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Does my 4 year old have OCD?

by Dr. Marie Hartwell-Walker

I am having trouble with my 4 year old daughter. She has several things that she cause her great distress if they are not done her way. Our major one we deal with is the bathroom. After she has gone to the bathroom she has to have a certain size piece of toilet paper “too big” is a common phrase we get. On top of it she wipes for what seems like an eternity to me always feeling like she is still wet. She’s not but she will try to wipe every area until she is basically red. I have tried to help her but she has to do it herself, if I try she just gets more angry. If we are in a hurry to get somewhere and I try to help her by wiping her and getting her pants up she has a fit and has to pull her pants down and wipe some more. Same goes with handwashing, it’s the drying part but it’s how long she has to wash. She soaps up for 3-5 minutes then rinses, we have to turn the water off to get her to stop yet if there is one small bubble on her hand left, we have to rinse some more and more and more. This is just the bathroom issues we have.

Is this OCD??

I’m at a loss because I feel bad for her and I want to help her. Some think I am just being silly, others think there is something wrong.
Just don’t know what to do. The last visit with her pediatrician left us with a chalk it up to her age explanation.

Help!! Mommy needs help here!!

Mothers are rarely silly; they more-often-than-not know when something isn’t quite right. I learned long ago to trust mother-instincts. I am unable, of course, to make a diagnosis on the basis of a letter alone. But I can tell you that what you describe is consistent with OCD. Many pediatricians who are excellent general doctors are not trained to recognize psychiatric problems in young children. The onset of OCD usually tends to happen later, so he may have ruled it out due to her age. However, it is not unheard of for a child as young as four-years-old (or even younger) to have symptoms.

According to National Center for Biotechnology Information, “Obsessive-compulsive disorder (OCD) is a very distressing disorder for both patient and caregiver. Usual onset of the disorder is in late second or early third decade of life. It is diagnosed in children but rarely before 5 years. However, symptoms can appear in first decade sometimes as early as 2 years.”

“Estimated prevalence of OCD in very young children (5-7 years of age) is 0.01% which is much lower than in general pediatric patients (0.5-4.0%). Pre-pubertal onset is more common in boys than girls, in the ratio of 2-3:1.”

Some of my adult patients have told me that they can’t remember ever not having the compulsions of OCD.

Please take your child to a child psychiatrist for an evaluation. Because she is only 4 and may not respond well to questions, the psychiatrist will be relying on you to provide detailed information about what your daughter does and under what circumstances. Take careful notes over a week or two so you can give specific examples of what happens and how often. Please do some reading to educate yourself more about OCD so you can ask good questions during the visit. As with most things, early diagnosis and early intervention is very helpful.

I wish you well.
Dr. Marie

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