Plan a first step at home

• I stay with them until they fall asleep. What you could say “I know it feels scary to fall asleep on your own, and I know you can cope with feeling scared. I’ll come back once to check on you, like we agreed.” A first small step Keep a short, fixed wind-down with you in the room, such as one story or ten minutes of chat. Then say goodnight and leave, and come back once at a time you have told them in advance, for a brief check rather than to stay. If they call out before then, answer from the doorway with the supportive statement and do not lie down with them.
• They sleep in my bed, or I end up sleeping in theirs. What you could say “I know it feels hard to sleep in your own bed. You’re strong enough to do it, even on the nights it feels hard.” A first small step Choose two nights a week, named in advance, when they start and end the night in their own bed. If they come through during the night, walk them back calmly and say the supportive statement once, without a long conversation. The other nights stay as they are for now.
• I answer the same bedtime worries again and again, such as whether the door is locked or whether they will have a bad dream. What you could say “I can hear that the worry is loud tonight. I’ve already answered that one. Not being completely sure is uncomfortable, and you can live with it.” A first small step Answer a bedtime worry once, kindly and briefly. When the same question comes again, give the supportive statement in place of the answer and move on to goodnight. You are still responding to your child, just not to the repeated question.
• One of us has to stay upstairs until they are asleep, so our evenings are planned around it. What you could say “I know you feel safer when I’m upstairs. I’m going to be downstairs, and I trust you to manage up here on your own.” A first small step Tell them that from an agreed night you will be downstairs after goodnight, and that you will come up once at a set time. Keep to that time even if they call out before it, and keep the visit short.
• The bedtime routine has to be done in exactly the right order, or we start again. What you could say “I know it feels wrong when it isn’t done exactly the same way. I know you can cope with that feeling, and I’m not going to start again.” A first small step Pick one part of the routine that you do for them, such as a particular form of words at goodnight or checking the wardrobe, and stop doing that one part. Everything else stays the same for now. If the routine goes wrong, you do not restart it.

If your child is missing school, speak to the school before you change anything, so that home and school are working to the same plan. If you are not sure whether stomach aches or headaches need checking, see your GP.

• I let them stay at home when they say they feel too ill or too anxious to go. What you could say “I can see how worried you are about school, and I know your tummy really does hurt when you feel like this. We’re getting ready as normal, because I believe you can manage it.” A first small step Keep every school morning the same, with getting up, dressing and breakfast done by a set time, whether or not they end up going in. If they do stay at home, the day runs like a school day, with schoolwork at the table and no screens or treats until the school day would have ended.
• I take them right into school or the classroom, or stay until they settle. What you could say “I know saying goodbye feels really hard. You can get through it, and I’ll see you at pick-up.” A first small step Agree with school where the handover happens, for example at the gate or with a named member of staff, and say goodbye there. Keep the goodbye short and the same every day, and leave even if they are upset. Many children settle more quickly once the goodbye is over, and school can let you know how the morning went.
• I answer questions about the day ahead many times, such as who will be there and what happens if they feel sick. What you could say “I can tell you’re worried about today. I’ve told you what I know, and I’m sure you can cope with the parts nobody knows yet.” A first small step Go through the day’s plan once, at breakfast, in a few sentences. After that, repeat questions get the supportive statement in place of more detail.
• I ring or email school to get them out of things, such as PE, assemblies, reading aloud or trips. What you could say “I know you really don’t want to do it, and I understand why. I’m not going to ask for you to be let off, because I know you can manage it.” A first small step Choose one thing you currently arrange exemptions for and stop arranging that one. Tell your child before it comes round, and tell school what you are doing so that staff do not offer the same exemption themselves.
• They message or call me during the school day and I reply to settle them. What you could say “I know it helps to hear from me. I’ll see you after school, and you can get through the day without messaging me.” A first small step Agree one set time when you will reply, such as lunchtime, or none until pick-up, with school able to reach you if there is a genuine problem. Messages outside that time wait until then.

