Self-harm in primary school-aged children

Introduction

Self-harm in primary school-aged children is a growing issue of concern. Evidence suggests that increasing numbers of children are engaging in self-harm behaviours, with a greater than three-fold increase in the rate of intentional self-harm hospitalisations among females aged 14 years and under between 2008 and 2023 (Australian Institute of Health and Welfare, 2025).

Self-harm refers to deliberately causing physical injury to oneself to cope with distress or intense emotions (Headspace, n.d.). Self-harm may also be defined as an intentional, non-fatal act of self-poisoning or self-injury (Geulayov et al., 2022). It includes behaviours such as self-battering, cutting, choking/hanging, scratching, jumping from heights, hair pulling, head banging, reckless behaviour (e.g. running onto the road), restricting food intake and self-poisoning (Borschmann et al., 2020; Geulayov et al., 2022; Townsend et al., 2022; Townsend et al., 2024).

Researchers also commonly use the term ‘non-suicidal self-injury’ (NSSI) to describe most self-harm behaviours (DeVille et al., 2020; Simundic et al., 2024). However, the term NSSI does not usually include deliberate self-poisoning in its definition (Borschmann et al., 2020).

Self-harm in primary school-aged children is associated with long-term negative health outcomes, including ongoing and sustained mental health challenges and substance use issues (Headspace, n.d.). Self-harm behaviours are also a risk factor for suicidal ideation and suicide (DeVille et al., 2020; Krysinka et al., 2020; Paul & Ortin, 2019). Therefore, it is important that practitioners are aware of the signs and symptoms of self-harm among children in order to provide appropriate support to children and their families.

This short article summarises the research on self-harm behaviours in primary school-aged children. It discusses the prevalence of self-harm and the factors associated with self-harm behaviours among primary school-aged children. Some practice considerations for how to support children engaging in self-harm behaviours are also provided.

How common is self-harm among younger children?

Understanding how common self-harm behaviours are in primary school-aged children is challenging. This is partly due to the difficult or confronting nature of the topic and subsequent under-reporting by children and/or parents (Townsend et al., 2024). For example, children may not tell their parents about their self-harm behaviours because of shame or fear of consequences; parents may also feel shame, embarrassment or fear their children being removed if they report the child’s self-harm (Geoffroy et al., 2022; Townsend et al., 2024).

The prevalence of intentional self-harm behaviours in young children and pre-teens is difficult to accurately measure (Torok et al., 2023; Townsend et al., 2022). A systematic review of international studies published between 1980 and 2018 that focused on self-harm and suicidal behaviours among children age 12 years and younger estimated that 1.4% had self-harmed (Geoffroy et al., 2022). The review authors noted that there are several key limitations to the current evidence, which include the variation across studies in the terminology, measures and items used to assess self-harm behaviours, as well as the quality and size of studies.

Although we have limited knowledge of how common self-harming behaviours are in school-aged children, researchers have suggested that some children may be more likely than others to engage in self-harm behaviours. For example, it has been suggested that there may be a higher risk of self-harming behaviours among:

• children experiencing child abuse and neglect (Paul & Ortin, 2019)
• children from families experiencing financial disadvantage (Deville et al., 2020)
• gender diverse children (Headspace, n.d.; Townsend et al., 2024)
• Aboriginal and Torres Strait Islander children (Headspace, n.d.)
• neurodivergent children (Headspace, n.d.).

What factors are associated with self-harm behaviours in children?

Emerging research suggests that there are several interrelated factors associated with self-harm behaviours in primary school-aged children. These factors are not necessarily direct causes of self-harm behaviours, nor do they mean a child will self-harm if the factor is present. However, they have been identified as indicators or risk factors for self-harming behaviours in primary school-aged children. These factors include:

• Bullying: There is an association between bullying (e.g. social exclusion, isolation, teasing and cyberbullying) and self-harm behaviours among children (Borschmann et al., 2020; Headspace, n.d.: Townsend et al., 2022; Wilson-Lemoine et al., 2024). For example, a study of Australian children aged 11 to 12 years found that those who reported being bullied were 24 times more likely to have self-harmed (Borschmann et al., 2020).
• Peer relationships: Having few friends or having difficulties with peers is associated with self-harm behaviours. An Australian study of children aged 11 to 12 years found that children who had few friends were seven times more likely to self-harm (Borschmann et al., 2020).
• Mental health: Mental health has been highlighted as both a factor contributing towards self-harm behaviours (Geulayov et al., 2021), as well as an outcome of self-harm behaviours (Borschmann et al., 2021). Borschmann and colleagues (2020) found in their study that depressive and anxiety symptoms were more present in children who had self-harmed than those who had not. They also found that children who had self-harmed were seven times more likely to experience depressive symptoms and five times more likely to experience anxiety symptoms.
• Family factors: There is an association between familial conflict and self-harm behaviours in children (DeVille et al., 2022; Geulayov et al., 2021). For example, in Geulayov and colleagues’ (2021) English study of children aged under 12 years presenting to hospital for self-harm behaviours, relationship problems with family was the most commonly reported problem preceding self-harm.
• Gender: The evidence on the relationships between gender and self-harm in children is currently mixed and/or contradictory. A systematic review of studies on self-harm by children found no relationship between gender and self-harm behaviours. However, other studies have found some differences in behaviour associated with gender (DeVille et al., 2020; Geulayov et al., 2021). For example, research by Geulayov and colleagues (2021) found that between the ages of 5 and 10 years, boys were more likely to present to hospital for self-harm, but girls were more likely than boys to self-harm once they reached 11 to 12 years of age.
• Trauma, maltreatment and child protection history: There is evidence to suggest that children who have been exposed to child maltreatment, in particular physical abuse, are more likely to self-harm than children who have not experienced maltreatment (Paul & Ortin, 2019). In the same study, the authors found that children who had experienced maltreatment and had attention difficulties (e.g. sitting still or concentrating, impulsiveness, or inability to complete tasks) were at a higher risk of self-harm behaviours.

