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Ask the Mental Health Expert Archives 2001-2004

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Child with OCD

Q. I am a psychiatrist in Fort Worth, Texas and have a case that baffles me and I need help.

I have a 5-year-old step grandson who is battling with some OCD demons. His magical number is five and surprise, he won't eat more than five bites of food which is obviously a problem for his further development. He has been taken to a few pediatricians by his other grandparents with the response always being: he is ok.

I can tell you he does show OCD type behaviors which have begun to interfere with his growth and subsequent development. I am at a loss of what to recommend to the other side of grandparents who have guardianship as they have indirectly come to me looking for help. What is out there to help with this type of problem?

A. It's always difficult when family are involved, but I think you would serve your step grandson well by getting him seen by a child psychiatrist ASAP, preferably someone in an academic setting who has a lot of experience with childhood-onset OCD. With all due respect to our non-psychiatrist colleagues, I do not think childhood OCD--if that is indeed what your grandson has--is best managed by pediatricians.

Some specialists believe this is a somewhat different disorder than adult-onset OCD; and, as you probably know, some childhood-onset cases appear to be related to recent strep infections (the so-called PANDAS phenomenon; see Arch Pediatr Adolesc Med 2002 Apr;156(4):356-61). There is a pretty good literature on treatment options for childhood OCD; e.g., CBT may be effective in the acute treatment of pediatric OCD (Benazon et al, Behav Res Ther 2002 May;40(5):529-39). As in adults, SSRIs also appear to be helpful.

In one study,sertraline (50-200 mg/day) was effective and generally well tolerated in the treatment of childhood and adolescent OCD for up to 52 weeks (Cook et al, J Am Acad Child Adolesc Psychiatry 2001 Oct;40(10):1175-81). But, the first step is to get the patient into the hands of an experienced specialist.

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December 2002

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