When Your Child Is Self-Harming: How to Respond and What Helps

All through June, in the summer heat, fifteen-year-old Emma kept wearing a hoodie. Her father noticed and decided not to make a thing of it. Then one evening, sorting the laundry, her mother found tissues with dried blood on them in a pocket. Outside Emma's door a few minutes later, heart pounding, she felt every possible reaction rising at once: panic, anger, tears, the urge to pretend she had seen nothing. Finding out that your child is hurting themselves is one of the most frightening moments a parent can face. Self-harm is more common than most parents realize. It is a sign of serious distress, not of bad behavior, and young people do get through it, especially when the adults around them respond with calm and care. This guide explains what self-harm is, why young people do it, how to respond when you find out, and what treatment involves.

At a glance

It is common, and often hidden. The UK's National Institute for Health and Care Excellence (NICE) cites a national study in England in which 7.3% of girls and 3.6% of boys aged 11 to 16 had self-harmed or attempted suicide at some point, rising to 21.5% of girls and 9.7% of boys aged 17 to 19.
It is a sign of distress. The NHS describes self-harm most often as a way to express or cope with emotional distress. Not everyone who self-harms wants to die, but self-harm is clearly linked to suicidal thoughts, so it always deserves professional attention.
It often happens again. In an English study of nearly 4,000 young people aged 10 to 18 who went to hospital after self-harm, more than 1 in 4 self-harmed again during the follow-up period.
There is a therapy with good evidence. A 2021 Cochrane review found that dialectical behavior therapy adapted for adolescents (DBT-A) lowered the rate of repeated self-harm from 43% to 30%. NICE recommends considering it for young people who self-harm frequently and struggle to manage intense emotions.
No checklist can predict risk. NICE advises professionals not to use risk scales or "low, medium or high risk" labels to decide who receives care; every young person deserves a proper assessment of their needs.

What it is, and what it isn't

NICE defines self-harm as intentionally poisoning or injuring oneself, whatever the apparent purpose. It covers a wide range of behavior, from injuries no one ever sees to swallowing medicines, and it may happen once or many times.

A few things it is not:

It is not always a suicide attempt. According to the NHS, many people describe self-harm as a way of coping with feelings that seem unbearable, some even as a way of staying alive. But it is not harmless either: some young people who self-harm are at higher risk of suicide, and NICE notes that a person's reasons can change from one episode to the next. Only a professional assessment can tell you where your child stands.
It is not bad behavior to be punished. The NHS advises treating any amount of self-harm as a possible sign that a young person is feeling extremely distressed, however minor the injury looks.
It is not a phase to wait out. Self-harm can become a pattern, and the problems underneath it rarely resolve on their own. It is worth getting help now rather than waiting.

How it can look at different ages

Young people often go to great lengths to hide self-harm, so signs may be indirect. The NHS lists signs such as:

keeping covered up at all times, even in hot weather;
unexplained injuries, or blood stains on clothes or tissues;
becoming very withdrawn and not speaking to others;
low mood, tearfulness or losing interest in everything;
low self-esteem, such as feeling they are not good enough;
talking about ending things or not wanting to go on, which needs help right away.

What lies behind it can differ with age:

Children under 11: self-harm is less common, but NICE notes it can happen at any age. A younger child who repeatedly hurts themselves when overwhelmed, or who talks about wanting to die, needs a professional assessment just as much as a teenager.
Early teens (11 to 14): problems with friends, family and school are common triggers. An English hospital study found that the problems behind self-harm differ between late childhood and early adolescence, so assessment should take age into account.
Older teens (15 to 18): self-harm is more common in this age group, as the NICE figures show, and it may come alongside depression, anxiety, alcohol or drug use, or relationship problems.

Why it happens

Each young person self-harms for their own reasons, as NICE puts it. The NHS describes reasons such as:

expressing or coping with emotional distress;
relieving feelings that seem unbearable, if only for a moment;
trying to feel in control;
punishing themselves;
responding to intrusive thoughts.

