My 14-Yr-Old Resists Going Outside Because She’s Afraid Of Sweat And Insects

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone, welcome to the show, I am Dr. Nicole, and on today’s episode, I am answering a question from a listener. I get many questions each week, and this is a great way to provide answers that many of you will hopefully find helpful. If you have a question you’d like me to consider answering on a future episode, email it to support@drbeurkens.com and you just might hear it on an upcoming show.

Now, onto today’s question. This comes from Alisa, who writes: “My 14-year-old daughter resists going outside. She prefers being home and gets very uncomfortable in the spring and summer because she might sweat or because there are insects and bugs outside. She avoids any outdoor time now. I know it would be good for her to spend some time outdoors, and honestly, her anxiety about this gets in the way of activities she and our family need to do. Do you have any suggestions?”

This is a great question and one that actually is fairly common that comes up for many kids and teens with various kinds of diagnoses, as well as kids with no diagnosis, and it can be a struggle for parents to find out what is at the root of this and how to address it.

So in the big picture, I think that this is an important area to address because time outdoors is healthy and important on a number of levels for kids and for adults. We know that there is lots of research showing that time outside, time in nature is very beneficial for us physically as well as mentally. Not only has it been shown to do things like reduce obesity, lower blood pressure, support immune function, but on the mental side of things, we know that even short amounts of time in nature, 5-20 minutes can help to regulate sleep patterns, provide us with more energy, reduce symptoms of ADHD, improve our focus and attention, and of course reduce stress and boost our mood. So lots of really valuable health-related reasons to be outside, along with the fact that being outdoors when it is sunny helps us to maintain good levels of vitamin D, which we optimally get through our skin contact with the sun’s rays when we are not wearing sunscreen.

So vitamin D is another important reason to be outside, but just at a very practical level, being able to go outside is important for normal life-functioning activities.

A child who is afraid of going outside or highly resistive to spending any time outdoors, that’s a child who is having some diminished quality of life and can impact opportunities that they can take advantage of, certainly impacts the family’s life as Alisa refers to in her question. 

For all of these reasons, it is an important issue to address. Now let’s take a look at where this could be stemming from because certainly there can be lots of reasons why a child may be refusing to go outside or spend any time outdoors. It could be anxiety issues that they are having, in this case Alisa refers to her daughter having some fears or concerns around insects and bugs, around sweating, those kinds of things, so there can be anxiety-related issues for kids I’ve worked with in my practice. Anxiety can also be related to things like weather, can be related to fears of strangers and people they might encounter. There can be social anxiety, fears around it, fears of injury, so there can be lots of fears and anxieties that come up here. 

Another realm of things that we need to consider is sensory issues. Sensory processing and sensory integration issues, where kids sometimes are really struggling because of the sensory aspects of the outdoor environment, whether it’s the temperature, heat or cold temperatures can bother some people, could be the sweating is a sensory issue, kids concerned about sweating because they don’t like the feel of that, that’s very uncomfortable for them.

I’ve had kids that I’ve worked with where they have an aversion to things like the grass under their feet or the feel of things on their feet or on their body that are outdoors. Some kids have really sensitive visual systems and bright sunshine and things like that, some kids don’t like the feel of wind on them, so there can be sensory issues too, and those tend to be two of the big overarching issues that I see playing into this: Anxiety and then also the sensory issues.

So I think that as a starting point for Alisa’s 14 year old daughter and really for any of you who are dealing with something like this with your child is to openly talk about the concerns. Talk with your child about what might be going on. Approach it, not from the standpoint of frustration, but from a standpoint of curiosity. “I am interested to understand what’s going on for you that you are not wanting to go outside at all. You’ve talked about the bugs, you’ve talked about the sweating. I want to understand more about that”, and so making a list of all of the things that your child is concerned about, whether or not they make any sense to you.

You’re allowing your child to communicate what the concerns or the issues are. Now sometimes kids don’t have any input to provide. Maybe they are resistive to responding to those kinds of questions or don’t want to engage in that type of communication or are for whatever reason unable to articulate those things, or maybe they themselves aren’t really consciously aware of what the issues are. In those situations, you want to provide some ideas for them to consider, so here is where I like to use this phrasing of “Some kids don’t like the feel of sweat on their body, it feels really uncomfortable, so they want to avoid being outside because that feels uncomfortable to them” or “Some kids don’t like to be outside because they are worried about sweating because they think that other people will notice and that feels embarrassing to them” or “Some kids don’t really like how the grass feels if it touches them or they don’t like walking on uneven surfaces, it feels scary to them” or “Some kids feel a little scared to do things like on the playground or to do some of the activities other kids are doing, and then they feel embarrassed because they aren’t doing those things or they can’t do them as well as other kids.” So you get the idea, you’re providing some possibilities.

You’re saying, “Here is what some kids deal with. I wonder if this is an issue for you. You’re just putting those ideas out there and giving them the opportunity to respond: “Yes, that’s true for me”, “No that isn’t”, even shaking their head, giving a thumbs up or a thumbs down, those kinds of things to try to hone in on the particular concerns or issues here for your child. So that’s a good starting point. 

