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Ask the Mental Health Expert Archives 2001-2004

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Child Rearing

Q. I'm a nanny for a 4-year-old girl. Her parents are sweet, but a tad neurotic about certain things such as cleanliness and germs. The girl is currently in preschool and does not yet wipe her own bottom. If she defecates, she comes out and lays down with her legs up and either her parents or I have to wipe her up. Her mom and dad have not even encouraged her to try to wipe herself. What sort of repercussions do you think this will have on her?

I'm especially concerned because the teachers at her preschool have already told the mom and dad that they will not do that for her at preschool and by the time she gets into kindergarten, they will absolutely NOT do it. I have the feeling that the reason the mom and dad do it themselves, is to save laundry wear and tear. The girl often asks if she has "scuds" in her underpants in a worried demeanor. Can you offer any advice?

A. Perhaps the first question is, what are the repercussions this job will have on you? Do you really feel that you want to continue in this capacity, if you are colluding-albeit against your own better judgment--in what is essentially inappropriate toilet-training?

I realize you may not have any easy vocational alternatives available to you--but it may be necessary to set some limits with the girl's parents, regarding your role in this household. To address your question: I am not sure what repercussions this parental behavior will have on the child, nor did my literature search turn up much. However, it seems clear that if the girl does not learn how to self-clean, this will cause her to become isolated and singled-out in preschool and kindergarten.

That this girl is often worried about her toileting suggests the beginnings of an anxiety disorder, which could lead to further self-consciousness and social isolation, if it is not remedied. The available research does show that most children have been toilet-trained by age 3 or so--so this girl is evidently delayed in her development of these skills (Schum et al, Pediatrics 2002 Mar;109(3):E48).

Her parents could probably benefit from a frank discussion with their pediatrician--but whether it is your role to advise them of this, I couldn't say. It may depend on how much rapport and trust you have with the parents. In any case, it may be in your own interest to re-define your role.

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May 2003

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