A 3 year old's strange phobias
October 19, 2012 8:40 AM   Subscribe

Over the summer, my 3.5 year old developed a bunch of odd aversions/phobias. And now, over the last three weeks or so, he seems generally anxious when we go out. I'm wondering if it's just a phase related to his age, and I should keep him mostly at home till it passes? Or is this the start of a more serious anxiety condition? Or a sign that our city life is too much for him?

I've been reading about childhood fears, like: the dark, or monsters, or the bathtub, or bees. This is nothing like that, as far as I can tell.

He developed a fear of the choking/Heimlich maneuver poster in restaurants, and doesn't want to go in restaurants any more. Some days he even has trouble walking by restaurants because he will be thinking of the poster and wondering if it can be seen from the street. He says he doesn't like it because it reminds him that he could choke.

He also finds it frightening to look at people with piercings or tattoos, or dyed hair. The dyed hair thing extends beyond green or blue hair -- he reacts to people with the wrong shade of blond for their skin-tone, too. He is fine with temporary tattoos and wears them all the time.

He is completely fine at home. He is completely fine inside stores or a place like a children's museum, assuming we can get there. The general anxiety thing is newer, and happens whenever we leave our apartment. He wonders if there will be people in the laundry room. He worries about the places we go -- "Let's not go to that playground: we might see a mother scold her child like we did last time." If we go to visit his uncle at work, we might see tattoos. If we go to art class, we might see the administration woman with a nose ring. If we're riding the bus, he wonders about the emergency exit in the roof -- how would we get down from the roof of the bus if we had to climb out that way? He is always reading the signs that have warnings, cautions, rules, and asking about them in detail.

Up till now, he was not a worried person, though he has always been sensitive to noise, sensitive to odors, attuned to details, and rattled by emotional stories (e.g. books about kids who won't share). He loves amusement parks. He is social and extroverted and will even talk to these tattooed and pierced people -- he just won't look at them, and he'll be shaking the whole time. His odor sensitivity is at an all-time high right now.

We do live in NYC and in a busy neighborhood, so there are lots of colorful people around, plus sad/strange sights like homeless and drunk people.

His life seemingly has no stresses or traumas. Happy family, no deaths, no injury, (no choking), no school, no long separations, no siblings, no new bed, no new caregiver, etc.

I know that some fearfulness is normal at this age, but this feels like a big change. Or are big changes normal?
posted by misoramen to Human Relations (26 answers total) 4 users marked this as a favorite
I'm not a psychologist, but my instinct would be not to shelter him. These are irrational fears, and the best way to get rid of them is to confront them. He's too young to do that on his own, so it's your job to make sure he isn't allowed to cower from these perfectly harmless things/people and allow it to become ingrained due to being reinforced by subconscious thinking of, "mom stays away from these things when I point out that they're scary, so the fear must be legitimate."
posted by Urban Winter at 8:52 AM on October 19, 2012

This sounds like a classic case of PANDAS:
PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. This term describes a hypothesis that there exists a subset of children with rapid onset of obsessive-compulsive disorder (OCD) and/or tic disorders and these symptoms are caused by group A beta-hemolytic streptococcal (GABHS) infections.[1] The proposed link between infection and these disorders is that an initial autoimmune reaction to a GABHS infection produces antibodies that continues to interfere with basal ganglia function, causing symptom exacerbations.[2][3]

The PANDAS hypothesis was based on observations in clinical case studies at the US National Institute of Health and in subsequent clinical trials where children appeared to have dramatic and sudden OCD exacerbations and tic disorders following infections.[4] There is supportive evidence for the link between streptococcus infection and onset in some cases of OCD and tics, but proof of causality has remained elusive.[5][6][7] The PANDAS hypothesis is controversial; whether it is a distinct entity differing from other cases of Tourette syndrome (TS)/OCD is debated.[3][8]
posted by jamjam at 8:54 AM on October 19, 2012 [6 favorites]

I am also not a psychologist. I'm a parent of 4 kids, and the one thing that I know about this age is that my kids were pushed into their fears and loves by me, innocently. I didn't go out and say to my eldest son "You will like Pearl Jam," he just observed me liking Pearl Jam and wanted to emulate me. I have a clear memory of him jamming out to the band while in the back seat of my car.