Now, in this case for Alisa’s daughter, we’ve got a couple of issues to deal with, and I’m going to talk about these in a general sense for all of you who may have a child dealing with these things. So let’s talk about anxiety around bugs and insects. This, as I said, can be a common thing. Sometimes kids have had a negative experience, meaning they’ve been outside and they’ve gotten stung by a bee or something uncomfortable has happened with a bug. Sometimes they’re just anxious because of the unpredictability of them, not knowing when they are going to come into their personal space, feeling overwhelmed if they fly near them, those types of things. Maybe it’s a story or a show or something they saw that triggered some anxiety, or for some kids, it even becomes a phobia around bugs or insects. So here are some ways of approaching that: I think it’s important to provide facts, factual information and respond factually to kids’ questions or the distorted ideas or information that they have about bugs.

Now we’re not necessarily, by providing facts, trying to convince them that they shouldn’t be afraid of it, we’re just making sure that they have factual information. An example would be, I’m thinking of a kid from several years ago, who was convinced that every single bug that he encountered had the potential to hurt him, was going to bite him, sting him, whatever. So we address that factually. We did a little bit of research, looked at some resources, discovered that “Oh, lots of bugs like house flies and things like that are not going to bite you, they aren’t trying to hurt you.” So again, just making sure that kids, if there are some errors in their thinking, or they’ve got some stories that they’ve made up around it, that they have some facts. And responding factually and honestly to questions or concerns. Where this might come up is a child who is afraid of being stung by a bee, for example, and well meaning adults might say “Oh, you’re not going to get stung by a bee, it’s going to be okay.” Kids know that that’s not really true, right? So we want to be honest. “You know what? Bees do sting people sometimes. It doesn’t happen very often, but sometimes it does happen and yeah, that kind of hurts. It kind of feels like a big poke or it hurts for a couple of minutes and here’s what we would do if you got stung by a bee.” So again, not approaching it from the standpoint of “Oh, that’s not something that’s going to happen/That’s not something to worry about”, but empowering the child by saying, “Yup, that’s something that could happen. It’s not likely, but if it did, here’s how we would handle it.” So it’s really shoring up their confidence around “Okay, there would be a plan. There would be a way to manage this, which is really important when we’re talking about any type of anxiety. So we want to address that with the bug issue.” Then, there is sort of a process that we use with kids who have severe anxieties or phobias around specific things. We want to systematically expose them to the thing that they are fearing, but in steps that are manageable for them. So a child who is really afraid of bugs, a bug landing on them, a bug stinging them, whatever, it’s not a good approach to say “Well, you just have to get used to it” and forcing them outside or forcing them to be around bugs in order to get over it. They may comply with that, but it’s not going to help reduce their fear and it’s not going to help them get more comfortable and be able to manage the situation better. So instead, we want to start out with things that stretch their comfort zone, but not so far that it’s completely overwhelming to them.

So an example might be starting by looking at some pictures of bugs on a book, and it might be just looking at it quickly, and then closing it. Then extending the amount of time that they can look at it or read through a book, then we might go to putting our finger on the different bugs within the book. You might expand to things like looking out the window, counting bugs, “What kind of bugs do we see?/Let’s do some research online, let’s find some great resources”, depending on the age or developmental level of your child. Information about bugs and bugs that are in the region that you live in and exploring it from a sort of a research or scientist kind of perspective. You might then expand to being outside for a brief period of time. “Let’s just walk to the mailbox and back,” and slowly increasing that. So again, these are just some suggestions. And if your child has a true, serious phobia around something like this, a lot of times it’s beneficial to seek out some professional support from a therapist or someone with experience in this with kids who can really guide you with it. But this is sort of the process of just starting to expose in smaller ways that they may not be comfortable with, but are not completely overwhelming to them. So that would be some ideas around anxiety with bugs.

Then, if we think about anxiety around sweat, again, providing factual responses to your child’s questions or concerns, if they’re afraid of the smell, afraid of looking weird, afraid of it feeling weird, maybe afraid of it staining their clothing, whatever their concern is, being empathic and listening to that, not dismissing it, not telling them “Oh, that’s nothing you need to be worried about/That’s ridiculous”, but being empathic about it and then providing factual, honest responses. And then again, if your child is really anxious, either from a social anxiety standpoint or anxious from a feeling standpoint about how it’s going to feel with sweating, you want to start slowly. Maybe you start with just a minute or two outside, not enough to break a sweat, and then you increase the amount of time. You can also help with this by pointing out times when you and other people are sweating, “Oh gosh, I got really warm, oh I’m a little sweaty. Here’s how I’m going to handle that/Here’s how I’m feeling.” Talking about how you handle it. “Gosh. I remember having a big presentation at work and I got so sweaty from being so nervous, and I sweat right through my shirt, here’s what I did about it/Here’s how I talked to myself about it.” So just normalizing it and talking through your experiences and thought process also can be helpful to do some things indoors that create sweat, whether it’s exercise or sitting by a warm window or whatever, that environment may feel a little bit safer, especially if it’s more social anxiety around it or also getting them acclimated to how that feels on their body. You may also want to experiment with different types of deodorants, antiperspirants, things like that that may help address those issues like clothing choices. Again, with an older child, you can have them do some research and explore some possible solutions, depending on what the specific issue is. And then when we get into the realm of sensory issues with being outside, it really is a process of figuring out what the particular things that they are sensitive to, helping them become more attuned to that if they’re not even sure, and then slowly stretching their comfort zone with that, slowly. So again, we are trying to expand the comfort zone, but not in a way that’s overwhelming.