If your child is losing weight, is not growing as expected, or you are worried about their physical health, speak to your GP before changing anything about food. Very restricted eating can be ARFID, which needs a proper assessment.

• I cook a separate meal because they will only eat a few foods. What you could say “I know new foods feel really uncomfortable for you. There’s something on the table you can eat, and I know you can cope with the rest of it being there.” A first small step On one or two agreed evenings a week, everyone has the family meal, with one food your child reliably eats on the table. You do not cook a separate meal on those evenings, and you do not pressure them to eat the rest.
• I check dates, labels or how food was made because they ask me to. What you could say “I know it feels scary not to be sure the food is safe. I’m not going to check it, and I trust you to manage that feeling.” A first small step Stop checking one kind of thing on their behalf, such as use-by dates, and tell them in advance. When they ask, give the supportive statement instead of checking or looking it up.
• I prepare or serve food in a special way, such as cut a certain way, on a particular plate or with nothing touching. What you could say “I know it feels wrong when your food looks different. It’s an uncomfortable feeling, and you’re able to cope with it.” A first small step Pick one of the special arrangements and stop doing it, keeping the others for now. Say in advance which one is changing.
• I promise them the food is safe or that they will not be sick. What you could say “I know you’re worried about being sick. I can’t promise anything about that, and I know you can handle not knowing.” A first small step Stop giving the promise. The supportive statement goes where the promise used to go, and if the question comes again you let it pass without adding more.
• We avoid eating out, parties or other people’s houses because of food. What you could say “I know eating away from home feels hard. There will be something you can eat, and I’m confident you’ll manage.” A first small step Plan one meal out or one visit where you know there will be at least one food they accept, and go ahead with it as planned, without extra checking or promises about the menu.

• I answer the same worried question many times a day. What you could say “I can see the worry is really strong right now. I’ve answered that already, and I know you can cope with the worry without me answering again.” A first small step Answer each worried question once. The second time it comes, give the supportive statement in place of the answer and carry on with what you were doing. Both parents do the same, so that the question is not simply taken to the other one.
• I promise that nothing bad will happen, for example that we will not crash or that Grandma will be fine. What you could say “I know you’re worried something bad will happen. Nobody can promise that, and you’re strong enough to cope with not being certain.” A first small step Stop making promises about things no one can guarantee. Use the supportive statement where the promise used to go, and keep your tone warm.
• I explain plans in detail, well in advance, to head off the worry. What you could say “I know it’s hard not to know every detail. I’ve told you the plan, and I know you can manage the rest when we get there.” A first small step Share plans once, at an ordinary time, with the amount of detail a child of their age would usually get. Further questions get the supportive statement.
• I look things up, or ask other people, to prove the worry wrong. What you could say “I know you want to be sure. I’m not going to look it up, and you can cope with not knowing for now.” A first small step For one kind of worry, stop searching online, checking the forecast or asking other adults on their behalf. Tell them in advance that you will not be looking it up any more.
• I have to say a particular phrase, or say it a set number of times, before they can move on. What you could say “I know it feels like something is wrong until I say it. I’m not going to say it this time, and I know you can handle that feeling.” A first small step Choose one time of day, such as leaving for school, when you will no longer say the phrase, and keep it as it is at other times for now. This pattern is often part of OCD, and it is worth getting it assessed.

If rituals take up hours of the day, your child’s skin is damaged from washing, or they cannot eat, sleep or leave the house because of them, get a professional assessment before you start.

