Parenting K-6 Kids/Anxious 4 year old


My 4 year old son started full day pre-k in September.  He was in a private home daycare from 12 weeks where it was only him and a year later his younger cousin.  This is his first formalized experience.
He potty trained at about age 3.  At school, he asks to go to the bathroom constantly and we determined that it was with every transition so it was probably anxiety related, so they take him to the bathroom with each transition.  However, he also now poops his pants.  He doesn't indicate that he has to go or even that he has gone.  This happens once or twice a week.  Only ever at school.  Never at home or when we are out.
We have been in the process of having him evaluated for early intervention.  He has some fine motor delays and they are seeing that he may have some receptive language delays as well.  
What is the best way to overcome the pooping situation?  He is starting speech and OT.  Hopefully those two will help him stay focused on task and be less of a class distraction (he gets antsy and loses focus quickly unless having  1:1 direction).
The school is trying to get me to pull him out, but he has such anxiety about being left by me with strangers, I'm afraid if I pull him to a different school now, it will only make things worse.  Thank you in advance for your input.

Hello, Anna;

As you've noted, your son is exhibiting signs of anxiety, symptoms of which often include the behaviors you describe. It's possible his level of social maturity is somewhat below chronological age - perhaps at the 3 year level. Though this may self-correct with time and the educational services you're providing through the school, one might normally expect soiling to occur episodically at 3 years of age. At that developmental age, soiling is still within the broad range of "normal" bowel habits for boys.

So, several approaches could be considered. First, using pull-ups for school and advising the teacher to proactively take the child to the bathroom on arrival and perhaps 2 hours later and again mid-afternoon might solve the problem. Motivation could be enhanced if the teacher gave a smiley face after each bathroom visit with clean pants or pull-up.

If no improvement occurred over several months, formal psychological testing might be indicated. This includes IQ, Achievement, Social Maturity and Projective (emotionality) testing. Developmental delays and other cognitive deficits are so defined and a specific educational program can be designed and monitored.

Bowel incontinence occurring in only some settings suggests a child has a degree of control over soiling. This makes neurological disorders unlikely, though not impossible. Certainly, worsening of soiling frequency or its occurrence in many locations would prompt Neurological and GI evaluations.

Hope this is helpful.

Parenting K-6 Kids

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Alan M. Davick, M.D.


As a Johns Hopkins trained Developmental-Behavioral Pediatrician with 40 years experience, I have focused on distinguishing underlying willful, poor choice-making (like Oppositional-Defiant Disorder)from innate "conditions" masquerading as willful misbehavior (like ADHD, Autistic Spectrum Disorders, Bipolar Disorders, Cerebral Palsy, Developmental Delay, Epilepsy and "Behavioral" Seizures). Though I cannot act as a formal medical or psychiatric consultant, I will answer queries with generic information and suggestions for discussion readers may direct to their own professional advisers, including physicians, psychologists and educators.


I trained at the Johns Hopkins Medical Institutions in Pediatrics, Child Psychiatry and Behavioral-Developmental Pediatrics. Thereafter, I've continuously practiced Behavioral-Developmental Pediatrics and have taught the principles mentioned above to parents, colleagues and professional groups.

American Academy of Pediatrics SW Florida Sportsman's Association Florida Writers Association

First Travel Meds - 1987; Managing Misbehavior in Kids: The Mis/Kidding Process; Bullying: Rarely Travels Alone; Discipline Your Child (without going to jail); AD(H)D: What Every Parent Needs to Know

Undergraduate - NY University WSC Arts & Science, NYC 1959-63 - B.A. Medical Degree- State University of NY, Upstate Med Ctr, Syracuse 1963-67 - M.D. Internship/Residency - Johns Hopkins Hosp/University - Baltimore, MD 1967-70 Major, US Army Medical Corps, Chief Pediatric Section, Savannah, GA - 1970-72 Sp. Fellow, Dept Child Psychiatry - Johns Hopkins Hospital/University - 1972-73 Practicing Behavioral-Developmental Pediatrician, lecturer, author - to date Currently practicing Child Psychiatry - SalusCareFlorida, Fort Myers, FL.

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