Hand Washing

Q & A

Q. My child has had some issues with feeling anxious and it usually shows up in behaviors like asking a lot of questions and hand washing. He seemed to be doing pretty well, then COVID hit. He’s washing his hands constantly. They are becoming red and dry, like in the past when his skin would crack and become very irritated. Telling him to stop doesn’t work. Making a rule about hand washing hasn’t worked. Explaining why so much washing is not good doesn’t work. His mother and I don’t know what else to do.

A. This is a very common question, and you are not alone especially since COVID.

Convey Hope

It’s very true that some children will move through this phase, sometimes in weeks, sometimes in months and sometimes it will ebb and flow over a year or more. When we feel like we have failed at helping our child solve the problem, we tend to give up and just worry. But in my professional experience, it is more common for the issue to fall away and at worse, be an occasional nuisance, than for it to continue to get worse and progress into a debilitating Obsessive Compulsive Disorder that impacts their future. Therefore, it is fine to tell your child, “Ah, yes, I see you are feeling this pressure to wash your hands a lot. That happens to a lot of people. You will get through it and we will help you.”

Insight

Ask your child to tell you what they are experiencing, what it is like for them, what are they thinking. Don’t interrupt, don’t help, don’t try to fill in the blanks, just let them express. If they have only have a basic statement like, “I don’t know. I just feel like I need to wash my hands.” You say, “What else?” or, “Tell me more.” If they still have nothing, tap into your English class lessons; who, what, why, where, when. Don’t try to interpret or help clarify. You want to send your child the message that they are very smart and very resourceful. You can say things like, ” Wow, you already know a lot about this.”

Science

After the “insight” discussion, it is a good time to make sure the nuts and bolts of immunity are understood. Obsessive, compulsive behaviors are tricky in that there is enough truth to make the worry feasible; germs could cause death, curling irons left on could burn the house down, going out of your lane could result in a motor vehicle fatality. At the same time, people who struggle with obsessive, compulsive behaviors often understand that their actions are incongruent, over-the-top responses to the risk or threat. Children who do not understand that their body is already equipped with germ fighting mechanisms, may benefit from education. An internet video search for this topic will bring up quite a few results. The vocabulary and science facts aren’t important. You just need the basics of germs entering the body and the “good guys” attacking the “bad guys.” (Someone should make a video game of this!) Here’s an example.

Minimize Stress

The compounding effect is when multiple factors collide to create a bigger problem than would be present if there were just one factor. There could be a family predisposition to anxiety, a child picking up on a parent’s anxiety or unhappiness, other stressors in the family that the child is being impacted by. Mom and Dad, guardian, grandparent – whomever the adults are that the child lives with, need to raise their awareness about stressors in their family environment, and/or raise their action in working toward mediating the stressors they already know about. Pay attention to what you are discussing in front of the children, news and other things you can control so that the child doesn’t take on this stress.

Boundaries

If the child recognizes that their hand washing is interfering with their life or happiness, that’s great. They are going to lead the plan to solve the problem. If they do not recognize it, the parents will have to establish a boundary. This boundary isn’t punitive, but more like expected guidelines. You may be able to tell the child,

“Look, we can’t have your hands cracking and opening you up to more risk. Here’s what you can do. When you wash your hands, go ahead and use a little soap and warm water, but rub your hands together lightly, not vigorously. Barely touch your hands to each other. Pat your hands dry. Do not rub them roughly with a towel. We’ll have a look at your hands in a few days and see if this is helping.”

or, make a check-list, “Before you wash your hands, ask yourself;”

  • When was the last time I washed my hands?
  • Have I done anything since last washing my hands that necessitates me washing my hands now? Used the bathroom, blew my nose, etc.
Empower

Parents I meet are constantly thinking they have to solve every problem. You don’t. Ask your child, “After all of the things we have talked about, which ones do you like the best and how can I HELP you.” This is a child-centered/child-developed plan with parent support. Every time we “fix” it for them, they learn to be more helpless. Don’t steal their thunder! Let them start to problem solve.

Faith

Sometimes, we cannot understand the origin of a problem or how to fix it. For example, someone who experiences migraine headaches with no known origin, ultimately, has to learn to manage this pain the best they can. But we all have faith. Whatever your faith, or if you are not sure, seek it, learn about it, practice it. You may find comfort there and relief from pain. Post words of encouragement, scriptures, inspirational quotes, affirmations in every room. Fill your soul with love, hope and encouragement.

Making a New Path in the Brain (more science)

You may not be familiar with the term “neuroplasticity” but for children who have learned mindfulness in school, they may be. Basically, this means that we can rewire the brain with our thoughts and actions. We can make a new path, a calm path. We must develop this path when we are in a non-anxious state, so that when the anxious feelings emerge, we can hop quickly from the anxious path to the calm path.

Just like muscles. We can bench press 200 lbs when we never even bench pressed 50. You must build those muscles. We can’t hop on to a calm path in the brain if that path hasn’t been laid yet.

For more info on Neuroplasticity (Rewiring the Anxious Brain, Emma McAdam.)

For more info on mindfulness for kids, click here.

The Actual Plan

Again, if possible, keep your child in the driver’s seat and you remain a passenger. Have the child write it down (or assist with a pictograph for pre-readers). Keep it simple. Schedule a follow up to review and fine tune the plan, and to celebrate success!

Other Considerations

There may be dietary or lifestyle changes that can be made that will be a part of the solution; minimizing electronic time/screen time, getting more exercise, burying oneself in a book, etc.

Medication and/or supplements. Notice I include this part last. Persistent symptoms of anxiety deserve a conversation with your child’s pediatrician. Considering medicating a child is a serious decision and should be treated that way. Both parents’ (even in the case of separation or divorce), opinion should be expressed openly and questions should be discussed thoroughly, such as, side effects, length of time on the medication, what would your child be told about the medication, and others.

Be careful about labels. I have seen far too many teens and adults who have identified themselves as having “mental health issues,” a concept which is most often follow by, “I can’t…”, “I’m not good at that because…” There is nothing wrong with talking about “feeling anxious” vs. “I have an anxiety disorder.”

I invite you to comment with suggestions that have been helpful in your life.

Have a question for Tracy? Ask it here!