Extreme Child Phobias: More Than Fear, Sometimes Dangerous, Even Deadly

Feb. 17, 2008— -- A child absolutely refuses to leave the house after a dog bite; another won't leave her room if a cat is in the building.

In 2005, an 8-year-old U.K. girl in may have starved to death because she refused to open her mouth after a traumatic visit to the dentist.

Yes, children can have phobias too. By definition, a phobia is an extreme, life-disrupting fear, but experts say a phobia in a child can pose special challenges that make them harder to detect and perhaps more detrimental.

"I think we tend to minimize it because we say, 'oh they're just being a kid, they'll grow out of it,'" said Jennifer L. Hartstein, a child adolescent psychologist in New York City who specializes in treating anxiety and depression.

"Yet, the earlier you intervene, the better the prognosis is," said Hartstein.

Below is a list of extreme child phobias, with expert advice on how to recognize and help children facing debilitating fears.

Childhood Phobia: The Dentist

British authorities started an inquest this week into the 2005 starvation death of Sophie Waller, according to reporting by the Daily Mail.

Her parents say Waller developed a phobia after a dentist accidentally cut her tongue during a routine visit when she was 4 years old.

By age 8, Waller was still afraid. According to the Daily Mail, her fears were so extreme that she refused to eat for three days when she learned that she had to go to the dentist again for a cracked tooth.

Her parents and doctors decided to send her to the hospital to pull the cracked tooth, but Waller's parents told the Daily Mail that the doctors decided to pull all eight of her remaining baby teeth at the hospital, instead of the one.

When Waller awoke, her parents said she would not open her mouth to speak or eat and had to be fed with a tube. She continued to refuse to fully open her mouth after she was released. Two weeks later, Waller died in her bed from starvation and dehydration, according to a local pathologist.

The tragedy of Waller's life may be twofold; perhaps the proper medical intervention could have kept her living, and perhaps a therapist could have treated her phobia.

Childhood Phobia: Fear of Food

"A lot of times, if you can catch this fear early, you don't have the same phobia as adults," said Hartstein.

"If it's a true phobia, what they can learn is strategies to manage their phobias," she said. "A lot of times the best way to get over a phobia is to expose yourself to your fear, in a controlled way."

Several children in the U.K. made news this year with phobias so severe that they could not eat. But instead of the dentist, these children simply feared solid food. After an Edinburgh Evening News report of one family struggling to save their son, another family came forward with their story of success.

Leo Coning was so terrified of eating solid food that he had to be fed with a tube while he slept, according to reporting by the Edinburgh Evening News.

Finally, by the time Coning turned 5, his family found a clinic in Austria that treated this very fear with controlled liquid food restriction and plenty of solid food. Within a few weeks, Coning was eating like a normal child.

Childhood Phobias: Bugs, Dogs and Cats

Anxiety experts say bugs and pets -- especially dogs -- are some of the most common child phobias. A true phobia may be missed, however, because children are commonly afraid of these animals.

Donna Pincus, a clinical psychologist and director of the Child and Adolescent Fear and Anxiety Treatment Program at Boston University, said at least part of this fear may be ingrained in the human psyche.

Children may start with a fear of the dark, then get over it and develop a fear of monsters, and continue the cycle with more complex adult fears.

"[Studies] show that even cross-culturally, fears show this kind of progression," said Pincus.

Very young children are likely to have a detachment fear, or fear of the dark, said Pincus. Preschool-aged children fear animals, kids may fear monsters, and tweens or preteens begin to develop social fears and anxiety.

"You actually can notice that the natural progression of fears follows a line of cognitive development," she said.

Luckily, most children who are afraid of bees or the neighbor's Rottweiler grow out of it.

"They're not called a phobia unless it's outside the range of normal," said Pincus. "It can really change the course of a child's life in many ways."

Pincus once treated two brothers who developed a phobia of dogs; one who was bit by the dog and the other, who saw it happen.

She said the brother who watched had a notably more severe phobia, but "both of the kids were refusing to go outside." Apparently the thought of possibly running into a dog on the street or in a neighbor's yard had produced a phobia so severe that the brothers might as well have had agoraphobia.