Practice considerations for supporting children who engage in self-harm behaviours

Based on the limited research evidence available on the most effective ways to support and respond to young children who self-harm, we have provided some practice considerations for people working with children who have used self-harm behaviours or are at risk of engaging in these behaviours.

• Screen younger children for self-harm behaviours (Ayer et al., 2024; Townsend et al., 2024). During consultations with children who have existing mental health conditions, are in contact with child protection and/or youth justice, or who have other engagements with child and family services, practitioners may wish to raise the issues of self-harm and suicidal ideation in developmentally appropriate ways. For example, using art (e.g. giving children the opportunity to draw) when talking about self-harm (Townsend et al., 2024). Further, it may be beneficial to assess self-harm risk with children directly rather than relying solely on information from parents (Deville et al., 2020).
• Consider providing the child’s parents/caregivers with knowledge and skills about self-harm behaviours. Parents play a central role in protecting against self-harm behaviours in children and in responding to and supporting children who have already practiced self-harm (Burke et al., 2023; Townsend et al., 2024). Providing parents with support and reliable, accessible information about self-harm can help them better support their children.
• Understand self-harm behaviours to be a form of communication from the child. A child who self-harms is, in many cases, communicating that they need support. Practitioners may find it useful to ask children how they would use words to express how they are feeling. Practitioners can then begin to explore the underlying needs, emotions and motivations driving the behaviour (Kemperman, 2025).
• Seek to listen and understand children’s experiences. It is important to not judge children’s self-harming behaviours but rather to actively and respectfully listen to them, explore any problems they may be experiencing and seek to understand how these problems may contribute towards any sense of despair and/or distress. Practitioners may also want to explore strategies that children are already using to cope and how well these strategies are working for them. These conversations can include parents’ perspectives of their child’s experiences. These practices position professionals to better support children and address self-harming behaviours (Emerging Minds Learning, 2024).
• Explore using existing interventions aimed at preventing and reducing self-harm in adolescents with younger children (Borschmann et al., 2020). Given the lack of interventions for younger children, some of the strategies and techniques of interventions for adolescents may be beneficial. These may include strategies outlined in some of the additional resources listed at the end of this article, such as the Royal College of Psychiatrists resource, which provides information and strategies for managing self-harm behaviour.

How this resource was developed

This article summarises evidence and literature from a review of peer-reviewed academic and grey literature on self-harm behaviours in primary school-aged children. The author acknowledges the input of Dr Mandy Truong, Dr Stewart Muir and Amanda Kemperman.

Related resources

From Emerging Minds

Understanding and supporting children who self-harm: Giving them a voice

This podcast episode hosted by Amanda Kemperman with Dr Lyn O’Grady (community psychologist) and David Newman (narrative therapist and social worker) discusses recognising and responding to self-harm behaviours in children.

Understanding and responding to childhood suicidal ideation

Presented in partnership with the Mental Health Professionals Network, this webinar is the first in a two-part series on understanding and responding to childhood suicidal ideation. The webinar is facilitated by Amanda Kemperman and panellists include David Newman, Dr Lyn O’Grady and Arianne Coad.

Understanding and responding to childhood suicidal ideation: A case scenario

Presented in partnership with the Australian Institute of Family Studies, this webinar is the second part of a two-part series that discusses understanding and responding to childhood suicidal ideation. The webinar is facilitated by Amanda Kemperman and panellists include David Newman, Dr Lyn O’Grady and Arianne Coad.

Understanding and responding to childhood suicidal ideation

This online course from Emerging Minds is for practitioners who work with children who are experiencing distress, sorrow and despair and may experience suicidal ideation.

From other organisations

Understanding suicide, suicide attempts and self-harm in primary school aged children | Headspace
This evidence summary provides a background to suicide, suicide attempts and self-harm in primary school-aged children.

Self-harm: What you need to know about self-harm | Headspace
This fact sheet provides a brief summary of self-harm behaviours in young people. It includes information on what self-harm is, why it occurs, how to seek help and ways to provide support.

Coping with self-harm: A guide for parents and carers | Orygen

This resource has been developed for parents and families. It provides information on self-harm behaviours, reasons for why these behaviours may be occurring and ways to support a child who may be self-harming.

Suicide and young children | Australian Psychological Society

This article by Dr Lyn O’Grady discusses suicide and younger children. It provides information on children’s understanding of suicide, models of suicidality, the role of psychologists and what can be done.

Self-harm in children and young people | Royal College of Psychiatrists UK

This resource has been written for children, young people, parents and carers. Although it was written for a UK-based audience, this is a helpful resource. It contains information for children and young people on what self-harm is and why it happens, as well as information for parents and carers who have a child that may be self-harming.