‘Since Covid-19 my son is obsessed with washing his hands’

Question: Even before Covid-19, my nine year old was always a bit obsessed about cleaning and worried about catching colds, etc. Now in the height of Covid, this anxiety has sky rocketed. He obsessively washes his hands many times a day and is reluctant to go out even in the garden.

Yesterday, he got up in the middle of the night to rewash his hands because he was worried that he had not cleaned them well enough before he went to bed. His hands are becoming chapped from all of the washing, though he will rub in moisturiser afterwards which is helping. I am not sure how to help him, because if I challenge him about the washing, or tell him he has done enough, he gets upset and goes on about how he is going to get Covid, etc.

I am particularly worried about his reluctance to go out and I can see his anxiety building about the return to school this week.

Answer: During the Covid-19 crisis, anxiety problems have increased for children and teenagers. With lockdown and school closures many children have developed phobias about going out and others are constantly worried about loved ones catching Covid. Obsessive Compulsive Disorder (OCD) symptoms have increased for lots of children, like your son, who are constantly washing their hands and/or obsessing about keeping safe.

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Managing OCD symptoms is much more complex in the time of Covid-19 when of course there are real public health fears, and regimes of good hand hygiene are important in keeping everyone safe. In helping your son, the goal is to encourage him to follow reasonable hand hygiene while keeping his obsessions and fears contained so they don’t overtake his life. Below are some ideas.

1 Acknowledge his fears as real

Encourage him to openly talk about his fears to you and to let you know what is on his mind. Communicate to him that his worries are completely understandable in the time of Covid and point out that it is a sign of his concern for himself and others. Point out to him that he is one of the good children who are doing the right thing trying to keep everyone safe.

2 Try to agree reasonable hand hygiene standards

Sit down with him and go through what are reasonable hand hygiene and cleanliness standards. Probably the best way to do this is to look up reputable guidelines online (from the World Health Organisation or the Health Service Executive) and to go through these step by step with him. These will include when and where he should wash his hands (eg once before he goes out and once when he gets back in), how long he should wash for (eg 20 seconds) and the best specific technique (there are lots of good videos).

Then try to agree with him that washing his hands for longer or more frequently than these guidelines is too much and a sign that his worries are taking over. He might argue back and you may have to agree a compromise – at least initially until he gets his symptoms under control.

3 Make a plan to manage his worries

Acknowledge that he is likely to feel like washing his hands much more than the guidelines and discuss how he can manage this. For example, he might find it useful to notice triggers that cause the urge to wash his hands (eg touching a surface) and then to identify ways to interrupt this and do something else instead.

It can also help him to identify what thoughts and worries are going through his mind at the time (“That surface is dirty, I might catch Covid”) and then to invite him to challenge his thinking (“The surface was cleaned today”).

Naming his worrying thinking as external to him can be a helpful strategy. When he is overtaken by an urge to clean you can say, “That sounds like OCD thinking, you don’t have to listen to that.” Obsessions and worries are often fuelled by exposure to constant news and statistics about the virus. Limit his exposure to these and instead try to fill his day with enjoyable and creative daily activities.

4 Focus on small steps

Focus on making small steps of progress rather than solving the problem overnight. If he is washing his hands about 20 times a day when the guidelines are recommending five times, set an initial goal of reducing the amount of times he washes so that he slowly begins to take control. When he is fearful of going out, try to agree a short manageable journey in the first instance. Praise and celebrate any signs of progress such as when he goes out safely, even for a short time, or when he successfully resists the urge to overwash his hands.

5 Create a good routine around school

A good daily routine will help him manage his fears and obsessions. Include in the routine lots of exercise and fun relaxing things that take his mind off his worries. Take time to prepare for the return to school and to think through a routine that will work for him and help him feel safe and relaxed. This might include an early bedtime with a period of reading, getting up early for a family breakfast time and then plenty of free time after school to help him unwind. Contact the school in advance to check what hygiene standards they will have (eg distancing, using sanitiser, etc) and go through these with him so he can be reassured about what he needs to do.

6 Reach out and seek help

If his anxiety or obsessions continue, consider seeking help from a child mental health professional. Contact your GP or his school to explore what supports might be available in your area. There are also some good children’s books online on managing anxiety and OCD that might help such as What to do when your brain gets stuck by Dawn Huebner.

– John Sharry is founder of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. He is author of several parenting books including Positive Parenting and Parenting Teenagers. See solutiontalk.ie for details of online courses.