The brief relief is part of why self-harm can become a pattern: the feelings ease for a while, the underlying problems remain, and shame and secrecy often follow. The NHS notes that it is often a build-up of many smaller things rather than one event. Common sources of distress include bullying, pressure at school, arguments at home, low self-esteem, anxiety or depression, grief, and abuse or other trauma. Young people with ADHD or autism may also be more vulnerable.

In an English study of more than 5,600 young people aged 11 to 18 who went to hospital after self-harm, the problems they most often described were social: difficulties in the family, pressure around school and studying, and problems with friends. Naming family difficulties is not about blame. Every family has conflict and hard seasons; the finding shows that relationships are often where both the pain and the repair happen, which is why good care involves the family.

How it is assessed

See a doctor after any self-harm. If there is an injury that may need treatment, or your child has swallowed medicines or anything else, go to the emergency department straight away. Otherwise, make an appointment with your doctor or pediatrician soon; the NHS notes that young people under 18 may be referred on to a children and young people's mental health service.

What happens. NICE recommends a full "psychosocial assessment" by a professional experienced in working with young people who self-harm. Expect questions, some asked to your child alone, about what led up to the self-harm and how they felt afterward; home, school and friendships; social media and life online; alcohol and drugs; whether they think they might do it again; and, calmly and directly, about thoughts of suicide. NICE also asks professionals to consider any safety or child protection concerns.

Not a risk score. NICE advises against using risk assessment tools and scales, or "low, medium or high" labels, to predict who will self-harm again or to decide who gets help, because no tool can predict this accurately. Instead, the professional builds an understanding of your child's situation, what makes things worse and what protects them, and turns this into a care plan made with your child and, where appropriate, with you.

Confidentiality. Teenagers often talk more openly without a parent in the room. Clinicians will usually explain that what your child tells them stays private unless there is a risk to their safety. This protects their trust in treatment.

What you should be given. NICE recommends that families receive information and support: how to cope, what to do if self-harm happens again, how to recognize warning signs and how to help reduce the chance of it happening again. Ask for this if it is not offered.

Only a professional can assess. Only a qualified professional can understand what lies behind your child's self-harm and how much risk they face. Reading about it is a reason to ask for help, not a conclusion.

Treatment: what the evidence supports

Treat what lies underneath. Self-harm is a behavior, not a diagnosis, so treatment also addresses what is driving it: depression, anxiety, trauma, bullying or overwhelming pressure. NICE asks professionals to take any coexisting conditions into account, and states that age or a diagnosis should never be a reason to withhold psychological help.

Dialectical behavior therapy for adolescents (DBT-A). For young people who self-harm frequently and struggle with intense, fast-changing emotions, NICE recommends considering DBT-A. It teaches practical skills for getting through emotional crises without self-harm, managing strong feelings, staying in the present moment, and handling relationships. Programs usually combine individual therapy with a skills group in which a parent often takes part, plus support between sessions. A 2021 Cochrane review of 17 trials with 2,280 young people found that, across four trials, repeated self-harm fell to 30% with DBT-A compared with 43% with other care.

In a 2018 US trial, 173 teenagers aged 12 to 18 who had already attempted suicide and had self-harmed repeatedly received six months of either DBT or supportive therapy. At the end of treatment, about 9 in 10 of the DBT group had made no suicide attempt, compared with about 8 in 10 of the others, and just over half had no self-harm at all, compared with just over a third. Over the following six months, both groups kept improving and the difference narrowed. NICE notes that most of the evidence comes from girls over 12 who had self-harmed repeatedly.

Other therapies. Many young people are offered cognitive behavioral therapy (CBT), family-based work or other talking therapies, and the NHS notes that therapy can involve the family. The Cochrane review found the evidence for these in reducing self-harm in young people still uncertain, which is not the same as evidence that they do not help; they are often the right treatment for problems underneath, such as depression or anxiety.

A safety plan. NICE recommends that the young person and professional write a safety plan together, developed with the family where appropriate and shared with them as the young person agrees. It lists early warning signs, coping strategies that work for them, people and places that help, contact numbers including out-of-hours and emergency ones, and steps to make the home safer.