My advice in this is to try and focus your behavior and actions to counter his fears. If he has a fear of something, start talking about how much you like that thing, or about how good that thing is. I know it sounds ridiculous, but if you get good at it, it starts to be a simple way of working on their behavior without specifically telling them what or what not to do.
posted by thanotopsis at 8:56 AM on October 19, 2012 [1 favorite]

I think you're right to be concerned. My child had some weird phobias at that age too (some of which sound similar, like about body modification) -- but if it's to the point where he is feeling anxious about going outside, and he's been through a similar phase before, if I were you I would see a counselor trained in these issues.
posted by chickenmagazine at 8:58 AM on October 19, 2012 [3 favorites]

I agree with chickenmagazine. I know plenty of children that age with phobias that don't make sense to adults -- one three-year-old I knew was terrified of those doorstops with springs on them that get mounted to walls, another has nightmares about her house's air return vents -- but since it's lessening the quality of his life to such a degree, it could be worth talking with a therapist about it.

This doesn't mean years of psychoanalysis and/or medication -- it could just be a bit of play therapy to figure out what the fear is, and some techniques he can learn to help himself deal with it.

(P.S. He sounds like a smart, empathetic kid!)
posted by The corpse in the library at 9:11 AM on October 19, 2012 [1 favorite]

I read an article once discussing how to talk to your kids about world tragedies like September 11, etc. It said that although it seems like lying, you should tell them that "That won't happen to us; we're safe." And that children are not capable of understanding the nuances of likelihood and that just because someone could potentially choke in a restaurant sometime, it will probably never happen to him or someone he knows.

It sounds like he's very sensitive in general--things that might superficially bug or bother someone affect him very significantly, like strange hair colors or piercings, or the potentialities of disasters and emergencies. And sensitive in a way that I think will probably be to his advantage as an adult, as long as he learns to cope properly.

To some degree I can see all of this as something that's part of being this age, normal childlike fixations, like not wanting different foods to touch on the plate, only wanting to use a certain spoon, needing certain stuffed animals in certain positions on the bed before going to sleep, etc. Those are all things that I went through... and still harbor feelings about to a certain degree. I also tend to focus on the possibly negative (though improbable) outcomes of a situation. But for all intents and purposes, I have completely grown out of all of that and it doesn't affect my day-to-day life--I have no fears or anxieties about leaving the house or interacting with aesthetically-unpleasant people. As a grown-up I can say to myself, "Yes, that spoon is my favorite but I'm hungry now so I'll use this other one."

And I have always been extremely sensitive to scents, in good and bad ways. I'm always identifying and noticing scents and smells and other people think I'm crazy.

It won't hurt to pass this by a professional, though. It probably wouldn't have hurt if I had been passed by a professional as a child!

There's also that whole thing about "highly sensitive children"--I never looked into it sets off my quackery meter a little bit, but if there is something valid in it, I think your son would certainly qualify.
posted by thebazilist at 9:14 AM on October 19, 2012 [1 favorite]

Seconding chickenmagazine. Keeping him home would reinforce his anxiety about 'out there', and you really don't know that this is a passing thing. It's escalated since summer, and been pretty bad for three weeks. There's no telling what is going on his head. Whatever touched off his anxiety weeks ago, he probably couldn't even tell you. Maybe something he overheard, or saw on tv got his clever little brain going like a hamster on a wheel. A counselor could help before it becomes a thing.

