Skin Picking or BFRB

If your child with a PDA profile picks at their skin, you are definitely not alone.

Skin picking can be incredibly difficult to watch—especially when it leads to sores, bleeding, scabs, or scars. And the more we tell them to "stop picking," the more difficult it can sometimes become.

So what is actually going on?

🌸 Why Might a PDA Child Pick Their Skin?
For some children, skin picking can be a way of managing stress, anxiety, overwhelm, or dysregulation.

A child may pick when they are:

• Feeling anxious or worried
• Overwhelmed by demands
• Bored or under-stimulated
• Tired or dysregulated
• Seeking sensory input
• Trying to soothe themselves
  
• Experiencing a strong urge that is difficult to resist
  

**It’s also worth knowing that some medications can increase or worsen skin picking. If you notice a change after starting or adjusting a medication, talk with your doctor about whether it could be contributing.

🌸 You May Hear Different Names for It
Depending on the reason behind the behaviour, you may hear terms such as:

Skin picking – the everyday term most parents use.

Excoriation disorder – the clinical term used when recurrent skin picking causes significant damage or distress and becomes difficult to control.

Body-focused repetitive behaviour (BFRB) – an umbrella term that can include behaviours such as skin picking, nail biting, or hair pulling.

Sometimes skin picking can also look OCD-like, particularly when a child feels driven to remove an "imperfection" or feels unable to leave a scab alone.

These terms can overlap, but they aren't necessarily interchangeable. The important thing is understanding what is driving the picking for your individual child.

🌸 What Can Help?
There isn't one solution that works for every child.

You might try:

Reduce the stress:
Look at what is happening around the times your child picks. Is there a particular demand, transition, or situation that seems to trigger it?

Provide something else to pick:
Fidgets, putty, textured toys, fabric, or other sensory activities can give busy hands something safer to do.

Protect the skin:
Bandages, hydrocolloid patches, clothing, or other protective coverings can help prevent picking while wounds heal.

Keep hands busy:
Drawing, crafts, Lego, sensory activities, or even playing with a pet can sometimes help redirect the urge.

Avoid constant reminders:
Repeatedly saying "Stop picking!" can increase attention, anxiety, or the sense of demand. Try a gentle redirection instead.

💗 Most importantly...
Skin picking isn't something a child necessarily does because they "won't stop."

Sometimes their body is trying to regulate something their words can't express.

Instead of only asking:

"How do I get them to stop?"

Try asking:

"What is their body telling me?"

💗 Understanding the reason behind the picking can be the first step toward finding a safer and more supportive way to meet that need.