Doing things over and over such as checking doors, arranging things, or cleaning

Ritualistic behaviorsmean doing things over and over, sometimes following a set pattern. For example, a child checking a door many times to make sure it is locked. In many cases, the child feels the need to do something to calm down or prevent something bad from happening. Even if they seem strange, these behaviors usually make sense to the child at the time.

Repetitive movementsare actions that are done again and again. These can be simple, like blinking their eyes or twitching their fingers, or complex, like bending and touching objects. Repeating these behaviors doesn’t mean the child is doing it on purpose or that it’s something they can simply stop. Some of these repetitions may be related to brain function.

These behaviors often worsen in situations of anxiety or stress.

What is typical?

Children often like routines because they are safe, predictable, and comforting. At home, parents and kids set up routines like morning, after-school, homework, and bedtime routines. When children need to change their routine, they might feel stressed or resist.

Routines are things that need to be done, such as brushing teeth and making the bed. Rituals are done for a purpose and often make kids feel better. These rituals can help children feel less afraid or anxious.

Some repetitive behaviors and rituals are normal parts of development and are not a cause for concern. For example:

• Children between 4 and 10 years old often repeat jokes or stories they like.
• Teens might have a way to warm up before sports or habits before a test. Some athletes have rituals they believe bring good luck before a game.
• Some children develop habits, such as always arranging objects in the same way or repeating phrases to feel calmer.

These behaviors are fine as long as they do not cause distress or interfere with daily life. Often, these behaviors disappear over time as the child grows.

When should I be concerned?

You should be concerned if a child or teen keeps doing these behaviors over and over and cannot stop, or if the behaviors affect their life or others around them. It is worth observing more closely when the child or adolescent:

• Becomes very distressed or irritated if interrupted.
• Spends a lot of time doing these actions, which interferes with sleep, school, or time with other people.
• Avoids places, objects, or people for fear of touching them, getting dirty, or causing something bad to happen.

It’s also important to be concerned if your child shows anxiety, shame, or sadness because of these behaviors, or if peers start making fun of them.

Concerning repetitive movements:

• Blinking a lot
• Clearing your throat often
• Body twitches or shaking parts of the body
• Moving your mouth, nose, or face repetitively
• Touching things repeatedly
• Shoulder shrugging
• Facial grimacing
• Sniffing a lot or smelling objects repeatedly
• Making sounds repeatedly

Concerning rituals:

• Washing or cleaning things, themselves, or others over and over or in a very specific way
• Not wanting to touch or be close to certain things or people for fear of getting sick or dirty
• Checking things like locks, doors, or belongings over and over
• Asking for reassurance from parents, teachers, or other trusted people over and over
• Straightening, lining up, counting, or touching things over and over
• Checking or asking over and over if they caused something bad like a fire or car accident
• Asking others to be with them to make sure they do not harm themselves or others
• Going back over and over a conversation or an action in their mind to make sure they did not do anything wrong
• Repeating certain phrases or actions until things feel ‘right’
• Praying over and over to prevent bad things from happening or to stop unwanted thoughts
• Spending more than an hour a day doing these repetitive actions
• Avoiding things, places, or people because of these actions
• Trying to stop doing these repetitive actions but being unable to

What can I do to help?

As a caregiver, you can help with these behaviors. Here are some things you can try:

1. Talk calmly.Ask simple questions with interest and affection to understand why they do what they do. Listening can help you understand what they are feeling.
2. Be supportive.Let them know you see what they are doing, and you are there to help. This helps them feel safe.
3. Problem-solve together.Ask if there’s anything else that could help them feel calmer, like deep breathing, listening to music, or taking a walk.
4. Guide them to stop the behaviors.Encourage your child not to do the rituals. Make small changes gradually, such as reducing the number of times they repeat an action, and praise each step of progress.
5. Avoid participating in rituals.Even if your child asks, try not to join in the repetitive behaviors. Kindly explain that you’re there to help, but you won’t do the ritual with them.
6. Stay calm.Even when things are difficult, try to maintain a calm tone. This helps your child feel more stable and secure.
7. Identify triggers.Help identify situations that may worsen behaviors, such as stress and fatigue, and try to reduce these factors.

Encourage your child or teenager to talk about their feelings so that they don’t feel alone.

What kind of professional support can I seek out?

Caregivers should not feel embarrassed or guilty if their child has these behaviors. Know that these difficulties can happen to anyone, and there are ways to deal with them.

Talk to your child’s pediatricianor family doctor. They can refer you to other specialists, such as mental health professionals. Mental health professionals can help both the child and the caregivers. They can work with you to support your child at home and in therapy.

You can also find free support through the Unified Health System (SUS). Care often begins at your local Basic Health Unit (UBS). Other services include Child and Adolescent Psychosocial Care Centers (CAPS i), specialty centers, and clinics at university hospitals.