On preview: jinx Tcitl
posted by toastedbeagle at 9:14 AM on October 19, 2012 [1 favorite]

I'm not an expert, but the range and depth of his fears does seem a little unusual to me. Is he around any adults who are very nervous people? If so, that could be a big factor. If not, I would discuss this with his pediatrician.
posted by Dansaman at 9:18 AM on October 19, 2012 [5 favorites]

Hi, I'm the grownup version of your son!

I was a very phobic child. My parents mostly didn't indulge my phobias, except for the ones that were easy to deal with, like my fear of heights and scary movies (no horror movies, no ferris wheel at the fair). But the weirdo irrational stuff like being afraid to eat certain foods or go certain places or experience certain ubiquitous things, their approach was that that's life.

I turned out fine, though I will say that the phobias of my young childhood translated directly into anxiety as I got older. While I think my parents handled my phobias exactly right on the micro level, I wish they'd recognized my constant state of low level anxiety (I was having panic attacks based on irrational phobias by the time I was 12) and considered therapy for me.

While I'm not especially phobic as an adult, I definitely have trouble handling anxiety. I wish that someone had recognized those tendencies in me when I was younger and given me the tools to handle something that ended up being a major feature of my everyday life into adulthood.
posted by Sara C. at 9:33 AM on October 19, 2012 [8 favorites]

I am not an expert either, but it sounds like your child's anxieties are in the range that would benefit from you consulting a professional.

Although it sounds like you are providing a nice, stable life for him, I wonder if he is *too* sheltered? No school at his age? School at his age is less about "learning" and more about peer socialization and introduction to the outside world.

Also, I would try to think back to any possible traumas...when I was about his age, there was a huge flood in our area and the pipes under our house ended up bursting and ruining a lot of our stuff and we had to move really quickly. It didn't occur to my parents to inform the school, and my teachers called my parents in because suddenly I was bringing a stuffed animal to school and exhibiting other signs of stress. Apparently it didn't mega-traumatize me and things worked themselves out, I just mention it because maybe there is something that happened that you overlooked?
posted by radioamy at 9:33 AM on October 19, 2012

Keep in mind that you might be unintentionally confirming his anxiety. By cooing and fussing and otherwise reinforcing the idea that the object/person is provoking anxiety and worry, you'll continue to reinforce the anxiety. You might want to read up on how to actually address fears and anxiety, rather than avoiding them. The quick leap to "the urban life is too much for him" makes me think this could be true. You might consider some play therapy or family counselling, or parenting books for you, to figure out ways to address this a bit more proactively. It's not that he's "broken" it's that your communication with each other is having a blip and needs to be reset.
posted by barnone at 9:40 AM on October 19, 2012 [1 favorite]

Maybe just check with your pediatrician?

Kids see things so much differently than adults do. I remember having a phobia of a certain type of weed when I was a wee tot...he may associate the things he is phobic with with things that aren't that obvious. As a parent, I wouldn't freak out about this just yet but it would be wise to check with a professional to make sure.
posted by St. Alia of the Bunnies at 9:42 AM on October 19, 2012 [1 favorite]

he'll be shaking the whole time

To me, this indicates a pretty high level of anxiety; I agree with the other commenters who think your son should see a pediatrician. It could be "normal" anxiety, but best to get a professional opinion.
posted by Specklet at 9:56 AM on October 19, 2012 [9 favorites]

As a father of boy with autism, I strongly encourage you to contact local authority (School district) for Early Intervention evaluation ASAP. They will perform a battery of tests (including psychologist) for free. Write down ALL your concerns with detailed 'incident reports', that will help them to decide if any additional test should be administered. You and your wife will be almost grilled (positively) for all the information and that time this detailed incident report comes handy.
posted by zaxour at 10:48 AM on October 19, 2012 [2 favorites]

I have a 3.5 year old too, and while it has seemed that 3 has brought out a bit more of reactions to stuff (more fears, or more reactions to things he was fearful of before), it is nowhere near your son's level. Moreover, the reactions your son seems to be happy seem to suggest a bit more generalized anxiety sorts of problems. It may just be a phase, but I'd at least talk to your pediatrician about it, see what they say.
posted by katers890 at 11:05 AM on October 19, 2012