Pincus estimated about 2 to 4 percent of children have a clinical level of fear that would warrant treatment.

Childhood Phobias: School

In some very rare cases, the child complaining of a stomachache and who doesn't want to go to school may have a true school phobia, not just an excuse.

"Signs are they just start to be sick, they just might be sick or have headaches," said Hartstein.

Even if parents recognize the illness as a sign of fear, "oftentimes they are ignored and they're minimized, and kids are left to figure it out alone," said Hartstein.

But Hartstein says a true phobia can be worked out, and it could be an easier fear to overcome than many parents think.

Hartstein said many school phobias might be rooted in a more specific fear. Yet children may lack the sophistication to isolate why they are feeling afraid.

"Kids will generalize things much more," said Hartstein. "Kids may be afraid to go to school, because they may be afraid to go to the bathroom in the school."

"I had a girl who was acutely school refusing," said Hartstein. After much questioning, Hartstein realized her patient was actually fearing a bully in her class, but she had generalized the fear into a paralyzing physical reaction to the entire school.

"It went from being in the class, to being in the school, to just being on the block," said Hartstein. "She would stand there and hyperventilate."

"We had to do a lot of work on recognizing that it was a person, not just the class," she said.

In the end, Hartstein said the girl tried again with a different school. "Now she goes to school everyday," she said.

Childhood Phobias: Vomiting

Believe it or not, there is a formal term for a vomiting phobia, called emetophobia.

Most people of try to avoid this unpleasant experience as much as possible but when it happens, they gargle and move on with their lives.

But those with emetophobia literally fear the act of vomiting and often severely restrict their lives just to avoid the possibility of getting sick. Adults with the problem have had trouble going to work, keeping friends or finding dates.

With children, the fear can interfere with school.

"They might refuse to eat certain things, they might restrict their food, they might be afraid to go in cars or public transportation after eating," said Pincus.

Pincus said that a phobia of vomiting is one of the more common phobias she treats, along with a thunder phobia.

"We've had kids afraid of seaweed, kids afraid of hiccupping, kids afraid of costumed characters," she said.

Childhood Phobias: Pigeons

Pincus confirmed that those harmless, cooing pigeons on the sidewalk are capable of sending some people running in fear.

As most major cities collect a sizeable pigeon population, this particular phobia can keep a person country-bound, limiting careers and travel.

"I treated a child once who was so afraid of pigeons and couldn't go into any major city... she would start climbing on me, or on her parents, or on passersby to be safe," said Pincus. "The minute she walked outside, she used to watch the sky for pigeons in the area."

Using what Pincus calls a "bravery ladder," many anxiety experts ask children to research all possible facts about the object they fear. Then, little by little, the children face their fears until their anxiety dissipates.

"You don't actually have to teach people to relax, in fact it can interfere... the fears have to dissipate," she said. "You need to learn habituation -- you allow new learning to happen in the brain."

Although the pigeon phobia was severe while she had it, Pincus said it was not that difficult to treat.

"The girl who was afraid of pigeons, she went and studied in London," said Pincus. "She sent me postcards over the years of all the places she was with all the pigeons around her."

Childhood Phobias: Allergic Reaction to Peanut Butter

Experts say a common difference between adult phobias and children's phobias may be the ability to rationalize one's fear.

"Adults tend to have more cognitive distortion," said Hartstein. "An adult may say 'Oh I think I'm afraid of dogs, but of course, I should be afraid of dogs' and give a list of reasons why."

Hartstein said children are much more likely to simply say "I'm afraid," without a lot of rationalization.

But having a food allergy may be one case for kids to develop a rationalized phobia.

"I had a girl, who I just treated who had a horrible peanut allergy. So basically she developed this incredibly irrational fear that every food that she had was going to have peanuts in that," said Hartstein.

Hartstein said that treating allergy phobias takes a little extra work to teach the child to take control of their diet and ask strangers a lot of questions about food.

However, for the most part, Hartstein said children's phobias can be easier to treat and have better outcomes than adults.

"You have to challenge the resistance in adults, where in kids are much more trusting," said Hartstein.