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Compulsive habits: How serious?
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Q I'm a general pediatrician in private practice and the mother of 4-year-old twin boys. Eight months ago, one month after the twins started preschool, one of the boys began licking objects compulsively. The objects included stairs leading up to a play structure, walls, and some toys. To help address his oral fixation, my husband and I offered him sugarless gum and candy as well as foods of different textures.
During succeeding months, my son abandoned the licking behavior and started touching both sides of his face and nose with his fingers followed by touching his open mouth. The behavior occurs any time he is awake, but becomes accentuated when he is excited or trying very hard to accomplish something. He has a blanket, which he has slept with since infancy, and he puts some of it in his mouth.
Although initially shy in new settings, my son plays well with his brother, friends, and other children. He and his brother have made friends together and independently at school and are easily separated for some group activities.
He was a 37-week infant and has been very healthy except for viral upper respiratory infections and several ear infections. His hemoglobin and lead levels are normal. His father and I are healthy, but we both recall some transient compulsive behaviors when we were children, such as counting passing cars or adding numbers together. I changed jobs last summer. Otherwise, there has been no significant change in our personal life.
Our approach to our son's behavior has been to ignore it and offer alternatives such as gum. We have not noticed a significant change, however. What is the natural course of compulsive behavior such as this? Will it gradually disappear or does it intensify?
A Although obsessive-compulsive disorder may, rarely, become symptomatic at 4 years of age, I would look elsewhere for an explanation of your child's behavior. Compulsive-like behaviors are not uncommon in this age group. In some children, perhaps including your son, they are a self-comforting, self-regulating strategy that help the child cope with the strong surges of feeling that accompany excitement or struggle with a challenging task. Wide differences in such adaptive strategies occur, even in twinsespecially if one of the children has a particularly sensitive temperament. I would also consider a sensory-processing difficulty and suggest that the child be evaluated by an occupational therapist skilled in sensory integration therapy.
Consider also how much time you and your husband spend with each of the children individually. If the time spent seems insufficient, I recommend scheduling individual timeapproximately 15 minuteswith each child at least three times a week doing something both you and the child enjoy, such as taking a walk, working on a simple puzzle, playing a game, singing, or some other activity that involves close interaction. This prescription is often effective for parents who work full-time outside the home.
For a more detailed discussion of compulsive-like behavior, read Evans DW, Leckman JF, Carter A, et al: Ritual, habit, and perfectionism: The prevalence and development of compulsive-like behavior in normal young children. Child Dev 1997;68:58.
Your son's behavior will probably improve in time. Remember: Sensory integration therapy and more one-to-one interactions are key strategies to work with in the meantime.
Behavior: Ask the experts. Contemporary Pediatrics 2002;12:29.