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Who’s afraid of big, bad germs? Kids and health anxieties.

• Thursday, October 1, 2015
• Shona Innes Psychology

When you think about health, what do you think about? How fit you are? Whether you have a disease or not? Being injury free?

Most people think about health as being something they either have or do not have, when, generally speaking, we are probably all on a spectrum of health. Some people who have chronic illnesses can be considered healthy if their conditions are managed well. However, like many things, when we start to think about health or sickness as something we either have or don’t have, we can open up a dyad of absolutes in our thinking that can generate anxiety. If I’m not healthy, I must be sick!

If you are a little person, your brain will tend to see things more in absolute terms. If you are told often enough that germs will make you sick, or “don’t’ touch that you’ll get germs”, then the idea of germs linking to illness and probably death can easily become something that dominates the thinking of an anxiety prone child.

How old were you before you understood exactly what a germ was?

In order to avoid explaining complicated medical situations to children, many adults just tell them that a germ made them sick. Anyone who knows even the slightest thing about germs and the immune system know that many people can be exposed to the same virus or bacteria and some will become ill and others will not. The more you understand about health and the human body, the more you know that it is complex relationship. Health involves a complicated interplay of a person’s biology, their environment, their psychology (or the way they are thinking about it) as well as the society they live in and the society’s expectations about health and wellness. To put poor health, or death, down to germs can be dangerously oversimplifying things for some little people who are vulnerable to health anxiety.

Sadly, some children can become so preoccupied with germs or getting sick that they begin to shape their lives in ways that make it very hard for them to enjoy day to day life, even though all of their vital signs are healthy!

When too much importance is placed on germs or health, the intense focus can actually make a young person mentally unhealthy and very unhappy.

Having a fear of germs or illness can become excessive and can lead to behaviour that is unhelpful – focusing too intently on body signs, checking poo and wee, washing hands excessively, not eating food that is close to its “use by” date, avoiding sick people, not being able to use public toilets, avoiding school camp or even school for fear of getting a germ that might make them sick….and die. Some children with a fear of germs or a health anxiety can need lots of reassurance from friends or family. They can ask too many questions about a person’s health, they cannot visit a sick friend or relative for fear of getting sick themselves or they may even be unable to watch medical shows on television. Factors on the outside of them can combine with factors in their thoughts. Sometimes, because they are so hyper aware of any possible symptom in their body, a rumbling tummy combined with news of a heath scare can combine to produce debilitating anxiety.

Some parents with health anxieties can exacerbate the problem for their children. At the earliest sign of any tiredness or fatigue, they are on the computer asking Dr Internet about child Leukemia. Yes, on some occasions tiredness is a sign of a disease state in a child, but there is a sensible response to exploring symptoms and there are over-anxious or even avoidant responses that can exacerbate a child’s anxiety.

Researchers are finding that people who are anxious about their health often do have certain vulnerabilities linked to their childhood. Sometimes, things have happened in their early life and their early attachments may be insecure, leaving them feeling vulnerable and prone to attack even before their brains have developed the ability to talk or think about it in words. It could be that a child has experienced poor health in their early years or that someone in the family has experienced very poor health. Sometimes, children can be left thinking that they have to be sick in order to be cared for and have their needs met. Sometimes, they have such a lousy time of it that they become hyper-vigilant to any sign that they might get ill again. There is also some new evidence that suggests that people who are anxious and monitor their health too closely, may also need more skills in being able to get along with people so that they do not feel so distant from others and do not need to worry about being sick in order to have warm interactions.

Clearly, the health anxieties in children and adults are complex, and if a child is being affected by a fear of germs or being sick in a way that limits their involvement and enjoyment in life, it is worth having a professional consider all of the factors that could be contributing and then working through the factors to find some relief for the affected child.

So, let’s stop giving germs a bad reputation!

Instead, let’s work on helping children to have balanced thoughts and beliefs about health.  To this end…

• Teach children about their bodies in age-appropriate ways. Human bodies are truly amazing things – let’s celebrate what they can do rather than go looking for signs of illness.
• Encourage a healthy relationship with “germs”. Do some research with your child about germs and the roles they play in our health and in making the World tick.
• Don’t avoid talking about death or illness, but modify the conversation to match your child’s understanding and to gradually extend and expand on what they know. If they have questions, find ways that you can answer them together or go, together, and ask someone who may know more about it than you do.
• Rather than making too many rigid rules about cleanliness, try to go with general guidelines. I think a general guideline might be that you wash your hands before you help with the cooking or before you eat your dinner, but if you do miss one or two occasions there’s no need to panic.
• Watch for avoidance and checking.  Keep  children involved in life, even if they are genuinely not well for a time, keep the relationships and learning going if they need to miss school or dance class/basketball/swimming.
• If your child has a an excessive fear of germs or getting sick that is starting to get in the way of them having a happy and involved life, then take them to your GP to consider a referral to a qualified psychologist or mental health practitioner.

No more bad press for germs!