Expert: John Date: 9/25/2006 Subject: OCD in toddler
Question I have a daugter who will be 2 in a month. She is a skin picker. This has been going on for 6 months. It started with picking mosquito bites until they bled. It would take several weeks for a bite to heal because of the picking and then a new bite would take its place. I didn't become concerned until 2 months ago when my daughter started picking old wounds. I put pants on her to keep her from picking her legs but she has started picking her face now. One wound in particular took 4 weeks to heal. I celebrated her finding new spots to pick so that the old one could heal. I celebrated her finding 4 spots to pick instead of one so that the blood in her sheets wasn't as heavy in the morning. With 4 spots to concentrate on, the wounds don't get as deep. My daughter will put her arm out to me and say "stop" or "stay mommy" and then pick. She does it as I'm trying to get her to sleep, she'll take her milk and scan her face with her fingers for a spot to pick.
OCD runs in my husbands family. My 4yr old son has been diagnossed with tourette's syndrome a year ago. My husband has tourette's and OCD though not officially diagnosed.
I'm looking for advice on what to do for my daughter. Where do I start for help? What can I do at home to distract her? What are we in store for with a child so young displaying OCD?
Answer First, I would try to see the inpatient chief of psychiatry at the closest teaching hospital near you. A teaching hospital is one with a medical college attached to it. You may need the help of your peditrician to try to get an appointment. Do this for a number of reasons. A psychiatrist who is at a teaching hospital will have access to the latest information on treatments for OCD. Or he or she will be able to know who in your area will be suitable to see your daughter. As far as distracting her part of her treatment may very well be behavior modification. That is she will not be allowed to pick at anything even if this means her hands will have mittens or gloves on them 24 hours a day but not tied so tight as to cut off circulation. People with OCD who are washers and take showers for several hours at a time are alllowed to have a 10 minute shower twice a week and they have to wear the same clothes for three days in a row until they are broken of this obession. A similar thing may be required with your daughter. You are not punishing the person or child you are only letting them know that pickimng at sores is out. When people are phobic about something they are gradually exposed to whatever they are phobic about until they can touch the item or creature or subtance.This results in a gradual lessening of the anxiety they experience so they can then manage it. I think in the future that drug therapy will be an option since the same drugs that seem to lift depressions are also effective at lifting the symptoms of OCD. So its obvious there is a chemical issue in the onset of OCD in people. This of course may be a stage she is going through but since you are in a position to know if this is so or is a continuing thing you will know if she stops this behavior or shifts to a new ritual. Rituals seem to be the hallmark of OCD. They need to be dealt with immediately. She may need to be made "tired" so she will naturally drift off to sleep instead of involving you in a pre-sleep ritual of picking at her face. I hope I have given you some ideas to try and hwere to turn for help. Your daughter may think she is being punished when you are not punishing her at all. She will need to know that mommy loves her and thats why mommy has to do this. You may also want to do your own trimming and sanding of her fingernails so she cannot pick at a scab. Keep an eye on her nails and if she tries to use an object to pick at her skin.
