Four year old completely changed

[Burntout888]

Hi all!

I don't really know where to start. I'm having problems with my 4.2 year old daughter. Until the week before Christmas she had otherwise been a totally normal child-quite highly strung and always been a bit funny about the feel of clothes but nothing that severely affected her day to day life. She was otherwise happy, funny, bright, charming.

I feel like the following changes/symptoms are a stupidly long list so bear with me.

-She started preschool in September and had been totally fine until the last week. They had a school concert which disrupted the routine a bit I gather, and howled through the concert itself. She has now started crying at every drop off (DH does drop offs on the way to work)

-She has been stool witholding on and off for a few months prior to this (I think due to not wanting to poo at school) maybe pooing once a week. She got to 10 days before Christmas so the GP prescribed Laxido which I believe has traumatised her. She was leaking poo from her bum for about 10 days before I took her off it.
-Over Christmas she totally refused to get dressed in anything, even pants, for 5 days. We couldnt leave the house. She now still screams getting dressed unless I let her watch her ipad and physically get her dressed myself. Even when the clothes are on she screams at the feel of them and needs major distraction tactics
.
-She now has majorly intense separation anxiety from me-I can't even go to the toilet without her crying. I've slept in her bed for the last 3 weeks. She went off to school with her dad today absolutely howling. She has always been a clingy child (Covid baby and quite preterm so I did cuddle her a lot after she came home from a long NICU stint so she is used to being very tactile).

-Her moods have been hideous-hiding under tables, in the corner, constant meltdowns.

-She seems to feel the cold intensely and looks freezing constantly.
-She has developed a few spots on her face-not a rash as such, looks more like preteen spots.

Any ideas what's going on? I suspected anaemia-she does take a multivit every day but I'm loathed to give iron because of the stool witholding-I don't want to bung her up even more. She is offered a good diet-veg and fruit and every meal and does eat it (although a limited selection-peas, broccoli, sweetcorn, cucumber, a mixed veg tomato sauce on pasta homemade, strawberries and apples). She drinks whole milk for breakfast and school snack and I make sure she's hydrated throughout the day. She does love snacks and sugary things and I'm not as strict as some but definitely not crazy. As I previously stated, sleep is bad at the moment.

She has two close friends at school and a few aquaintances but has always been more of a "few close friends" kid rather than talk to anyone. I would say she's on the shyer side. She has also been quite secretive and will deny any negative emotions even if it's obvious she feels them. This isn't new-she has always been this way despite me reading lots of books about emotions, talking open and honestly etc etc. She has a 20 month old sister who she loves dearly but does get quite intense around having me to herself (again she has always been this way). I try not to show difference and spend time with both equally.

Sorry for the essay. Am I missing something? I'm trying to be logical and rational about this but I'm a stay at home mum and the constant melting down 24/7 is taking it's toll on my already frazzled brain.

Thanks is advance for any suggestions of what I can do x

Please watch this award winning video about constipation in children.

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With the coldness and spots along with everything else I would take her to the GP and ask for a blood test. It could be anaemia as you say, or something else. Best to rule out physical issues I think.

I'm sorry - it sounds really difficult!

There's quite a few flags there for sensory issues and potentially ASD. Lots of ND in my family, my DD has anxiety and is autistic and itfirst showed in anxiety around transitions and changes and separation anxiety around this age. She wasn't diagnosed for a couple years, didn't twig until after her brother was diagnosed. Many autistic girls present quite differently from what people typical think is autism.

Oh bless her. Have you spoken to the preschool about it all? She may be quiet when there so they might not have noticed she's struggling so much. She might be struggling to bond with an adult there?

Edited to clarify - if she could bond with an adult who Coyld make a bit of a fuss / play / chat with her she might cope better.

Look up PANS PANDAS - these conditions relate to sudden behaviour changes.

Have you properly treated the constipation would be my first question

Has she been ill since starting school? I’m thinking impact of Covid (symptoms would match)

Poor wee thing! I would also say that making sure the constipation is properly sorted is the first port of call. If it isn't, that will be making her feel very out of sorts, and then everything else is harder.

I agree there are some things that could fit with sensory difficulties and possible ASD, so worth a read of what that can look like in girls (often quite different from the classic male presentation) and see if it feels like it might fit. I'd ask preschool for a meeting to discuss how she's doing there more broadly, but this could be part of that discussion.

