​Paediatric Social Phobia and Selective Mutism


Selective mutism is a disorder in kids where they fail to speak in certain circumstances, whereas they have are capable of normal communication in others. Selective mutism coexists with anxiety in kids where the child may feel ashamed to publicly interact with people. This causes social anxiety; such kids remain silent despite negative repercussions which may include punishment, shame and social ostracism.

Selective mutism is often accompanied by other anxiety disorders such as separation anxiety disorder, social anxiety disorder (formerly called social phobia), agoraphobia, and panic disorder, as well as by shyness and anxiety. This disorder generally occurs in children by the age of five. However, it starts to formally represent itself when the child starts school and begins social interaction. In school, the child will lack assertiveness and confidence. Often, a child with selective mutism will designate a friend or close family member to serve as an intermediary of communication and interact with him or her only.​

Besides the incapability of speaking, your child may suffer from the following symptoms:

  • Difficulty maintaining eye contact

  • Stiff and awkward movements

  • Shyness, social anxiety, fear of social embarrassment, and/or social isolation and withdrawal

  • Blank expression and reluctance to smile

  • Desire for routine and dislike of changes

  • Difficulty expressing feelings, even to family members

  • Sensitivity to noise and crowds

  • Tendency to worry more than most people of the same age

Inform your doctor at the Children’s Hospital Service Line at The Aga Khan University Hospital if you see any of the above symptoms in your child, especially when he or she begins school. Your doctor will be able to guide you through the prognosis and suggest related treatment. A referral to a Child Psychiatrist may be needed for further evaluation and management.

Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.

Selective mutism will be diagnosed by your child specialists through thorough a medical examination. Your doctor will sit down with you and ask your child’s behaviour exhaustively. You will have to explain your child’s behaviour as thoroughly as possible. At some instances, your doctor will also ask you to discuss the situation with your child’s school teacher to better understand your child’s behaviour in a public setup. ​

Contrary to what popular beliefs suggest, selective mutism does not go away with time and as your child grow. It is very important to treat your child at the earliest possible time so that you can model his or her personality.

Diagnosis of the condition will be conducted through observation of the affected child’s responses and behavior with strangers and family members in different scenarios. These will be carried out in controlled environments and may be recorded for diagnostic purposes. In addition, the child will gradually be encouraged to talk, starting with making certain sounds and then progressing to words. 

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage. 

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.


​​The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.