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My 4 year old granddaughter was fully potty trained. Her father recently moved back to the same state and her parents are not together. She stays dry but now won't use the bathroom for B.M.'s. I feel that it is emotional upset for her but not sure if should wait it out and be patient or if counseling is best. Any one have similar experiences?

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    How long since she refuses to use the bathroom? – Stephie Oct 1 '16 at 4:58
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    Hi, Michelle, and welcome. :) To get the best answers, questions should contain as much detail as necessary, like how long the behavior has been going on, what has been tried so far with what kind of results, if her BMs are painful, if she is soiling herself, etc. More detailed questions get more helpful answers. Thanks, and again, welcome! – anongoodnurse Oct 1 '16 at 21:07
  • What kind of contact has she had with the father? Or did he just move back to the same state without contact with her? Does she still have bowel movements but just doesn't use the bathroom for them, or has she quit pooping? – Warren Dew Oct 2 '16 at 16:19
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My go-to answer is always to be kind and understanding and to put the child back on a toilet schedule. Sit with her if necessary. Read a book -- anything to make it less of a chore, but also telling her that she is back on potty-training because she needs extra help. Go every hour to ninety minutes. Reward using the toilet with praise. Be matter of fact, not mad or upset if she has an accident.

Any new upset or change -- good or less-good, can cause upsets with young children.

My only concern is that a change in bathroom habits can mean something else is wrong. It could be a coincidence that her father has returned. It could be that she has had a bad experience with a teacher or daycare worker or neighbour, caregiver, and that she was upset over something -- being ridiculed, being touched, being punished. She could be ill. So many things can start a change. If any of that is possible, I'd suggest a trip to her doctor with your concerns mentioned out of your daughter's hearing.

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Need more info. Is she refusing or constipated? Is she uncomfortable?

100% apple juice would be my first course of action either way just to help get things moving. Then move on from there.

Is her tummy hurting, visibly bloated or tender to touch? These are signs of constipation and apple, prune, pear juice is sometimes helpful.

If you know that she is withholding this link will take you to a similar post.

what i first assumed was withholding, but after reading your question again, it also sounds as though she could be having accidents. Whatever you do, don't make a big deal of it. Don't get upset about it, but show concern and talk about it with her. Non-retentive fecal incontinence (medical term if you want to search for more info) or having BMs in underwear is common too and can be caused by emotional distress as you have described.

No matter the cause i highly recommend play therapy because of the parental situation. This therapy, specific to young children, is covered by most insurances and every therapist I've ever spoken to would work with a concerned parent if finances are an issue. I would try to go 3 times the first week to get her comfortable with the therapist and location and to give the therapist something to assess. The longer she goes the more familiar the therapist becomes and is able to detect emotional irregularities.

Play therapy places the child in a room with toys chosen deliberately and the therapist watches what and how the child chooses to play. The therapist interacts very little with the child.

Good luck.

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    A thermometer to stimulate bm for a 4 yo.? As we probably all suspect psychological reasons, not physical ones, that sounds more like a violation of her personal boundaries than real "help". And OP writes "regression" and "won't use the bathroom", not "hasn't had bm". – Stephie Oct 1 '16 at 8:29
  • Well in the case of severe constipation a pediatrician is likely to use anorectol manometry which will be far more invasive than a thermometer. I began my response with the request for further information and mentioned that technique just in case. I will edit my response to clarify that simulation should only be used in the even of constipation. And to give a link to a similar situation. – Jess Oct 1 '16 at 12:34
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    Hi Jess. Usually on SE site, links to more authoritative sites than blogs are preferable (the older Dr. Sears is generally pretty good, but with the two younger doctors Sears, I think there are issues. The mommy blog is not an appropriate site to link to.) I also agree with @Stephie that at this age, using a rectal thermometer is not indicated. Increase fluids and fiber first, and depending on circumstances (which were not yet clarified by the OP), a glycerin suppository may be called for, stool softeners, etc. Again, we need some clarification from the OP. – anongoodnurse Oct 1 '16 at 21:03
  • Noted and edited – Jess Oct 2 '16 at 2:55

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