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Penny Rayas, MFT
Penny Rayas, MFT, Therapist
Category: Mental Health
Satisfied Customers: 395
Experience:  I have 20 years experience in the mental health field
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My 4 year old grandson has begun (since Oct 4) repititiously

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My 4 year old grandson has begun (since Oct 4) repititiously asking his parents if something is in his mouth. He does it over and over again to the point that they are going crazy with it and are near tears over this. They are calling me for advice. They have been to a child pschologist for help and nothing is working. Help please any advice would be so welcome. Does this sound like compulsive disorder? In such a young child?? I think it is anxiety of some sort but the repitition frightens me. Help!  Is there any safe medication to give a 4 year old for this??  What would you do in this situation.  We are going crazy ourselves!
Submitted: 5 years ago.
Category: Mental Health
Expert:  Penny Rayas, MFT replied 5 years ago.
Hello there and thanks for asking JA. I agree with you it sounds like anxiety. What happened before this started? Any changes in the family? Was he sick or did he see someone chocking? What did the psychologist say? I have seen younger children with OCD symptoms, he may not have the disorder but symptoms.
Customer: replied 5 years ago.
He was playing with a game that had dice and his mother said "be careful, don't put that in your mouth" - why she said that I don't know but that started it. Just today, he saw a cigarette on the floor and all day today he was asking "Do I have a cigarette in my mouth" - that is scaring his parents because the question doesn't make sense to them. Of course the cigarette isn't in his mouth, its on the floor?? He saw a commercial about smoking and in that commercial the person was shown to have black lungs and after viewing the cigarette and the mouth question, he also asked "Am I turning black inside??? - I was on the phone with my son earlier and I could hear Joey in the background saying - there isn't anything in my mouth is there?? He asked this repeated as I was on the phone (Maybe 5 or 6 times in a few minutes) He has a cold right now and that seems to have made it worse as his nose is running and he probably has nasal drip and cough. The only change is he started preschool in September (2 days a week) My son (Joey's dad) has slight OCD - he washes his hands alot and does ask me questions often but it isn't enough to be really called full blown OCD. What I don't understand is can a 4 year old have OCD?? So suddenly?? Out of nowhere? What can we do to help this little fellow who is only 4 and asks over and over and over "is there something in my mouth??" I hope you have some kind of answer to help. We are trying to reach the pyschologist tonight but to no avail. My son said would "benedryl help him to relax??" We are besides ourselves to help. Help!!
Expert:  Penny Rayas, MFT replied 5 years ago.

I am really sorry about everything your and your son and daughter in law are going through. Yes OCD and develop after a stressor like starting preschool. I think the school would be a good place to talk about testing.

OCD is inherated so your grandson is probably having some of the symptoms. The symptom of fearing of having something inside his mouth may be a result of fear that he will die or fear of abandonment. A therapist needs to asses him to figure out why this is happening now. As you know your grandson has some of the symptoms of OCD.

Here are the symptoms of OCD

According to the Diagnostic and Statistical Manual-IV, (otherwise known as DSM-IV), obsessions are persistent ideas, thoughts, impulses or images that are experienced, at least initially, as intrusive and senseless. The child attempts to ignore or suppress such thoughts, or to neutralize the reaction to them, by substituting another thought or action in its stead. Moreover, the child understands that the obsessions are a product of their thinking and not imposed from, or by, external sources.

To further illustrate the DSM-IV's definition, imagine the following hypothical example.

For instance, let us assume that a child like your grandson with obsessive-compulsive disorder fears the death of a caregiver. One vision that may intrude upon the child's thoughts who has obsessive-compulsive disorder is the image of the caregiver being hit by a car. Another possible worry he may not be able to shake is fearing that the caregiver could die in a plane crash. To offset these intrusive images and thoughts, the child may learn to substitute walking, in such a way, as to avoid stepping over the cracks in the sidewalk.

As the child experiences several exposures to walking in this distorted manner, he/she may develop a rule system around the substituted behavior. For instance, he/she may now believe that in stepping as to avoid a crack, the caregiver is able to avoid imminent danger of death.

To summarize, the child IS NOT obsessing about cracks in the sidewalk, but the avoidance of stepping on cracks, somehow tells the child that he/she has some relief from the overindulgence of worrying about the caregiver's death. In essence, the distorted stepping as to avoid cracks in the sidewalk has now become a compulsion.

Eventually, the child may assign a specific number of

sidewalk cracks to sidestep. This magical number provides the child with a relief from the anxiety of worrying about the caregiver, as the number may offer him/her a sense that in completing the task that number of times that somehow the caregiver has been offered a reprieve from death.