• I wash my hands, change my clothes or shower when they ask me to. What you could say “I know it feels awful when you think something is dirty. I’m not going to wash again. It’s a really uncomfortable feeling, and you can get through it.” A first small step Pick one situation, such as coming in from work, when you will stop washing or changing at their request, and tell them beforehand. When they ask, give the supportive statement and carry on.
• I wash their clothes, towels or bedding separately, or much more often than needed. What you could say “I know it feels wrong to you when things haven’t been washed separately. It’s hard, and you’re able to live with it.” A first small step Put one item, such as towels, back into the ordinary family wash on the ordinary schedule. Other items stay as they are for now.
• I check locks, switches or the oven for them, or confirm that they have checked. What you could say “I know you feel unsure whether it’s done. I’m not going to check it for you, and I know you can handle feeling unsure.” A first small step Stop checking one item on their behalf, and stop confirming that they have checked it. The supportive statement replaces the answer.
• I keep buying extra soap, wipes or hand gel because they use so much. What you could say “I know you want more. We’re keeping to the usual amount, and I’m confident you’ll manage with that.” A first small step Buy the amount the household would ordinarily use and do not top it up early. Tell them in advance that this is changing.
• I clean things before they touch them, or keep them away from things they see as dirty. What you could say “I know touching it feels really uncomfortable. I’m not going to wipe it, and you can touch it even while it feels that way.” A first small step Stop wiping or cleaning one item before they use it, such as the TV remote or their dinner plate. Other items stay the same for now.
• We wait for their rituals to finish before we can leave or eat. What you could say “I know you’d like to finish first. We’re leaving at eight, and I’m sure you’ll manage.” A first small step Set the time you will leave or start eating, tell them in advance, and keep to it. You are not stopping the ritual yourself, only no longer waiting for it.

• I speak for them, such as ordering food, answering adults or making phone calls. What you could say “I know it feels hard to talk to people you don’t know. I know you can do it, and I’ll wait.” A first small step Choose one familiar, low-pressure situation, such as ordering at a café you often go to, and wait instead of speaking for them. If they do not speak, you do not step in, and you try again another time.
• We turn down invitations, parties or clubs because they are anxious. What you could say “I know the party feels scary. I know you can handle feeling nervous, and we’re going to go for an hour.” A first small step Accept one invitation or activity and agree in advance how long they will stay. Go as planned, and do not cancel on the day if the anxiety rises.
• I stay with them at activities other children of their age go to alone. What you could say “I know it feels better when I’m there. I’ll be back at the end, and I’m confident you can manage without me until then.” A first small step Stay for the first part only, for an agreed time, then leave and come back at the end. Next time, leave a little earlier.
• We avoid places because of their fear, such as parks with dogs, lifts, crowded shops or the dentist. What you could say “I know you’re frightened. We’re still going, and I know you can cope with feeling scared.” A first small step Go back to one ordinary outing that the family has dropped because of the fear. You do not push your child to approach the feared thing, but the outing itself goes ahead.
• I go with them to places they could manage alone for their age. What you could say “I know you’d feel better if I came. You’re old enough to do this on your own, and I trust you to.” A first small step Choose one short, familiar trip, such as walking to a friend’s house, and let them do it alone, with the usual safety arrangements for their age.

• Brothers or sisters have to follow rules because of the anxiety, such as not touching things, staying quiet or answering questions. What you could say “I know it’s hard when your brother or sister does it differently. You can cope with that, even though you don’t like it.” A first small step Release the siblings from one rule. Tell your anxious child in advance, and make sure the siblings know they no longer have to follow it.
• We rarely have visitors now, or visitors have to follow rules. What you could say “I know you feel worried when people come over. I know you can manage it, and they’re coming on Saturday.” A first small step Plan one visit from someone familiar, tell your child in advance, and let the visit run as it ordinarily would.
• One of us always stays at home, so we no longer go out together. What you could say “I know you feel worried when we both go out. We’ll be home by ten, and you can manage the evening without us.” A first small step Book one evening out with a sitter your child knows. Tell them in advance, keep the goodbye short, and do not ring home to check unless the sitter needs you.
• Holidays, journeys or plans get changed or cancelled because of the anxiety. What you could say “I know the journey feels scary. We’re going, and I know you can cope with feeling scared on the way.” A first small step Keep one planned trip or outing as it is, without changing the route, timing or destination for the anxiety.
• I avoid certain words, programmes or topics because they might set off the worry. What you could say “I know that bothers you. I’m not going to avoid it, and I think you can handle hearing it.” A first small step Stop avoiding one word, topic or programme in ordinary family conversation. You are not bringing it up on purpose, only no longer steering round it.