Child is afraid of germs

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By Patrick J. McGrath, OC, PhD, FRSC

Question:

My 13-year-old son is really afraid of germs. He avoids anything that might be dirty. He washes his hands if he touches anything. He uses Kleenex to touch most things. He hides it most of the time but I know he worries a lot. I think it started with the SARS thing a few years ago. Every story of a new infection makes him more worried.

Dr. Pat responds:

Fear of contamination by germs is a common phobia. If he were just a bit of a clean freak, there is nothing that I would do about it. But it sounds that he is more than just cautious about being clean.

Washing hands several times a day is a good idea. Infection control specialists suggest that we hand wash:

after using the bathroom
before fixing food
before eating
after touching animals
when hands are dirty
more often when someone in the home is sick

However, his germ fear is unreasonable and seems to be interfering with his life. It is wise to help him overcome this fear. Over time, he could become a prisoner in his own home.

The best way to overcome any fear is to be exposed to what we fear and not escape from it. Over time, we realize that it won't hurt us. Gradual exposure is best.

This treatment is easier said than done. Most people avoid exposure to what they fear. When they are exposed, they try to escape. Avoidance and escape only strengthen fear.

Most fears have a "grain of truth." It is natural to focus on this. The need to wash hands to prevent infection is the "grain of truth" in your son's fear.

Together with your son, make a list of his feared situations. Have him rate each one on a 0 to 100 scale, with 0 being no fear and 100 being terror. Some examples might be something like this:

10: touching a wooden chair in my own home with bare hands
20: touching the kitchen counter that I didn't see washed right before
50: picking up a ball that the dog has had in his mouth
70: getting hands dirty in the garden
80: emptying the garbage from the bathroom or kitchen
100: touching a public bathroom door handle with bare hands

Each person's list would be different.

It is best to have 15 or so items on the list. They should be spread out across the levels. The list can be changed as the fear changes.

Then his task is to work his way through the list from the least feared to the most feared. First he should imagine doing these and imagine not washing his hands for five to 10 minutes.

He can practice saying things to himself like: "I can do this without getting sick. Germs are not all bad. They help build my immune system."

Then, he should start going through the list in actual life without washing his hands for five minutes afterwards. So, on the list above, he would purposely touch a chair and not wash his hands for at least five minutes. When that became possible, and it might take three or four times practicing it, he would do the same with the dog-slobbered ball and so on.

Over time, the goal would be that he not wash his hands at all, for those things that don't need hand washing. It is not a good idea to wash your hands every time you touch a chair, table, or doorknob.

He will likely need your encouragement. It will take several weeks of daily practice. He may have to get help from a mental health professional to get through this.

Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. He is also the CEO of the Strongest Families Institute, which provides mental health care to families across Canada.