Medication. NICE advises that medication should not be offered as a treatment for self-harm itself. If your child also has a condition such as depression, a child psychiatrist may recommend medication for that condition, usually alongside therapy; this is a medical decision made with the family.

Recovery takes time. NICE asks professionals to treat each episode in its own right; a setback is not a failure of treatment or of your child.

What helps at home

Pause, then lead with care. Take a breath before you speak; your first reaction shapes what happens next. The NHS advises trying to understand their feelings without judging, rather than focusing on the self-harm itself. "I saw the tissues. I'm not angry with you. I love you, and I want to understand what has been so hard."
Check for injuries and get medical help when needed. Make sure any wound is looked after. If an injury may need treatment, or your child has swallowed medicines or anything else, go to the emergency department straight away, even if they seem fine.
Ask directly about suicide. "Sometimes when people hurt themselves, they also have thoughts of not wanting to be alive. Have you had thoughts like that?" A 2014 review in Psychological Medicine found that asking does not put the idea in someone's head and may reduce suicidal thoughts. If the answer is yes, or you are unsure, get help now.
Make the home safer, without punishment. The American Academy of Pediatrics advises families to restrict access to lethal means, and NICE makes this part of the safety plans it recommends. Lock away all medicines, including over-the-counter painkillers, and sharp objects; if there is a firearm in the home, remove it or store it locked and unloaded, with ammunition locked separately. Explain why, calmly. The NHS warns against trying to force a young person to stop or threatening to take away their control.
Ask what would help, and stay close. The NHS suggests asking how they would like to be supported, letting them know you are there, and reminding them of their good qualities. "When it gets really bad, what helps you, even a little? What could I do?" Ordinary time together, a walk, a meal, a shared show, keeps the connection open.
Work with the school, and look after yourself. NICE recommends that schools make a support plan with the student and family. Shock, guilt, fear and even anger are common reactions for parents; NICE recognizes the emotional impact on families and recommends support for them too. Talk to someone you trust, and see your own doctor if you are struggling.

Myths and facts

"Self-harm means they want to die." Often it is a way of coping with unbearable feelings rather than an attempt to end their life. But self-harm and suicidal thoughts are linked, and intent can change, so always ask about suicide and always get a professional assessment.

"If the injuries are minor, it isn't serious." The size of an injury does not tell you how much pain a young person is in. The NHS advises treating any amount of self-harm as a possible sign of extreme distress.

"Strict rules or punishment will make them stop." Pressure and punishment tend to increase shame and secrecy. What helps is calm connection, a safer home, a safety plan and treatment that teaches other ways through the worst moments.

When to get help right away

Call your local emergency number or go to the nearest emergency department if your child:

has swallowed medicines or any other substance, or has an injury that may need medical treatment;
talks about wanting to die or to kill themselves, or about being a burden;
has a plan, or you find a note or items gathered for that purpose;
says they cannot keep themselves safe;
is very distressed, confused or intoxicated after self-harming.

Stay with your child, and remove anything they could use to harm themselves.

In one sentence

Self-harm is a sign of serious distress, not bad behavior: respond calmly, check for injuries, ask about suicide directly, make the home safer and get a professional assessment, knowing that therapies such as DBT for adolescents help young people find safer ways through.

Sources

National Institute for Health and Care Excellence (NICE), "Self-harm: assessment, management and preventing recurrence", NG225, 2022
NHS, "Self-harm" health information pages ("Why people self-harm", "How to help someone else", "Assessment and treatments"), 2023
Witt K.G. et al., "Interventions for self-harm in children and adolescents", Cochrane Database of Systematic Reviews, 2021
McCauley E. et al., "Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial", JAMA Psychiatry, 2018
Hawton K. et al., "Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Self-harm in England", Journal of Child Psychology and Psychiatry, 2012
Townsend E. et al., "Life problems in children and adolescents who self-harm: findings from the multicentre study of self-harm in England", Child and Adolescent Mental Health, 2022
Dazzi T. et al., "Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?", Psychological Medicine, 2014
American Academy of Pediatrics, "Suicide and Suicide Risk in Adolescents", clinical report, Pediatrics, 2024

General information, not a diagnosis or medical advice. Only a qualified professional can assess a child.