Clothes Horse

Q: Why is my 3 1/2-year-old son so obsessed with his clothing? For example, he has to have his shirt tucked in "just so," his belt has to be just right, etc. I lose my temper after about the sixth change during the day. Help!

A: I understand how frustrating this can be. Some children are extreme perfectionists. In addition to concerns about clothing, they're easily frustrated and very concerned about making mistakes. This type of behavior seems to run in families, although it's unclear how much is due to genetics and how much is due to family environment.

Is there anyone else in your family who likes things "just so"? Sometimes, the tension over adults' strong expectations can make children more anxious about doing things "right." If you loosen up, your child may do the same. Also, talk in front of your child about the mistakes you make. Spill something on the floor in front of your child (even on purpose) and lightheartedly comment, "Oh, look at that spill. No big deal!" or some such remark. This lets your child know that it's okay to make mistakes.

If the problem continues over the next year, speak with your pediatrician. A referral to a child psychologist or psychiatrist often can help. —Lawrence Kutner, PhD

Un-identical Twins

Q: I have 19-month-old twins. My daughter already notices the difference between her body parts and her brother's. How soon before they should take separate baths?

A: The basic rule is that opposite sex bathing should stop at age four or five. This is mainly because children's sexual interest becomes a major issue by then. Children start to play with their own genitals and display interest in others' as well. This is the time to teach them that their interest is natural and healthy, but that nudity and sexual play in public are not acceptable. It's best not to overreact to this behavior, but to treat it as any other lesson in how to behave properly. If your 19-month-old points to her anatomy or her brother's, just name the body parts as you would eyes or belly button. If she grabs for his penis, teach her that we don't do that without making a major issue out of it.

Children's sexual awareness does not start suddenly at puberty, but evolves gradually. Most parents want to strike a balance between developing a relaxed and open attitude in their children that avoids guilt and fear while still maintaining a sense of privacy and self-protection as children get older. Sometimes this is difficult, especially when dealing with natural curiosity. —Loraine Stern, M.D.

Toilet Time

Q: My 3-year-old daughter is partially potty trained. She wears underpants and will go to the potty when she has to pee. When she needs to have a bowel movement, she will come ask for a diaper and hide under the table, then ask to put the poop in the potty. Any suggestions on how to get her to poop on the potty instead of in her diaper?

A: Your daughter is not alone. For some children, the act of depositing this precious part of themselves in the potty is a daunting task. Not only that: Passing poop is a little trickier than peeing. If her feet are not on the floor or a step stool, it may be difficult to push a bowel movement out; under the table in a squat is easier. If she has constipation, the task is even harder and requires balancing herself over the deep, disappearing swish of water for a long period of time. To make things easier for her, go back to using a potty chair rather than the big toilet. If she has hard stools, work on softening them with more fluid and fiber in the diet. Put the poop from the diaper into the potty seat and then give her the task of plopping it in the toilet. Flush later.

Reward her when she does it herself in the potty chair. Let her decide when she's ready to plop and flush on her own, rewarding each step of the way. Never shame or scold her for an accident. Don't despair: At age three, your daughter has made good progress in learning to go into the bathroom for a bowel movement by herself. About half of all 3-year-old girls are behind her in this task. —Suzanne Dixon, M.D., M.P.H.