A persistent, pervasive fear of water

Q A 2-year-old boy is fearful of water, to the extent that he will neither bathe nor swim-not even in a baby pool. He will step in up to his ankles, but is not happy about it. He will not play in water, and is not swayed by watching his siblings have a great time in the water. The parents usually have to bathe him, forcibly, once a week, with much screaming and carrying on. The parents have tried to bathe him in the sink, but the child wants no part of it. He is the third child in a family of four boys, and has had this fear as long as the parents can remember.

Kristen M. Christian, MDRochester, NY

A Most children between 2 and 6 years of age develop at least one fear-often, more than one. The number of fears increases as the child grows older, and peaks at about 11 years. Common fears among 2-year-olds are separation, loud noises, toilet training, bed time, and bathing. Clinical experience suggests that many children have a fear of water at some point during the first five years of life; one year the child is happily splashing and playing in a pool or lake and, the next year, won't go near it. The opposite also can occur.

I suggest that, first, you assure the parents that a fear-and this fear of water specifically-is common. Then provide specific strategies to help them to help their child cope with, and ultimately overcome, this fear-without trauma or conflict.

First, the parents should not coerce or try to get him into a bath or wading pool. To keep him clean, a parent can have the child stand on a beach towel near the sink and then use a soapy wash cloth or sponge to clean his body. Unless he has been playing in dust or dirt, a child needs a complete washing only twice a week. The child's face, hands, and perineum should be cleansed daily (the latter can be accomplished with the child on a changing table). Also, advise the parents to prevent, if possible, his siblings from teasing or bothering the child, especially by throwing water on him.

Last, the parents can help the child overcome his fear by letting him control his involvement with water; if the climate allows, offer him buckets of water outside, or let him play with a water hose, or even a squirt gun. The goal is to encourage him to be involved in water, under his own terms.

Barry Zuckerman, MD DR. ZUCKERMAN is chief of pediatrics and medical director, Boston Medical Center, and the Joel and Barbara Alpert Professor and chair of pediatrics at Boston University School of Medicine, Boston, Mass.