This is limiting your son's quality of life beyond the typical impact of childhood anxieties. I'd make a peds appointment.
posted by DarlingBri at 11:37 AM on October 19, 2012

Jamjam's PANDAS link was fascinating, because the behavioral symptoms matched me to a T when I was a kid. Some of your son's symptoms similarly remind me of me when I was that age. I didn't know (still don't) if there was any organic cause at the time, and of course in the early 1960s my parents certainly wouldn't have considered that there were any causes other than "Oriole's being a pain", but I can remember seeing something that "grossed me out" for whatever reason, and then I would consciously avoid any reminder of said thing. For example, I vividly recall seeing my baby brother vomit in his high chair while we were both eating ice cream, and for years I couldn't bear to even look at cartons of ice cream in the supermarket because I immediately thought of gross puke and....eeeew. It's hard to describe how the memory/thought process worked, but I remember my childhood being punctuated by things that scared me.

(Another example - when I was in the 3rd grade they showed us this Child Molester movie during a special assembly. I'll always remember that it was winter and I had these rubber over-boots (not traditional galoshes) pulled on over my shoes that emitted a distinctive rubbery odor. That movie scared the beejeezus out of me, I feared that Bad Men were going to climb through my bedroom window at night, etc etc, and that rubbery smell triggered the fear. I could never wear those boots again, and I remember freaking out in the tire department at Montgomery Ward when Dad took us shopping - he didn't understand and I couldn't explain why I wouldn't stand nearby while he browsed at whitewalls and kept running off to a different department.)

I was never taken for any sort of counseling as a kid, but many years later as an adult I was diagnosed with OCD. Whether there's a PANDAS connection I don't know, but I would strongly recommend having a professional talk to your son - a child psychologist or whatever type of medical specialist who would be able to diagnose things like severe OCD that is affecting the child's day-to-day life.
posted by Oriole Adams at 11:46 AM on October 19, 2012 [3 favorites]

I am totally not an expert, but my parenting instinct would be to talk these things through and show him how it relates to his own life but is maybe a little different and that's ok.

Using your examples, I would talk about how sometimes children misbehave and their parents have to scold them. If they didn't, the child might be in danger. Then compare that to how we behave in our family, and remember that time he reached for the stove and Mommy got a little upset and it made him scared, but how we talked about it afterward and we decided we both still love each other and we always would, no matter what type of behavior he does. And we don't scold like that in our family, but every family is different and they get to choose how they talk to each other.

Or for the poster, lots of reassurance that he won't choke, look how often he eats and all the different things he has eaten (be specific and make a big long running list) and he hasn't ever choked. But if he ever did (actually I would probably use a stranger here as an example instead of himself), isn't it good to know that lots of people would know how to fix the problem. You could have him practice on his bigger teddy bears and show him that if he looked at that poster, even he could have the power to save someone's life, but he would probably want to wait until he was a little older. Talk about doctors and/or paramedics and their job is to save people's lives, but with the poster then anyone can do it if they have to. We all help each other.

Or the hair - lots of talk about all the people you know who have lots of different colors, and isn't it fun that some people like to paint on paper like he does, but other people like to paint on their hair or body. Maybe it makes them feel like a superhero (relate this to his life and the characters he knows) or maybe it helps them play make-believe. Maybe he would like to play, too, and let's see what color we could paint on our arms or on our hair, just for a few minutes. And look, it washes off and the real color is underneath...etc.
posted by CathyG at 11:51 AM on October 19, 2012 [2 favorites]

I am not a parent or an expert. A 4 year old visited me for 2 months this summer who had all kinds of irrational fears. Her mother is a very anxiety-ridden person (you don't sound like this to me though). When I was alone with the child and she said she couldn't do this or that because it was to scary I asked her what scared her and tried to get her to talk it through. Then I offered her money to do whatever she didn't want to do. We turned it into a game. By the time she left I am sure she was just making things up for the dough. I am hoping she took something away from this summer experience that will help her in the future.