You mention a concert throwing off the routine. Is she ordinarily quite routine-focused? Even if she isn't, I would double down on being very clear about plans for the day (on whatever timescale works for her; some four year olds would want to know the whole day, others just the next two activities). This might help with the clinginess as well – 'I'm going to the toilet, then we'll do some colouring'. Potentially give her a little job for whilst you're gone so she's busy – 'Can you get out the paper and the felt tips so we're all ready?' I would potentially ask preschool if they can support her in the same way (or make sure she's taking it in when they're saying it to the group).

With the clothes, I would be inclined to make that as easy as possible for her – she just doesn't need to spending her limited ability to cope on dealing with uncomfortable clothing. Seamless socks, tags cut out, pants worn inside out so the seams are on the outside, whatever makes it more comfortable for her. If you can (and it's remotely weather suitable), I'd buy enough of her preferred clothing that she can wear it every day if she wants to, whether that's joggers or dresses. Does her preschool have a uniform? Even if it does, they should be able to accommodate something like leggings instead of trousers as a reasonable adjustment.

Sorry, that's an essay as well!

Our four year old was also withholding her poos, it started late summer into starting school. We followed Disimpaction via ERIC website with support from our GP and a prescription of laxative. It's not easy and does get worse before better as you have to clear her system properly of old compacted poo. Her constipation really affected her behaviour and mood. She also developed spots on her face which I put down to toxins building in her body from not going to the toilet.

I was also going to suggest you look up PANS/PANDAS, especially if this followed an illness.

if you have money to spend, you could contact Brainstorm Health - they work with these kind of issues through nutrition etc

Why do you think she is stool witholding rather than having constipation?

With those symptoms, the constipation, the spots, I'd say milk allergy would be fairly high on the list. I would stop the whole milk and maybe try dairy free for a month and see if symptoms improve.

Thanks for all your replies, you've all been so kind and helpful.

I had considered ASD as an option back when I started noticing her sensory difficulties with clothes, but she waz really young at the time 18 months and seemed to only be bothered by materials that I myself might find scratchy- wool, sequins etc so I suppose I sort of thought if she was easily placated by not having to wear these sorts of materials then I could just forget about it. Maybe not. I'm curious if there any any resources to help parents with how to support their children in these possible early stages before a diagnosis.

I have spoken to her teacher and she says as soon as she's through the door she's totally fine. Plays, joins in, is bright and talkative. This makes me think maybe ASD isn't likely. I've had a quick read on ASD symptoms in girls and it doesn't immediately scream it to me apart from transition and dressing difficulties. It is a spectrum though right, so I guess she could be somewhere there. She is a strong communicator, early talker, but there are definitely some other traits. I will definitely read more into it.

Re stool witholding, I suppose I thought it was that rather than constipation as when she passes poos they arent hard or painful to pass. Does everyone think I should put her back on Laxido? My DH is dead against it after seeing how upset she was over Christmas, but the more I read and having watched the suggested video above, she might need to be on it for a long time.

I will also go to the GP re blood test I think as she is often also more tired than her peers. She lies in sometimes until 8.30/9am on a weekend, and seems to be happier with more downtime than her sister and friends.

Thanks again for all your kind words and advice-I really do welcome it all x

My (autistic, bright, excellent verbal ability early talking dd) hated using the school toilets and used to do anything to avoid it - have to asked her what she doesn't like about the loo at school?

You may need to try and get her on a schedule where she drinks a lot before school and goes then - my dd didn't feel safe at school and that played into it, plus school loos smelly, other kids congregate in them - it's a quite different experience to going at home.

Also post school tiredness can be a symptom of sensory overload, some children do need a lot more downtime than others.

Did your dd do nursery before pre school?

DD was this age when she was diagnosed with coeliac. The constipation, tiredness and being cold might fit with that, so it's worth ruling out.

DD is also autistic and was bright, chatty and social at school, but there were definite sensory traits from early on. The other traits appeared gradually through primary age.

From her perspective preschool went all funny and different and then stopped completely and she was at home instead. So now she doesn’t know what she can rely on. She is crying when she goes to preschool because she doesn’t know what to expect, when she gets in she’s fine because she can see it’s back to normal. She’s become more clingy to you to make sure you don’t suddenly change/disappear as well.
Plus whatever is going on in her little body is making her feel weird too.
I would up the amount of attention. Have her with you all the time if she wants to be, you need to make her feel reassured and secure again and then she will feel more able to leave you.
I would also make life very boring and routine for a couple of weeks to help her reset.
Can you make a visual timetable so she knows what will be happening each day, and then each morning go through it with her so she knows what’s going to happen.
Christmas can send any kid a bit off the rails. Ones who might be ND will struggle even more so.

