Last Modified: March 15, 2023 | Published: March 9, 2023
Some kids and adolescents have increased anxiety around germs and want to wash their hands frequently.
It is normal and expected for a child to want to wash their hands after using the restroom or before a meal. However, when your child is washing their hands obsessively after every activity, it may be time to help.
Hand-washing is a fairly common compulsion. That is, some kids get obsessed with washing their hands to the point that their hands are cracked and bleeding. In this case, you can try a few strategies at home listed below. Keep in mind, though, that most parents will need help to implement these. Information about professional treatment is provided later in this article.
1. Validate your child’s concerns about germs.
Your child’s hand-washing behavior may be due to a high level of anxiety about germs. As a parent, you may be feeling frustrated and want to tell your kid to stop worrying. It will help your child more if you can validate their feelings. Validating your child’s experience does not mean you agree with the fear. It is letting your child know you heard them.
You can let your child know that it is normal to worry about germs and other seemingly scary things we encounter every day in life. However, it is also possible to pay less attention to those ‘threats’ by focusing on other aspects of our environment.
To validate your child’s experience, try this. Use the 3 R’s.
Resonate: First, simply resonate with your child’s fears. Say something like, “I understand that it can feel scary to be around germs.”
Relate: Next, relate your child’s experience to that of other people. Say, “It is normal to be afraid of certain things, like germs. Most people feel afraid at times.”
Redirect: Finally, redirect your child’s attention to something safe. Say, “Did you notice the cozy fireplace and the furry dog trying to get your attention?” Or you might try, “Remember, you are safe here in our home. Everyone here is healthy and well right now.”
In this way, you are not dismissing your child’s fears as irrational. You are teaching your child that it is normal to have fears but that you have the power to not listen to them.
2. Teach your child to recognize their anxiety about hand-washing.
Generally, compulsive habits are about anxiety. The child feels the anxiety and does the compulsion to push the anxiety away. A cycle begins where the child feels the anxiety, does the compulsion, and the anxiety goes away for a minute. Then, when the anxiety comes back again, the child feels ‘compelled’ to do the behavior again. Anxiety is somatic, which means it is felt in the body. One way to help your child is to share how common anxiety is and what it feels like when it comes up in your body.
You can say, “Oh, here’s that worry bug again. I feel that tingling in my lips and butterflies in my tummy. I can handle it. It is okay for me to let anxiety come in and pass through. Just like a cloud, I let my worries come and go.”
Gently teach your child that pushing away one’s fears with compulsive behavior does not really help. Instead, your child can learn to recognize the anxiety and use a strategy to calm down in the face of it.
Reading a story such as Please Explain Anxiety to Me! by Laurie Zelinger can help your child understand the biology of anxiety. If your child is a little older, a great resource is Outsmarting Worry (An Older Kid’s Guide to Managing Anxiety) by Dawn Huebner.
3. Teach your child that intrusive thoughts about hand-washing are like brain spam.
When your child has a compulsive need such as hand-washing, it is like a spam message. Spam, such as the messages we get in our inboxes, is annoying and ‘intrusive.’ If we go onto social media and ‘like’ something, we often get more of those same spam messages.
Compulsions are the same. When your child gives into the fear and anxiety to wash their hands, the mind will create more anxiety-provoking thoughts. The way to overcome this is to pay attention to something else. Instead of focusing on the thought, your child can redirect their attention to the present moment experience. Your child can begin to notice that they are safe and secure right now.
4. Normalize the experience of ‘spooky thoughts’ about hand-washing.
Intrusive thoughts are not unusual. It can be helpful for your child to know that. Let your child know that it is normal for thoughts to just pop into our heads. Teach your child to stand up to those thoughts. Your child is not creating the thoughts. The thoughts have no power except the power we give them.
Just like a TV station with a lot of bad news, we all have to face distressing thoughts. We can’t always turn that TV off. Instead of tuning into the thoughts, though, your child can learn to change the channel. The thoughts have no power except the power we give them. Your child can learn to focus instead on other sensations in the environment. Your child can begin to notice a gentle breeze, a dog’s soft fur, the sun’s soft rays. In this way, the intrusive thoughts are not in charge.
5. Teach your child anxiety-reducing strategies about germs.
You want to teach your child how to relax their body in a healthy way. You can teach your child how to take deep breaths, relax their muscles, and change their thoughts. Are you looking for specific strategies that will help, a great resource for you is Cadey’s child anxiety course.
6. Create a goal about hand-washing.
As your child begins to work on their compulsive behavior, it can be great to set a goal. We want your child to reduce the number of times they wash their hands. When your child becomes worried and feels the impulse to wash their hands, encourage them to use an anxiety-reducing strategy. Start with something simple like, I will resist the urge to hand-wash 3 times per day.
One way to immediately reinforce this behavior is to reward the use of a coping strategy instead. For example, you could have a bin of small toys, and at the end of the day, if they are successful, they earn a toy. This way, the reward is immediate. If your child can delay gratification, they could earn a sticker as progress towards a larger prize.
7. Seek out therapy.
All of the above strategies can be great so long as your child’s obsession with hand-washing is not prolonged or severe. When your child’s compulsive behaviors are getting in the way of their participation in activities they enjoy, it is time to seek help. You would notice that your child is skipping out on school events, sports, or other social activities. You might also notice your child is extremely anxious all the time. In that case, you will want to work with a therapist who treats Obsessive-Compulsive Disorder.
Gradual exposure with response prevention
The best therapy for compulsions is something called ‘Gradual Exposure with Response Prevention.’ As the name implies, this therapy includes gradually introducing your child to the feared stimulus while disallowing the compulsive response. For example, if your child is so afraid of germs that they just ‘have to’ wash their hands, the therapist would gradually introduce some environments with germs. Your child would be taught to tolerate that stimulus by using a coping strategy. After a while, the child comes to see that it can be okay to be around germs for a while without washing their hands. Generally, nothing bad happens. The sequence is reinforced because the feared object (getting sick) does not come to be. Rather, the germs are there, and the child is still calm and safe.
With the support of a therapist, your child begins to face the ‘threat’ of germs and see that nothing happens. A new kind of tolerance is built. Your child is now capable of being somewhat calm with the germs around. In this way, your child is systematically learning to loosen up some control and still feel safe and comfortable.
This therapy is part of something called Cognitive Behavioral Therapy (CBT). This modality has considerable research to support its effectiveness. CBT can be paired with exposure response prevention treatments.
Cognitive Behavior Therapy can help kids understand their own obsessions and anxiety, recognize worry and fears, and develop healthy and appropriate coping strategies. OCD treatment is generally individual therapy, and parents or family members may be involved to practice these important skills learned in therapy.
If your child is obsessed with washing their hands, there is hope. First, validate your child, and next, teach your child about anxiety. Help your child find alternative ways to cope. However, if this feels like too much to manage at home, consider therapy. As mentioned, ‘Gradual Exposure with Response Prevention’ is the therapy of choice for compulsive habits.
If you would like to help your child learn tools for reducing their anxiety, a great resource is this course on anxiety and children.