I would expose him to some of his irrational fears. Like having someone with dyed hair over for lunch where he can touch and ask questions of the person.

Poor little guy. Growing up is hard work.
posted by cairnoflore at 12:35 PM on October 19, 2012 [1 favorite]

This sounds a lot like my daughter at that age - she had some early issues with sensory processing, she's super observant, started reading early, and developed some phobias like this around 3-4. She also had unusually strong stranger and separation anxiety. We have a family history of mild anxiety disorders and friends who have dealt with OCD, so we started managing her anxiety early and 3 years later it is 95% under control and not significantly affecting her life.

The most important rule: as much as possible, give her control over the stimulus. She was pretty fearful of strangers, which was hard when friends would come over, so we would warn her well in advance when that was going to happen, and told her that we wanted her to come out and say hi, but she could hide in her room if she needed to. In her moments of anxiety, one of the underlying problems was the lack of control. Something would show up in her world and cause her anxiety, but she wasn't able to control it, and was afraid that her fear would spiral out of control. It's not about simply taking away what she's afraid of, or forcing her to face it, but giving her a control knob where she can gradually change the volume of the stimulus at will, to both increase and decrease it.

She used to have this fear that if we took a different route coming home, we'd get lost and never get back home. New places cause the stimulation of her nervous system to spike to uncomfortable levels, and she gets afraid that this will stay high, or worse, keep getting higher. That gets articulated as "we'll never get back home," back to the familiar, low stimulation place. One way we handled this was sticking with the routine, but sometimes asking her if she wanted to take a different way home. Planning in advance is definitely important when you are doing controlled exposure to heightened stimulus.

Some other things I've learned:

- Conventional parenting advice isn't designed for children with mental illnesses. Run away from anyone who starts talking about "reinforcement". Parenting based on Pavlovian or behavioral principles like they are dogs or rats in a maze is bad for all children.

- Your child will stop you if you are over-coddling them. Most kids value competence and independence, even kids with anxiety -- they see their older peers and siblings and even adults and want to be like them. Even very young children are proud that they aren't a baby any more, and will resist being coddled if they believe they can do more. They need a strong base of safety and security to feel confident enough to take risks, knowing that there is a safe place to return to if they get in over their heads.

- Quite a few childless people are very liberal, open and accepting about unconventional lifestyles, but are surprisingly judgmental about deviating from the traditional parenting template. Most of our friends were understanding, but one or two were slightly offended when we didn't force our daughter to hang out with them. Since then, we've found an unusual number of scheduling conflicts that prevent us from seeing them as much anymore.
posted by AlsoMike at 1:22 PM on October 19, 2012 [4 favorites]

I'm a parent with a child that age. I know many children of all sorts of different parents with different personalities and parenting methods, and none of them come close to this level. This doesn't mean your kid is broken or that there is necessarily anything huge going on, but you're the parent, you know your kid, and I think if it worries you: go with your gut. If you have access to services to help figure out the root of all this, then don't be afraid to use them. No pediatrician or psych doc would demean you for bringing up these concerns with them, and if it were my kid and that happened, I'd go with another doc. Not because this is totally absurd behavior, but I'd say its pretty far beyond the pale, especially if you, as the parent, are not an especially anxious type who never goes out in public in the city for fear of imagined things. If there was an adult who suddenly developed intense phobia and change in their ability to cope with life as usual, as a nurse I'd be on high alert, danger, get thee to a doctor territory. Kids are a little different maybe because of developmental stages and their ability to reason, their imagination... But in this case, if it were my kid, I'd think it very worth checking out.
posted by takoukla at 1:51 PM on October 19, 2012

A couple of people seem to have kind of touched on this but not said it explicitly: Sometimes bright toddlers really get neurotic about stuff. Kind of a mismatch between their level of intelligence and level of life experience or "wisdom".

