BRIAN HAPPILY TOOK part in all sorts of morning activities today. During free play, he built a garage with several other 4-year-old boys. I could hear him chattering away with his classmates as they worked together in the block comer. When that project was finished, Brian asked if he could paint. I set up the easel, and he got right to work, making bold, multi-colored brush strokes, talking all the while to his painting partner on the other side of the easel. Then at group time, Brian contributed a funny story about his family's new puppy. With my encouragement, he passed around an adorable photograph of young Duke. It was a fun morning for Brian, but as always, his favorite part was yet to come.

Brian adores outdoor play. He can't wait to go outside and reluctantly comes back in for lunch. Today, he barely had time to wash his hands before digging into his bowl of spaghetti. So far, it had been a fine day for Brian. But a short time later, I was dismayed to see him in tears, doubled up on his mat with one of his stomachaches. I'd spoken to Brian's mom about these episodes earlier in the year. She brought Brian to their pediatrician who could find nothing medically wrong. I asked Brian if he wanted to use the bathroom, but he preferred to just lay there. Come to think of it, I always have to urge him to use the school bathroom. Could this explain his occasional stomachaches?


AS SO OFTEN HAPPENS, when Brian arrived home from school this afternoon, he headed straight for the sofa. Lying with his knees bent, he began to groan. "Not another stomachache!" I thought, wondering if Brian has been eating foods in school that don't agree with him. Our doctor had examined him last month and said Brian was fine-but he doesn't look fine to me now.

I was on the verge of calling Dr. Breen when Brian set off for the bathroom. Emerging with a relaxed smile moments later, he ran off to join a group of neighborhood children gathering in our yard. "No sign of the stomachache now! " I thought with relief. When they came inside, I overheard my son explain to a friend that he would be back in a minute because he needed to use the bathroom. It's interesting because he said, "Stay here. Don't follow me. I'll be right back."

I can't help but wonder if Brian's worry about going to the bathroom has something to do with a lack of privacy. I feel a little embarrassed about bringing this matter up, but I know I should speak to his teacher about it.

Dr. Brodkin's Assessment

It's not uncommon for a child to avoid using a classroom bathroom because he feels a lack of privacy. He might worry about another child opening the door or fret about taking too much time in the bathroom. Others whose toilet training had been accomplished quite recently are just more comfortable in a familiar bathroom at home. In any case, understanding the origin makes it easier for teachers and parents to help a child in this situation.

What the Teacher Can Do

Once Brian's teacher and parent have talked and agreed on a plan that will work at school, the teacher can chat with Brian: "You know those tummy aches you've been getting? Well, your mom and I think we have a good way to help stop them. You and I will try to find a special time for you to use the bathroom in school. I'll make sure you have all the privacy you need. Of course, you already know that you can go whenever you need to."

The teacher might also try to notice whenever Brian hasn't used the bathroom for a long while, so she can gently encourage him to go. It might help others as well if the teacher monitors the bathroom situation and encourages respect for everyone's privacy.

What the Parent Can Do

Brian's family did the right thing by consulting the doctor, especially since a child who avoids using the bathroom could develop chronic constipation. This could lead to more serious problems. Brian's mom should arrange for a short, quiet time indoors right after he arrives home from school where she can reassure Brian by telling him that the teacher has promised that everyone's privacy will be respected during bathroom time. If both the teacher and parent show Brian they understand and respect his wishes, he is soon likely to follow their advice to take the breaks his body needs.