do you notice they have ragged, tender-looking cuticles, or that they hide their hands when they think others are looking at them? If so, you may wonder how to stop your child from nail biting—and how much to push the issue.

Often nail biting—or its fancy medical term, onychophagia—is a harmless habit. However, excessive nail biting can cause infection or damage to the skin or teeth. Sometimes, it can even be a red flag for a mental health concern. We spoke with three pediatricians to better understand why kids bite their nails and how to help them stop.

Why Kids Bite Their Nails

Nail biting is a common habit, especially among kids. About half of kids bite their nails at some point during childhood.

Just as no two kids are alike, children bite their nails for different reasons. Some of the most common triggers for kids are:

• Anxiety: “Because it’s a repetitive habit, it may be a self-soothing behavior,” says Kimberly Montez, MD, MPH, assistant professor of pediatrics at Wake Forest School of Medicine and associate director of Integrating Special Populations for the Maya Angelou Center for Health Equity.
• Boredom or restlessness: Some kids have trouble sitting still or paying attention for long stretches. Nail biting is a quiet physical activity and provides sensory feedback that some children crave.
• Perfectionism: Some research suggests that people prone to planning and working at tasks for longer than others are more likely to bite their nails.
• Personal preference: “Sometimes it’s purely cosmetic,” says Antwon Chavis, MD, assistant professor of pediatrics at Oregon Health & Science University. “Some kids really like having short nails.”

When Nail Biting Is a Problem

Nail biting is typically harmless for kids. However, in some instances, it can lead to health problems or be associated with self-esteem or other mental health issues.

Infections

When done to excess, nail biting can damage a child’s cuticles or surrounding skin. Because the mouth carries a lot of germs, nail biting is a risk factor for paronychia, a skin infection around the nails.

“If the skin around the nail is red, painful, or has a discharge, your child should be evaluated by their pediatrician,” says Dr. Montez.

The nails can also be a vehicle for pinworms—tiny, thread-like parasites that grow in kids’ intestinal tract and lay eggs in the anal region while they sleep. Microscopic pinworm eggs can spread through shared bedding or toys.

“If kids play in the dirt a lot, there’s also the opportunity to get parasitic infections from eggs that may be in the dirt,” says David Hill, MD, adjunct assistant professor of pediatrics at the University of North Carolina School of Medicine and author of Dad to Dad: Parenting Like a Pro.

Dental problems

The fingers aren’t the only part of the body subject to nail-biting injuries. The force of biting down hard enough to break or tear a nail can impact children’s teeth.

Research shows that nail biting may contribute to gum and tooth root damage. People who bite their nails tend to have poorer dental hygiene as well.

Mental health issues

Often, kids are self-conscious about their nail-biting habit. Grown-ups or classmates may have noticed that their hands are often in their mouths. They may not like how their fingernails look ragged or their cuticles red and inflamed.

Lastly, nail biting can be a sign of depression or anxiety. “If a child is experiencing pain or discomfort from biting their nails, but they do it anyway, they may be trying to tell you that they have some anxiety that biting their nails is providing relief for,” says Dr. Chavis.

How To Stop Your Child From Biting Their Nails

Most nail-biting habits wane with time. Over 75% of teens prone to nail biting will stop by age 35.

“A lot of kids stop biting their nails as they age and start to look around and see that other people aren’t doing it,” says Dr. Hill.

If not? Parents should never be punitive or insulting about their kid’s nail-biting habits. “Often, calling attention to the behavior, especially through ridicule or punishment, will cause it to worsen,” says Dr. Montez.

Here are a few ways to help stop your child’s nail-biting habit.

Help them become aware of the habit

Dr. Hill explains most people are unaware of their habits, so the first step is bringing it to your child’s attention. One way to do this is by sitting your child in front of the mirror as they bite their nails and saying, “This is what it looks like and feels like when you’re biting your nails.”

Or, if your child is old enough, you can ask them about their nail biting. “When you gently bring it to their attention, you can say, ‘Do you feel better when you do that? Or are you just bored?'” says Dr. Chavis. “Kids can give very insightful answers to simple questions.”

Use the power of distraction

You can also try focusing your child’s energy on something else. For example, instead of biting their nails, they may hug a doll, play with a fidget spinner, squeeze a stress ball, or snap a rubber band.

“Every time you notice them trying to bite their nails, you remind them that they have a different, more acceptable habit to pursue instead,” says Dr. Hill.

Use positive reinforcement

Remember to give positive reinforcement along the way. For example, “You may say, ‘Oh, I like how you remembered to squeeze your stress ball just then,’ or ‘I love how your nails are growing right now. It looks like you haven’t bitten them in a little while,'” says Dr. Hill.

Perhaps, if you notice that your child is not biting their nails while watching a show, you can tell them they can watch one more episode as a bonus. Or, you can offer to give them a gentle hand massage or a manicure if they can keep their habit under control.

Look for stressors that may be causing nail-biting

For some kids, nail-biting may be a coping mechanism for dealing with stress. It is important to know if something is upsetting your child and help them find healthy solutions.

Don’t hesitate to bring up your child’s nail biting habit, especially if it’s causing physical or emotional harm, to their health care providers. Pediatricians, dentists, and mental health professionals should all be able to offer ideas for getting your child’s nail biting habit under control.