BATH TIME FEARS AND TEARS FOR A 3-YEAR-OLD

NEW YORK TIMES COLUMN: FAMILIES TODAY:
BATH TIME FEARS AND TEARS FOR A 3-YEAR-OLD
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Our answer to a letter about bath time fears and tears has stirred up sympathy, salutary suggestions, and speculation in readers across the country.

Q. The 3-year-old who fears baths and showers might be willing to sit in a baby bath tub and get clean or to sit in a sink. Also, he might like to have a small inflatable swimming pool brought into the house or if the family lives in a warm climate have a bath outside in the small swimming pool.

Is the child afraid of taking off his clothes? Children are so exposed to mass media today it is almost impossible to isolate the source of fear but I find that asking a child to tell you what should be changed for him/her to like doing something sometimes works.

A. What great suggestions!

If the child slipped or swallowed water or had a traumatic shampoo in the “big” bath tub, simply switching bathing to another location might help. And a smaller place to bathe like the baby bathtub, sink or blow-up pool you suggest might also be less overwhelming to a small child to whom a “grown-up” tub might seem like a vast and gaping ocean.

Introducing water and the bath slowly, in small amounts, and on the child’s terms all make sense. Best of all, we like your idea of including the child in figuring out the solution and giving him some control. This way he might be more likely to tell you what the fear is all about, including whether it all started with some scary TV show.

We wondered what kind of media exposure you thought might prompt a child to fear taking his clothes off. When children are exposed to overstimulating adult sexual behavior, they are more likely to imitate it and act it out. When children are exposed to violence that makes them worry about the safety of their own bodies, they may spend more time inspecting themselves to be sure “everything is still there.” We certainly have seen children who have been sexually abused fear taking their clothes off. They do seem to see their clothes as a kind of protection, and staying dressed as a way of fending off unwanted memories of the trauma. (Often, though, other changes in behavior and mood are present too.)

Perhaps some of our readers have seen similar behavior in children who have been traumatized by media exposure without having actually been sexually abused.

Q. I read with interest your possible explanations for why a child would suddenly develop a fear of bathing. All of your possible reasons were valid. However, may I suggest a more ominous one?

Often children who have been sexually molested develop fears of being vulnerable as one is in the bathtub. Perhaps this child should be gently questioned regarding if anyone has frightened him in any way of was he touched by someone who made him feel uncomfortable.

Hope you find the cause of the problem and hopefully it is not as serious as I suggest.

A. We couldn’t agree with you more that this possibility is one to consider, although we would caution against scaring either the parents or the child in doing so. We appreciate your recommendation that the questions be gentle, and would underscore that they must not be leading, since the resulting replies would be harder to know how to interpret. Such questioning is best conducted by a professional trained to address such issues with young children.

We agree with your emphasis on the traumatized child’s fear of feeling vulnerable, and would add to this the fear of activities that contain some reminder of the traumatic event.

The original text of our answer to the “fear of bathing” question did close with the following paragraph which was eventually cut due to space limitations:

Children who have been sexually molested may also appear fearful at bath time. But this is not likely to appear as the only symptom. Instead, other activities involving their bodies — using the toilet, getting undressed — also often stir up fear and attempts to avoid them.

This is a possible but unlikely cause in a child who shows no other changes in behavior. There are so many more common reasons for a child this age to become afraid of the bath.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.