As can be seen, compulsions, asking for others to check his mouth are repetitive, purposeful and intentional behaviors that the child performs, in order to respond to the obsession. Some of the child's responses may deal with rigid rules or stereotypes that are meant to neutralize the obsession. However, the activity does not connect in a realistic way with what the behavior is designed to neutralize or prevent. Sometimes, the behavior can make sense, as in hand washing to avoid fear of germs; however, the number of times the child washes hands may be excessive. In either case, the child recognizes that the behavior is excessive or unreasonable, unless the child is very young and not yet able to process motivations for the behaviors.

Parents who have children with obsessive-compulsive disorder report much frustration. They provide a list of interventions that they have tried. Some have tried rewarding the child only to find that the child sacrifices an incredibly valued toy or activity for the obsessive-complusive behavior. Some have tried disciplining the child, which only served to increase the tension in the home atmosphere. Still, the behaviors or thoughts continued.

The following is an explanation as to why neither rewarding nor disciplining of the behavior serves to alter the course of symptomatology:

As a child's brain develops, a parent can see the strengths and weaknesses of what a child is able to learn and understand. Sometimes, however, a parent can become aware of glitches in the child's thinking processes. Some researchers now believe that the tendency to obsess or engage in a compulsion is very much the way a tic manifests from a nerve ending. There is no ability to control the behaviors once they have started and once the child has proceeded with the compulsion. From the viewpoint of researchers, the child's brain is literally spitting out information that 'does not compute.' Moreover, the disorder begins with worrying and/or fear. The behaviors (compulsions) are ways in which the child is seeking relief.

Obsessions are not uncommon and tend to run in families, even in those families who have a genetic predisposition to tics. Many of us can recall the experience of having to recheck the turning off of the stove or lights, even though we were certain that we had done so the first time.

However, for a child who has obsessive-compulsive disorder, one recheck is not enough to reassure him/her. Instead, the child does not glean reassurance from a recheck. They must repeat the action many more times than what their conscious thinking tells them is sufficient.

However, researchers have found that parents can aid children who have compulsions by not allowing the child to use avoidance as a method to relieve anxiety. Instead, researchers report that exposing the child to those things he fears can go along way to ending the compulsive behaviors.

As a note of caution, a parent should not attempt to help a child if the parent is feeling too emotionally frustrated with the slow progress that the child is experiencing. Instead, it is best to refer the child to a psychologist who is licensed and who has an expertise in obsessive-compulsive disorder. The psychologist can recommend a medication evaluation that could empower the child's efforts to let go of the compulsivity of behaviors.

Assuming that a parent is able to portray a neutral attitude, let us demonstrate how the use of non-avoidance could help the child. For instance, imagine again the child who washes hands 12 times after eating. In essence, the child has a fear of germs. Researchers would ask that the parent obtain a bowl filled with mud and encourage the child to dip hands in the mud. The child would be asked to limit handwashing for several minutes. Understandably, the child would be filled with anxiety. The parent would be encouraged to soothe the child with calming words but to delay handwashing. After several minutes, the child would be permitted to wash hands but to do so only once. The child would then be encouraged to describe his/her anxiety until it dissipated. Sometimes this step would require several attempts before the child would no longer have an urge to rewash his/her hands.

As can be easily noted by the example above, the intervention to prevent avoidance can be very draining for a parent; therefore, it is imperative to recognize parental intolerance for the child's frustration. As stated previously, professionally licensed psychologists are trained to help with this work and may be better able to cope with the child's reactions. Also, medications can also improve the child's ability to tolerate exposure to the items he fears.

For instance, in the case of the child who fears the parent dying, the child would be encouraged to not walk in a distorted way. The child could then express in a drawing or in a journal, all the thoughts and fears of not sidestepping cracks in the sidewalk. Eventually, the child would be able to see that his not walking in a sidestepping method did not murder his parental figure. Therefore, that clarity in thinking might alter the need for the compulsive behavior.

In conclusion, it needs to be stated that a child who has obsessive-compulsive disorder is not willfully rebelling against a caregiver's wishes. Truly, the child has a neurological issue that requires professional and compassionate approaches. Letting the child know that he/she is not insane nor without options can also go along way toward improving the situation. The family physician or pediatrician would know of a referral for further help if necessary. I would teach him to take deep breaths and distruct him with things he likes to do. As for benedryl he would have to ask him doctor. Sometimes long baths help children relax. The best thing they can do is distract him with pleasent activities.

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