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Pediatric Onychophagia: A Survey-Based Study of Prevalence, Etiologies, and Co-Morbidities

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Abstract

Background

Onychophagia, defined as habitual nail biting, is a common disorder affecting 6–45% of the population and is more prevalent in children.

Objectives

Our primary objective was to determine the prevalence of nail biting in the pediatric population. Secondary objectives were to assess the presence of psychiatric co-morbidities associated with nail biting, and the effect of treatment on nail biting.

Methods

An anonymous voluntary survey was administered to participants at an outpatient academic pediatric clinic at Weill Cornell Medicine. Age, sex, psychiatric diagnosis, treatment sought, family history, and frequency of nail biting were analyzed across 282 enrolled patients aged 3–21 years. One patient was subsequently excluded due to incomplete data.

Results

Of 281 patients, 101 (37%) reported past or present nail biting lasting more than a month. Median age of onset was 5 years old (range 1–13 years). A significantly higher percentage of biters (18%; 19/104) than non-biters (6%; 11/177) were diagnosed with a psychiatric disorder (p < 0.01). Amongst biters, concurrent fingernail and toenail involvement was much less common (12%; 12/104) than that of fingernails alone (88%; 92/104). However, the ratio of fingernail and toenail biters to fingernail biters alone was greater in those with psychiatric diagnosis (0.36) than without (0.09) (p = 0.07).

Conclusions

Our study highlights behavioral patterns as well as familial, psychiatric, and other factors associated with pediatric nail biting. Familiarity with such factors, the clinical presentation of onychophagia, and available treatment options may aid in reducing its severity in affected patients and overall prevalence.

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References

  1. Halteh P, Scher RK, Lipner SR. Onychophagia: a nail biting conundrum for physicians. J Dermatolog Treat. 2017;28(2):166–72.

    Article  Google Scholar 

  2. Bienvenu OJ, Samuels JF, Riddle MA, et al. The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000;48:287–93.

    Article  CAS  Google Scholar 

  3. Pacan P, Grzesiak M, Reich A, et al. Onychophagia and onychotillomania: prevalence, clinical picture and comorbidities. Acta Derm Venereol. 2014;94:67–71.

    Article  Google Scholar 

  4. Wechsler D. The incidence and significance of finger-nail biting in children. Psychoanal Rev. 1931;18:201–8.

    Google Scholar 

  5. Foster LG. Nervous habits and stereotyped behaviors in preschool children. J Am Acad Child Adolesc Psychiatry. 1998;37(7):711–7.

    Article  CAS  Google Scholar 

  6. Magid M, Mennella C, Kuhn H, Stamu-O’Brien C, Kroumpouzos G. Onychophagia and onychotillomania can be effectively managed. J Am Acad Dermatol. 2017;77:e143–4.

    Article  Google Scholar 

  7. Garde JB, Suryavanshi RK, Jawale BA, Deshmukh V, Dadhe DP, Suryavanshi MK. An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children. J Int Oral Health. 2014;6(1):39–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Shetty SR, Munshi AK. Oral habits in children—a prevalence study. J Indian Soc Pedod Prev Dent. 1998;16(2):61–6.

    CAS  PubMed  Google Scholar 

  9. Ghanizadeh A, Shekoohi H. Prevalence of nail biting and its association with mental health in a community sample of children. BMC Res Notes. 2011;4:116.

    Article  Google Scholar 

  10. Lipner SR, Scher RK. Comment on “psychocutaneous disease: clinical perspectives”. J Am Acad Dermatol. 2017;77(5):e141–2.

    Article  Google Scholar 

  11. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  Google Scholar 

  12. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495–9.

    Article  Google Scholar 

  13. Pennington LA. The incidence of nailbiting among adults. Am J Psychiatry. 1945;102(2):241–4.

    Article  Google Scholar 

  14. Leme M, Barbosa T, Castelo P, Gaviao MB. Associations between psychological factors and the presence of deleterious oral habits in children and adolescents. J Clin Pediatr Dent. 2014;38(4):313–7.

    Article  CAS  Google Scholar 

  15. Reyes Romagosa DE, Paneque Gamboa MR, Almeida Muniz Y, Quesada Oliva LM, Escalona Oliva D, Torres Naranjo S. Risk factors associated with deforming oral habits in children aged 5 to 11: a case-control study. Medwave. 2014;14(2):e5927.

    Article  Google Scholar 

  16. Ghanizadeh A. Comorbidity of enuresis in children with attention-deficit/hyperactivity disorder. J Atten Disord. 2010;13(5):464–7.

    Article  Google Scholar 

  17. Ghanizadeh A, Mohammadi MR, Moini R. Comorbidity of psychiatric disorders and parental psychiatric disorders in a sample of Iranian children with ADHD. J Atten Disord. 2008;12(2):149–55.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, 9th Floor, New York, NY, 10021, USA

    James P. Winebrake, Pierre Halteh & Shari R. Lipner

  2. Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA

    Kartikey Grover

Authors
  1. James P. Winebrake
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  2. Kartikey Grover
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  3. Pierre Halteh
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  4. Shari R. Lipner
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Corresponding author

Correspondence to Shari R. Lipner.

Ethics declarations

Ethical approval and consent

Ethics approval was obtained from the Weill Cornell Medicine Institutional Review Board prior to enrolling study participants, and the study adhered to the tenets of the Helsinki Declaration.

Funding

Mr. Kartikey Grover, MS, was partially supported by the following grant: Clinical and Translational Science Center at Weill Cornell Medical College (1-UL1-TR002384-01).

Conflict of interest

James P. Winebrake, Kartikey Grover, Pierre Halteh, and Shari R. Lipner have no conflicts of interest to declare.

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Winebrake, J.P., Grover, K., Halteh, P. et al. Pediatric Onychophagia: A Survey-Based Study of Prevalence, Etiologies, and Co-Morbidities. Am J Clin Dermatol 19, 887–891 (2018). https://doi.org/10.1007/s40257-018-0386-1

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  • DOI: https://doi.org/10.1007/s40257-018-0386-1

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