OCD in a Young Child


OCD in a Young Child

PANDAS and PANS are clinical diagnoses that are strongly based on symptom presentation. OCD is a primary symptom, yet parents may not understand what OCD is or what it looks like in everyday life.

Below are some examples of what OCD may look like in a young child. We invite you to read the examples and also fill out the PANS/PANDAS SYMPTOM SCALE. These tools will help you present your child’s onset to your physician.

Often, if a child is unable to fulfill the urges or “needs”, they may become physical, cry, scream, or incessantly worry and not be able to focus on anything else. This is not a typical tantrum. Many use the word ‘meltdown.’

Please remember that reprimanding a child for OCD actions may not not help. Some parents have noted that the OCD tendencies improved a little over time without any intervention, therefore, they thought it was not a real issue. It may appear that things have improved, but it may have been replaced by a new OCD tendency, the child may be having internal thoughts and fears, or the child may have learned to hide his/her OCD. Even at a very young age, they can learn to hide what they feel they “must” do.

In the case of PANDAS and PANS, the root cause that is creating these urges and thoughts (a misdirected immune response) must be addressed.


  • Obsessive hand washing, due to fear of germs or stickiness or chemicals.
  • Obsessive need to pee
  • Not feeling clean enough after using bathroom – compulsion of obsessive wiping.
  • Brushing teeth for a long period of time
  • Inability to eat certain foods previously liked – may not be able to give a reason why
  • Refusal to brush teeth, bathe, or change clothes
  • Fear of germ or chemicals
  • Worry of choking on food (can be OCD related or swallowing issue)
  • Inability to touch certain things, such as food, clothing or toys that were previously loved
  • Repeating sounds others make
  • Obsessive concern about throwing up ( can also be the result of swallowing issues)
  • Avoidance of certain places or people or things
  • Refusal to touch other children when playing games like tag
  • Inability to use public restrooms or bathrooms at school or friends homes.
  • If they all of a sudden ask you to wipe them in the bathroom when they have been self sufficient for awhile.
  • Breathing off to the side -indicating the air in front of them is contaminated
  • Having to get their own utensils. Keeping utensils separate from others
  • Aversion to glue, glitter, etc. (this could be sensory or OCD)
  • Insisting on certain cup / straw / plate- to the point that it is that or nothing
  • Walking with closed fists
  • Wiping hands on pants over and over after touching something.
  • Needing to spin or shake after doing something like passing a specific person or a certain room
  • Needs to get their own food
  • Needs to eat self contained foods like cheese in a wrapper, applesauce from a single serve container
  • Hoarding spit or not wanting to throw out tissues or similar
  • Refusal to hold a parent’s hand crossing the street or in parking lot. Many cover hand with sleeve first

Symmetry Urges

  • Repetitively saying certain things, or asking others to say things in specific ways, tones, etc.
  • Lining up things such as toys or pencils.
  • Repetitively touching certain things
  • Inability to put hands in certain positions
  • Retracing steps
  • Going in and back out of doorways
  • Turning light switches on and off over and over again
  • Counting toys
  • Insistence on a certain order of events (if not done in specific order, must restart everything)
  • Putting together sets of items
  • Insistence on a certain order of events (such as reading certain books in only a certain order)
  • upset that they can’t stop blinking or breathing and trying to stop
  • Saying goodnight has to be done a very specific way. If you vary it, the anxiety rises and they need you to start over
  • Pushing chair in until it is just right, then making sure the chair is “even’. Sit, fix chair. * Look left, look right. Make sure it’s even
  • Can’t cross over numbers when using calculator/computer…my son is in GT Algebra class and it took him six hours to complete a test because he can’t “go across/over numbers”. He must move his hand around the calculator to the numbers on the outside first and if he touches another key he must start again…same thing with letters on the computer.
  • breathing in before reading each new sentence..
  • can’t sit on lines in carpet
  • Fussing with plate until just right. He’d turn and twist it until it was the way he needed it to be
  • Eating problems as a result of being unable to disengage from compulsive behaviors. My daughter is lining things up- I can spoon feed her during it, but she will not come away from it to eat or feed herself.
  • Has to tell you when to stop pouring a drink. The drink needs to be at a certain level
  • Messing with seat belts over and over
  • Wear the same clothes over and over
  • needing games to be played perfectly, played by different rules, or being unable to lose


  • Constantly asking for reassurance on the same/similar topic
  • Inability to make a previously simple decision for fear of consequences
  • Checking doors to make sure they are locked
  • Constantly changing mind- fear of wrong decision
  • Perfectionism – often seen in erasing work until the paper rips
  • Asking permission so the decision is not their responsibility
  • Repeating back what the child says because they need to make sure you heard them – can be reassurance

Numbers and Colors

  • Fixation on a certain number – such as needing to do, repeat, touch something 7 times.
  • Fixation on a certain number as being bad
  • Needing a parent to say certain things an amount of times before a task is complete
  • Child would fill up an entire piece of paper just writing “4” over and over until there was no room left. Open the fridge and can’t pick something out until he counted to “4”. Had to say good night 4 times.
  • “Favorite” color- had to wear the same Red PJs everyday, only color with red crayon (if the crayon would break it would result in crying for SEVERAL hours- only that particular red crayon would do)

Worry About Self-Harm & Harm to Others

  • Worrying about one of their actions causing harm to another
  • Inability to separate from a parent or authority figure.
  • Extreme worry about weather or robbers
  • Every safety message we’d ever sent turned into a crippling fear eg. never put plastic bags over your head became a terrifying fear of anything plastic touching her face, not wanting to go near plug sockets, worrying that bath water will be too hot.
  • If someone in the family gets hurt, they need reassurance over and over it will not happen to them. ie. someone break a toe….the child then asks multiple times a day…Is my toe broken?
  • Fears that someone was going to die
  • Fears that a monster was going to get them


  • Need to confess “bad things” such as unkind behavior
  • Feeling that they have cheated on tests or in school
  • Worry about being “bad”
  • Obsessive confessing (in stated or written form) often for no apparent reason
  • Needing to obsessively pray -if they do not pray something bad will happen

Magical Thinking

  • Obsessive magical thinking – if I think it, it will happen
  • Unable to read or write certain numbers or letters. If they read or write it, something bad will happen.


  • Refusing to throw out odd things
  • Keeping spit in the mouth, wanting the strep swab back from the doctor office, wanting the blood sample back from the lab. They need their bodily fluids in their own possession.