Tuesday 23 January 2018

Dear David Coleman: My four-year-old has a fear of germs and is constantly washing her hands - what can I do?

Clinical psychologist David Coleman
Clinical psychologist David Coleman
Use empathy and distraction to focus her on something else other than the repeated hand washing
David Coleman

David Coleman

Clinical psychologist David Coleman offers parenting advice in his weekly column.

Q. I'm having a hard time with my four-year-old, who has developed a complete germ-phobia. She is almost obsessed with washing her hands. I don't want to label her, but I have huge fears for her mental health down the line. If she feels there are germs on her hands, and I've told her there aren't and that she isn't allowed to wash her hands again, she goes into a screaming meltdown, which can last up to 40 minutes. My fear is that I'll cause irreparable damage by not dealing with her appropriately. Any help would be welcomed greatly.

David replies: Even though you say you don't want to label her, I do wonder what label you think might apply to her? Perhaps you are thinking about something like Obsessive Compulsive Disorder (OCD)?

OCD is an anxiety disorder in which children - or teenagers or adults - end up with recurring and intrusive thoughts (obsessions) or repetitive behaviours (compulsions). Typically, the obsessions or compulsions are the child's way of trying to reduce anxiety.

A child might have a fear that something very bad will happen to them or to someone else if they don't repeat a certain behaviour or don't carry it out in a certain way - like washing their hands in a particular way, or a particular number of times.

Your daughter may well have a developed an irrational fear of germs and their potential dangerousness, but it doesn't seem to me to yet fall into the category of OCD.

Have you any idea where this fear of germs may have come from? Often children's fears develop after seemingly innocuous comments of others. For example, you, or a pre-school teacher, or even a friend may have said something about needing to keep your hands clean to stop the spread of germs.

This may have been in the context of being in contact with a child with a cold, or after playing out in the garden or some other very normal and commonplace situation.

For whatever reason, your daughter may have taken such a warning to heart. As she has tried to process this kind of admonition, she has probably over-estimated both the amount of germs she carries on her hands and the potential dangerousness of those germs.

This is easily done. Many parents will have had similar experiences, for example when their eldest children put things in their mouths when they were babies. Parents fear that the child will get sick. By the time we have had more children we have come to learn that babies are quite robust and we worry less about them chewing on things that may have been on the floor.

Experience, in that example, allows us to moderate and change our perception of risk. Children need to have the same opportunity.

However, the best way for you to approach your daughter is to empathise with, and name, her fear of carrying germs on her hands. In truth, even after washing normally, she probably does still have some germs on her skin. What we know, as adults, is that any such germs are way less harmful, if not entirely harmless.

Rather than telling your daughter that she doesn't have any germs and isn't allowed to wash her hands, try acknowledging that she might still have germs on her hands and that you could understand that she is worried about that, but that you are confident that she will be ok, even if there are still some germs lurking.

Instead of creating a direct conflict about the fact that she isn't allowed to keep washing her hands, use empathy and distraction to focus her on something else other than the repeated hand washing.

Be warm about the worries that she seems to have and show her your willingness to support her to face those fears. Knowing the source of her worry - whatever she may have heard about germs - may help you to focus your empathy, accurately and target your reassurance of the specific fears she has.

At her age, however, she mostly needs you to be warm and understanding about her worries but confident that those things she is worried about can't harm her.

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