Are we raising little germaphobes?

Meg St-Esprit’s seven-year-old son had always been wary of germs. If a classmate “licked the end of a marker and put it back in the bin,” she says, he’d avoid the markers for the rest of the day.

But the constant barrage of COVID-19 news this past year amplified those fears to a fever pitch. “He’s a ball of anxiety,” says St-Esprit, a mother of four in Pennsylvania. “He got to the point where, within our house, he was like, ‘I don’t want a sibling to touch me because they might give me corona.’”

St-Esprit’s son’s anxiety, fueled by COVID-19, is far from unique. In a survey published by the American Psychological Society this fall, more than 75 percent of adults polled cited the pandemic as a significant source of anxiety; a CDC review released in November reported that the proportion of mental-health-related ER visits for five-to-11-year-olds increased by 24 percent over the last 12 months.

A fear of germs isn’t necessarily a problem. After all, being conscious of potential dangers—whether germs, spiders, or strangers—has evolutionary benefits. The concern, experts say, comes when a healthy caution becomes an obsession that disrupts your life.

“The line between healthy habits and mental health concerns really comes down to how much impairment the conditions or behaviors cause you,” says Joseph McGuire, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University.

So will the pandemic turn a generation of children into a sanitizer-toting, doorknob-evading, germaphobic horde? Experts say not likely—but parents should still know what signs to watch out for and develop strategies to help kids manage their natural fears.

Phobias, anxiety, and kids

Childhood fears are a normal part of growing up, with different ones appearing and fading at different developmental stages. Babies, for example, are afraid of strangers; toddlers fear the dark.

According to Kate Fitzgerald, co-director of the Child OCD and Anxiety Disorders Program at the University of Michigan, most kids grow out of these anxieties by the time they’re about 10 years old, when the part of the brain responsible for behavior adaptation and decision making matures. But in some cases, they persist and become diagnosable conditions.

Germaphobia is a layperson’s term used to describe a heightened awareness of germs. On the other hand, symptoms for clinical phobias are “usually triggered by observable external stimuli,” Fitzgerald says. Since we can’t hear, see, or smell germs ourselves, extreme cases of “germaphobia” are usually attributed to other disorders.

Let’s face it, though: Figuring out what counts as “extreme” is tough right now. Kids who might’ve balked at washing their hands before dinner in pre-COVID times are dousing themselves in sanitizer and backing away from people who aren’t family members. And in this strange new world, these are rational, not pathological, precautions.

But when the behavior starts to affect a child’s daily life, that’s when germaphobia might actually be something else. Doctors might diagnose a kid with obsessive compulsive disorder (OCD), which is characterized by obsessive thoughts paired with rituals that alleviate the anxiety those thoughts cause (“I might burn down the house, so I need to repeatedly check the stove”) or generalized anxiety disorder (GAD), in which worries about several different issues persist for at least six months.

Still, McGuire says fear that is restricted to germs is rare. “More often than not, that kind of single fear isn’t isolated,” he says. For example, if you restrict the kind of food that you’re eating because you’re afraid of being contaminated, then you’re not actually afraid of a certain kind of food. The same thinking applies to disorders related to germs: The fear is about much more than invisible particles invading your body.

Based on fMRI scan studies, Fitzgerald theorizes that children with OCD have less-sensitive neural circuits, which control goal-based decision making. She compares it to an alarm system for irrational behavior: In these kids, the alarm is too quiet, so they struggle to respond to irrational fears appropriately. Her team has also detected neurological similarities in children affected by GAD and OCD: Both have disruptions in the connections between the parts of the brain that process threats and make decisions.

But there’s hope for germaphobes with these diagnoses. Studies on adults have shown that when OCD is treated—either with drugs or therapy—the abnormal activity in these neural circuits disappears. Fitzgerald is currently working to replicate these results in children.

When your child might have a problem

External triggers like a global pandemic can induce anxiety disorders and OCD in kids, according to Sheryl Ziegler, a psychologist based in Colorado. But the vast majority of these cases involve a predisposition to these conditions, even if the child has never been diagnosed. Once a condition has been determined, parents can often recall subtle symptoms from earlier in the child’s development, such as expressing extreme worry about meeting new people.

The big question remains: In a world gripped by a pandemic that has everyone on edge, how can parents distinguish between rational and irrational responses to a very real threat? Ziegler advises that parents look at the impact these fears have on how a child functions every day. Some questions to consider:

• Does your child express feelings of powerlessness? (“I can’t control if someone gets within six feet of me.”)
• Are their worries about germs and contamination constant and uncontrollable, and do they engage in compulsive behaviors to cope? (“I need to wash my hands for 10 minutes every time I touch a doorknob.”)
• Do they need frequent reassurance? (“Do you promise I won’t get sick?”)
• Are their routines disrupted because they avoid situations in which they might encounter germs? (“I’m not going to school because I don’t want to have to use the bathroom.”)
• Do they exhibit physical symptoms such as sweaty palms, racing heart, shortness of breath, stomachaches, or headaches?

Especially now, Ziegler says, responses can fall onto a wide spectrum of possibilities and still be considered normal. If, however, your child spends much of the day on these anxieties, feels them intensely, and can’t be reassured through rational discussion, enlist the aid of a mental health professional.

What parents can do to help ‘everyday’ germaphobes

But even kids with mild germaphobia—whose healthy caution of germs might be a bit obsessive but doesn’t affect their day-to-day life—can benefit from some extra help.

Ziegler encourages parents to check in with kids to ask how they’re feeling, then listen to their responses without interrupting or judgment. Validate their concerns, but don’t reinforce them: “Yes, COVID-19 is still in our community; it’s still a relative risk.”

Follow up with a gentle challenge to suppress the anxious behavior: “If you do have to touch something that’s considered a high-touch area, you can wash your hands for 20 seconds. And we really believe that’s a safe way to get anything that could be harmful to you off your hands.”

Finally, expose them gradually to their fears in a safe and controlled way. For example, you might bring them with you to the grocery store during low-traffic periods and show them the reasonable measures you take to keep yourself safe.

These strategies are useful whether your kids are garden-variety germaphobes or might be struggling with more serious conditions. They borrow from the gold standard treatments for OCD and anxiety disorders, which involve identifying and challenging negative thoughts as well as suppressing the behaviors that grant temporary relief from the fear (like constantly washing hands).

Parents also need to model a healthy balance between caution and overcaution, says Carolyn Ievers-Landis, a psychologist at University Hospitals in Ohio. “If you’re someone who’s talking about the news a lot or doing certain rituals, your child can think, ‘Wow, I really am in jeopardy; this is really going to affect me,’” she says.

Distractions can also help break the cycle of germ obsession. “Plan activities, do fun things together, and make sure children have some sort of access to their friends and extended family,” Ievers-Landis suggests. For instance, when her family spent months rescuing frogs from a swimming pool slated for destruction, their bandwidth for virus-related doomscrolling shrank.

Once the pandemic passes, how will children, who’ve been taught to scrub their hands and maintain a distance of six feet, acclimate? Reentering society will be fraught for everyone, but children who experienced higher levels of anxiety during the pandemic might need additional treatment and support, Ievers-Landis says.

Still, “kids are amazingly adaptable and flexible, even the very little ones,” she adds. “They’ll adjust to the new normal.”