They might feel slightly uncomfortable, but it’s tolerable and they can work through it and acclimate to it. That’s our goal with all of this and also with the sensory issues on this. So slowly working up to bigger exposures. Maybe it’s a texture thing, we look at what shoes we can wear that help with that on the feet or maybe then to acclimate to it, we start with a sock on the feet, maybe then we work up to bare feet.

Maybe we start with our hands, we explore different kinds of textures. Providing options to cool down in the heat if it’s a temperature kind of issue: What kind of cool clothing could we wear, can we have an ice pack available? How about a water bottle with some really cold water in it? What are some ways that we can address this issue if it is a sensory issue of feeling really unsteady on uneven surfaces or on playground equipment or things like that? Again, doing some practice with that, starting off slowly, letting them take the lead just doing a little bit at a time to acclimate their system to it so that they get more confident. So those are some ideas around that. 

And then, the other category, I guess that we can talk about here are just general resistance that all kids have to things sometimes around lots of different issues. “I just don’t want to do this/I’m using this opportunity to refuse this because really, I’m upset about something else and I’m trying to have control over something.” There are always reasons why kids engage in resistance, but if that’s what’s going on here, you want to provide information about why it’s important to be outside, why you place a high value and priority on it, and then set expectations for what it is that you’re going to do outdoors and calmly, but firmly follow through with that. Now again, what this looks like is going to differ, depending on whether you have a child who is 3 or 15, where they are developmentally, all of those kinds of things, but you do what to be clear that this is important, that this is something you place value on, and ultimately that the reason that you want to work on this is because you want your child to have an improved quality of life.

You don’t want them to be left having fears or avoiding things that really are good for them, and especially if it’s just the resistance issue, say “I get it. Let’s look at some areas where you can have control. You can pick where we take a walk to, but we are going for a walk after dinner”, you know, those types of things. Then again, the modeling of this is critical. If you want your child to be comfortable and spend time outdoors, then you need to be doing that as well. So instead of saying “You need to get outside and go for a walk,” it’s “I’m going for a walk, I’d like you to come with me” or “We’re going to go for a walk after dinner.” Setting those expectations, staying calm but firm with them and also you taking the lead and modeling.

Also, it could be helpful to plan some things that the child enjoys that can happen outdoors to pave the way for that. For some kids, depending on the issues and challenges and circumstances, it may be appropriate to say “Okay, you’re going to have your video game time or some screen time, you can do that outside on the patio/on the porch/out in the yard” or whatever it might be, again, giving them an opportunity to do something that’s preferred and enjoyable and calming and comforting for them while they’re outdoors.

That doesn’t just have to be screen time, that could be other activities that they enjoy. Maybe there are some things that you’re going to do as a family outside. Maybe you will have a snack or eat outdoors, maybe you, as I said, go out to the mailbox. Different kinds of things that happen in the course of everyday living that you can involve them in that include some time outside. So again, pairing enjoyable things with time outside.

Setting a goal can be really helpful. “As a family, we’re going to work on getting x number of hours outdoors this week.” That can be a great thing to do. “Boy, I’ve noticed we all spend so much more time inside. We’re going to focus on getting outdoors a but more, especially now the weather is getting nicer and so we’re going to set a family goal to have this amount of time outside” or “Let’s think about for you…”, for each child, “…let’s set a goal for how much time you’re going to spend outside over the course of the week”, and then you can actually write that down.

You can have a little chart or maybe they can color in or mark off different blocks of time to see if they’re meeting their goal. That can be helpful to give kids something tangible to work towards and something visual that they can see their progress with that, and you can also, around this issue of general resistance, you tie something that’s preferred to spending time outside. Now again, I don’t encourage this as the only strategy to use, as in “You have to spend 30 minutes outside in order to get your screen time for the day”.

Certainly that is an approach, it can be helpful and it may be a good starting point, but that wouldn’t be the only approach that I would use, but that can be helpful if you feel like you’ve addressed the other underlying issues and it really is an issue of resistance or trying to have control, you can kind of come up with a compromise there. “Yup, I’m happy to give you 30 minutes on your computer game once you’ve spent 30 minutes doing something outside”, and you can organize it sort of like that to provide some incentive and also come to a compromise in a plan where they get some things they want and you get some things that you want them to do.

So I hope that that gives some practical strategies for Alisa, who asked the question, as well as any of the rest of you who are trying to help your child who maybe has some resistance or some concerns, anxieties or issues with wanting to be outside. Remember, if you have a question you would like to hear answered on a future show, email it to support@drbeurkens.com. You can put “Podcast Question” in the subject line, that will help us out, and thanks, as always, for being a listener. I will catch you back here next time.