Q. Our happy, outgoing, confident six-year-old daughter appears to be developing irrational phobias. To date, she is terrified of injections, dentists, wasps and to a lesser extent insects in general, tweezers and flying.
She hasn’t had a bad experience with any of these things. It all seemed to begin last autumn when she became upset and hysterical while she and her siblings were getting their vaccinations. We were hoping it was a one-off as she had been okay with injections before this and had never had a bad experience.
We thought maybe we had stressed her out by letting her know beforehand about the injection, so when we went for her MMR booster a couple of weeks ago, we didn’t mention the injection until we were in with the doctor. Unfortunately, she was uncontrollably hysterical again even before she saw the needle. Because of the measles outbreak, we felt she had to have the vaccinations and we had no choice but to keep going. We ended up having to get her daddy to hold her very tightly to get the injections.
As soon as she’d had the injections, she was her normal happy self, said they weren’t bad at all and asked for the toy I’d tried to bribe her with. Over the summer, she started to scream and panic whenever she saw a wasp even though she has never been stung or nearly stung. We do understand that many adults and children flap and panic around bees and wasps, so that didn’t worry us that much. The problem is that she now screams when she sees many insects and the list is growing even though we are not a family that is nervous of insects in general.
Things are now coming to a head. Last week, she got upset and then hysterical when I suggested using a tweezers to remove the splinter from under her toenail. She has a growing spot on a tooth, but she sobs and becomes hysterical if visiting the dentist is mentioned. What is causing these phobias and how can we help her get over them? Should we seek professional help?
A. Specific fears or phobias are one of the more common sources of anxiety for children during middle childhood. Such fears can be wide ranging and variable and can include things such as dogs, insects, needles or even things that are meant to be fun such as clowns or life-size characters. In most cases, these fears fade as the child becomes older, though he/she can still retain an inclination to be a worrier.
In tackling phobias, it is often best to do this gradually and one by one. Just as one uncontained phobia can grow and create new ones, when one phobia is managed this tends to improve all of them and/or give you and your daughter the confidence to tackle the next one.
The first step in helping your daughter is to be relaxed and calm yourself any time she is experiencing an anxiety. The more calm, positive and upbeat you can be, the more contained she will feel and the easier it will be for her to get through it. In tackling a specific fear, some rehearsal and practise can help. For example, you might play a game of taking her dolls to see the doctor to get their injections, or you can play a doctors and nurses game where you give each other injections with a pretend syringe.
As you tell the story, do so gradually and emphasise how normal and manageable the experience is – “It hurts a teeny bit, but dolly hardly notices because she is talking to mum”. It is okay to include a reward in the story – “Dolly gets a treat and feels great at being so brave” – as these are helpful in distracting children and helping them get through a fearful event. There are also some children’s books targeted at overcoming specific fears, such as Not Afraid of Dogs by Susanna Pitzer, that you could read together if you want to search for some of these online.
Take time to think through how best to approach specific events that might be scary for her. For example, if taking her for an injection, it is a good idea to discuss this in advance with the nurse or doctor. They might have strategies to make things easier such as special anaesthetic creams or child-centred ways of hiding the needle or injection site from view.
You can also prepare with the nurse or doctor some good distractions you can use such as letting your child suck a lollipop, or play with a favourite toy or even blowing bubbles together and so on. A noisy toy or distraction often works best.
In telling her about the trip, it is probably best not to give her too much notice in advance but to still give her a short warning so she can prepare herself. For example, when going to the doctor, you might not tell her until you park the car by the surgery. Then you make sure to be matter of fact and upbeat and to emphasise good distractions and rewards – “We are going into the doctor now for a little injection . . . I’ve got a new magazine you can have when you see the doctor and then we will be all going to the park.”
Over time, it is a good idea to teach your daughter relaxation and distraction strategies that she can employ herself when faced by anxiety such as visualising a happy, safe place, counting her breaths or repeating a relaxing statement to herself. These strategies are best practised at a relaxed time away from a fearful event, so she can become good at using them and draw upon them when her anxiety rises.
Whether you should seek professional support to help your daughter depends a lot on the severity of the worries and how much you feel they are negatively inhibiting family life. You could consider taking her to your primary care team or local child mental health service (your GP or public health nurse will have details) or you can find a private psychologist on psihq.ie. A good child mental professional should be able to help you practise some of the management strategies listed above with your daughter.
Dr. John Sharry, Irish Times Newspaper, October 2011. John writes in The Irish Times Health+ every Tuesday.