I have spoken to her teacher and she says as soon as she's through the door she's totally fine. Plays, joins in, is bright and talkative

FWIW my daughter was the same, right down to being a precocious talker with a big vocabulary, and not one teacher ever expressed a concern about autism throughout primary school, right up until she was finally diagnosed aged 9. And I only saw the signs with hindsight, after her brother was diagnosed.

Girls can present very differently and do get overlooked.

DD was also a stool withholder (it was so grim, she would frequently poop in her sleep because that was the only time she stopped clenching), had sensory issues with clothes, meltdowns when out of routine, meltdowns with transitions (some weekends we gave up trying to leave the house, even).

My advice is investigate her general malaise but definitely stay mindful of autism.

As this seems to be have been a fairly sudden change I 'd be concerned about something like an infection having an impact on her.

The constipation is likely to also be a problem and will be affecting her both physically and psychologically.

Could there be an intolerance or something here? Does pre school provide food that is not what she normally eats?

I developed lactose intolerance about age 9 and it is possible for both short and long term intolerances to develop as a result of a tummy bug.

Obviously autism is also a possibility but I'd explore other possibilities first or in parallel.

Intolerance is a big possibility given the spots on the face. My son’s lactose intolerance started with facial spots and symptoms gradually worsened from there.

I have a theory that neurodivergent kids/kids with sensory issues actually struggle more with feeling unwell, which makes sense when you think about it. So as @Octavia64 says it could be separate issues working in parallel to create a perfect storm of meltdowns and tricky behaviour.

My DD now 11 had poo withholding for about 18 months aged 2-3. The only thing that changed it was the book Poo goes to Pooland, it's a free download able PDF

She also had sensory issues, indeed she still has them. If she has to get up by alarm rather than waking naturally, she gets ready the night before and sleeps in her clothes for the next day. Somehow the sensory thing is more manageable in the evenings. This is something we started when she was little.

In general we have to make more time for planning or thinking through days but it takes way less time yhan managing a full on meltdown.

My DD masks amazingly well too but when she is really under pressure and has to, she needs clear down time amd solitude later to unravel a bit.

This is spot on, in my opinion.

ASD was my first thought too. DS is autistic and hated school toilets - wouldn't go all day even through secondary school. He wasn't diagnosed until secondary school age and this is often when it becomes more obvious if they are very high functioning - around GCSE exams is another point when things might all fall apart and lead to diagnosis.

DS is also funny about a lot of clothes, he has never worn jeans in his life and never would he also puts his hands over his ears if noise is very loud. He struggled with transitions when young too but has improved, your dd being thrown when her routine changed and struggling with the transition from home to preschool is not unusual. DS actually really enjoyed preschool and had good friends there, it was only as he got much older that he struggled more with friendships and spent more time alone.

She may not be denying negative emotions she may just not recognise them for what they are. Alternatively she may have picked up that these emotions are 'bad' and so she is distancing herself from them, she could pick this up from anywhere, tv, books. observing other kids at nursery etc My ds for example didn't like books where anyone did anything they weren't supposed to or where anyone got told off, he was really sensitive about it.

The thing I would really recommend is keeping a list of all the things you notice and adding to it as other things come up. You will forget things as she gets older and if at some point she is assessed it will be really useful to have. Lots of down time, lots of warning before transitions, lots of preparing for what is going to happen now and later, lots of routine with similar things happening before and after school.

With the stool withholding could she be impacted? That might explain why the poo would leak all around the impacted poo, I'm not an expert on this so i don't know if that would mean she needs to be on the meds a long time or if it would need other medical intervention.

DS's ASD definitely became more and more obvious as he got older, when he was young a lot could be put down to his age or being an only child etc he's very bright though and now doing really well as a young adult. I think the trick is to know your child and try to figure out as much as you can what is going on for them and why they are behaving the way they are.

I have spoken to her teacher and she says as soon as she's through the door she's totally fine. Plays, joins in, is bright and talkative. This makes me think maybe ASD isn't likely.

Im going to disagree there .
Many childen on the spectrum are excellent at masking. You’d never think there is an issue at school. They’re calm, often not creating any issues, getting on with things.
Its just a mask and it all unravels when they arrive at home.

Ive had that with ds.
School didn’t see him falling apart on small things. They didn’t see him ex
,idling agd hitting his sibling every afternoon after school.
They didn’t see the meltdowns.
Because once finally at home, they get all the stress out and explode.

Also many children on the spectrum have bowels issues. Ds had too. Many years of being followed for ‘chronic constipation’.
It was bad enough that his school had decided to put it under ‘disability’ for a couple of years.