One example: My oldest son whigged out about ladybugs in his room when he was three or four. Years later, he was able to tell me he thought they were bees because they were black and yellow. So he knew bees were black and yellow and could sting but somehow did not know they looked completely different from ladybugs. (I used to say he had enough intelligence to get into trouble but not out of it. He was a handful at that age.)

I have heard similar stories from other parents of bright kids. You might do well to pick up a few books on the topic or join a list or two. Some of this they outgrow. Some of this, they need help with. Talking to other folks with similar kids can help you sort out which is which and how to effectively approach it.
posted by Michele in California at 7:28 PM on October 19, 2012 [3 favorites]

This is tricky. My gut is wavering between having a compassionate, but firm talk with your son and help him deconstruct his phobias in some kind of rational way, and seeking pediatric guidance from a professional who could assess your son for PANDAS and/or an anxiety disorder. He may be working himself into a tiz when you see him shaking, or that could be totally involuntary. It's definitely something to keep your eyes on, though. Hope it passes.
posted by These Birds of a Feather at 8:57 PM on October 19, 2012

I'm not a psychologist, but my instinct would be not to shelter him. These are irrational fears, and the best way to get rid of them is to confront them. He's too young to do that on his own, so it's your job to make sure he isn't allowed to cower from these perfectly harmless things/people and allow it to become ingrained due to being reinforced by subconscious thinking of, "mom stays away from these things when I point out that they're scary, so the fear must be legitimate."

Oy, I would say be careful with this. I developed a phobia around food/eating at 10. My parents reacted by "not allowing cowering" and pushing me into it. When I continued to cower, they actually held me down and forced food into my mouth.

The result was a full-blown anxiety disorder, and two years of a very severe eating disorder that caused health issues I still feel the repercussions of.

I'm not saying that's what will happen to your son, and I hope you wouldn't go as far as my parents did anyway, but I think counseling is a good step for your boy, and I think it would be best if the process of fear confrontation, when it's the right time for that, is led by him.
posted by cairdeas at 1:53 PM on October 20, 2012 [1 favorite]

That shaking had me wavering, as well, between PANDAS and a related disorder also caused by Group A strep-- but not at all controversially:
Sydenham's chorea or chorea minor (historically referred to as Saint Vitus Dance)[1] is a disease characterized by rapid, uncoordinated jerking movements affecting primarily the face, feet and hands. Sydenham's chorea (SC) results from childhood infection with Group A beta-hemolytic Streptococcus[2] and is reported to occur in 20-30% of patients with acute rheumatic fever (ARF). The disease is usually latent, occurring up to 6 months after the acute infection, but may occasionally be the presenting symptom of rheumatic fever.
But because psychological issues seemed more central I suggested PANDAS.

However, the Wikipedia article I've linked goes on to say something that's making me think SC could be a better guess:
Sydenham's is also associated with psychiatric symptoms with obsessive compulsive disorder being the most frequent manifestation.
Sydenham's also has a much more clearly defined treatment protocol:
#1. The first tenet of treatment is to eliminate the streptococcus at a primary, secondary and tertiary level. Strategies involve the adequate treatment of throat and skin infections, with a 10-day course of penicillin when Sydenham's Chorea is newly diagnosed, followed by long-term penicillin prophylaxis. Behavioural and emotional changes may precede the movement disorders in a previously well child.
posted by jamjam at 2:04 PM on October 20, 2012

Just returning to add -- I looked at your previous questions, and saw that your child (assuming you're talking about the same child) has had motor delays, eczema, and allergies. I wonder if all of these are connected with the increasing anxiety somehow. I don't want to worry you, but could it be possible he's autistic? I would definitely talk to a pediatrician, maybe in addition to seeing a counselor.
posted by chickenmagazine at 1:42 PM on October 24, 2012

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