I’m a pediatrician who studies youth self-harm. Here’s what parents should know | Canada Voices

Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.

Few things shake a parent like suspecting their child is hurting themselves. In my practice, I see parents swing between fear (“Is this suicidal?”), guilt (“How did I miss this?”) and worry about saying the wrong thing (“What if I make things worse?”). I always tell families the same thing: Self-harm is more common than many people realize, it usually signals a young person is overwhelmed and a calm response is one of the most protective first steps.

When clinicians say “self-harm,” we mean intentional injury to one’s own body (for example cutting or burning oneself) used to cope with intense feelings, stress, numbness or harsh self-criticism. It isn’t the same as a suicide attempt – but the two can overlap, and self-harm tells us a teen is struggling. I encourage parents to take it seriously, even if their child minimizes it.

We’ve been seeing rising rates of self-harm among youth in Canada and elsewhere. In research I’ve led, we have reported a 3.5 per cent annual increase in the rate of youth self-injury from 2000 to 2024 across multiple countries – that represents more than a doubling of the rate over the last 25 years. It isn’t limited to one “type” of teen or family – I see it across the board. The drivers are complex, but often include higher stress, social disconnection, barriers to timely mental-health care, and, for some youth, online exposure that can normalize self-injury.

Whatever the reasons, the goal isn’t to solve this in one conversation. It’s to reduce shame, keep connection open and match the next step to the level of risk. Here are a few practical starting points.

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How to recognize possible signs of self-harm

Some teens will tell you directly. Others hide it because they feel embarrassed, fear being judged or worry they’ll get in trouble.

If you notice your child has unexplained or repeated injuries, wears long sleeves in warm weather, has blood on their clothing or bedding, or spends long periods locked in the bathroom or bedroom, it may be time for a gentle check-in. Changes in mood, sleep, school performance, friendships or social withdrawal can also signal they’re struggling. None of this proves self-harm – but it’s enough to start a conversation.

How to talk to your child (and what to avoid)

I often suggest parents start with the goal of understanding, rather than interrogating. Choose a calm moment (such as a walk) and share what you’ve noticed: “I’ve noticed you’ve seemed really overwhelmed, and I saw some marks. I’m not mad – I’m worried. Can you help me understand what’s been going on?” Keep your voice steady and ask open-ended questions.

Many teens describe self-harm as a way to manage emotional pain or release tension. You don’t have to agree with the behaviour to validate the feeling: “That sounds really hard. I’m glad you told me.” If they shut down, leave the door open for them to talk to you when they feel ready. Anger, ultimatums or punishment usually backfire by increasing shame and secrecy. Instead of graphic details, ask about the urge: “What was happening right before? What helps, even a little?”

When to seek mental-health support and what help can look like

I think of self-harm as a signal that a teen’s coping strategies aren’t keeping up – and that families may need backup. I suggest seeking mental-health care when self-harm is recurring, urges are escalating, or it’s happening alongside anxiety, depression, eating concerns such as changes to appetite, substance use, trauma or big drops in day-to-day functioning.

Therapy often focuses on emotion regulation (e.g., cognitive behavioural therapy or dialectical behaviour therapy) and safer ways to ride out urges. Your family doctor or pediatrician can help with screening, discuss medication when appropriate and co-ordinate referrals. Schools can sometimes help with accommodations and a support plan for rough moments.

Looking for a therapist? Here’s a guide to getting started

When to seek urgent medical care

In my practice, I tell parents to treat physical injuries like any other medical issue: Seek urgent care if bleeding won’t stop, a wound may need stitches or there are signs of infection. And of course, go to the emergency department right away for overdose, severe intoxication or any immediately life-threatening situation.

Even when the physical injury is minor, it’s important to consider suicide risk. Be aware of possible signs, for example, if your child talks about wanting to die, seems hopeless, withdraws suddenly or you feel they may not be safe, and ask plainly about suicidal thoughts. Asking doesn’t put the idea in their head; it makes it easier for them to answer honestly. If you think there’s immediate risk, take them to the nearest emergency department or call 911. If you’re unsure what level of help is needed, contact your child’s doctor or local crisis services.

Prevention at home: Focus on connection, not perfection

Parents often ask me, “How do I make sure this never happens again?” or “How can I prevent it in the first place?” We can’t control every moment of a teen’s inner life, but we can help build protective factors: consistent routines (especially sleep), regular one-on-one connection and a home culture where feelings are allowed – even the messy ones.

If self-harm has happened, I encourage families to make a simple plan for when urges spike, including who your child can reach out to for support, where they can go to feel safer and a few coping strategies (such as squeezing a rubber ball really hard, listening to loud music, or writing or drawing on a piece of paper about what has made them upset and then scrunching it up) that help the urge pass. It is also reasonable to reduce easy access to items your child has used to hurt themselves. Frame this as a safety issue rather than punishment: “I’m doing this because I love you and I want you safe while we get you more support.”

It’s also worth asking – without judgment – what your child is seeing online. Some content can increase urges or normalize self-harm. A collaborative approach is often more effective than a sudden crackdown: Talk about what leaves them feeling worse, review privacy settings together and consider boundaries around late-night scrolling.

A final word for parents

When a child is self-harming, parents often feel they have to carry it alone. In my experience, bringing in support early helps. Start with your child’s primary care provider and a shared approach among caregivers.

If you’re a young person reading this: You deserve support, and help is available. In Canada, parents and young people can call or text 9-8-8, the national Suicide Crisis Helpline, which is available 24/7 in English and French. Another resource is Kids Help Phone, which provides confidential, around-the-clock mental-health support online for kids, teens and young adults.

Dr. Natasha Saunders is a pediatrician and clinician-investigator at the Hospital for Sick Children (SickKids) and an associate professor at the University of Toronto. Her research focuses on child and adolescent mental health and injury, with a particular interest in self-injury and youth well-being.